Please select the eligibility criteria that correspond to the clinical trial below.
Title: Improving Newborn Survival in Rural Southern Tanzania: a Study to Evaluate the Impact and Cost of a Scaleable Package of Interventions at Community Level With Health System Strengthening
Brief Summary: This study will develop, implement and evaluate the effectiveness and cost of interventions at community level (focussed on a community-based health worker) and of health system strengthening on newborn survival in rural southern Tanzania.

Objectives

1. To develop and document a community-based package for improved newborn care, focussed around interpersonal communication through home visits in pregnancy and the early neonatal period .
2. To develop and document a quality improvement package for antenatal, intrapartum and postnatal care in health facilities.
3. To implement these strategies for improved newborn survival in such a way as to be both sustainable and scaleable at national level.
4. To monitor understanding of, and attitudes related to, neonatal care and survival from both health provider and community perspectives in areas with and without the interventions.
5. To measure incremental costs and cost savings to the health sector and society associated with the interventions, and to predict the cost of integrating the programme into routine health service provision and of scaling-up
6. To strengthen Tanzania's capacity to develop, implement and evaluate interventions to improve neonatal survival.
7. To estimate the effect of the interventions on newborn survival and household behaviours related to newborn health.

Study design \& methods. The interventions will be implemented in parts of Lindi and Mtwara regions. The health system quality improvement package will be implemented throughout the area and evaluated using a before-after comparison. The community intervention will be implemented initially in a randomly-chosen half of all wards (a ward is an administrative sub-area of a district). Implementation will be led by existing front-line health staff. Evaluation will include a health facility survey and a household survey to assess contacts with the agents of change, key behaviours and newborn survival in the community.


Options:
A: Inclusion Criteria:

* Pregnant Oregon WIC participants in Jackson, Washington and Hood River counties or Umatilla Morrow Head Start.

Exclusion Criteria:

* WIC participant outside of the 4 study agencies.
B: Inclusion Criteria:

* Full term or late pre-term infant (\> 34 0/7 weeks gestational age) discharged from the newborn nursery
* Feeding human milk (breast milk) during the maternity/newborn stay with intent to continue to breastfeed after discharge
* English speaking mother
* Singleton or twin infant

Exclusion Criteria:

* Premature infant \< 34 weeks gestational age
* Exclusively formula fed infant during nursery stay
* Complicated maternity/nursery stay requiring \> 2 night stay after a vaginal delivery or \> 4 night stay after a cesarean section
* A nursery course with atypical complications (e.g. a work-up for ambiguous genitalia)
* Infant with hyperbilirubinemia requiring phototherapy during the nursery stay
* Any major maternal morbidities and/or pre-existing condition that would effect postpartum care such as cancer, multiple sclerosis, lupus, etc.
* Previous maternal participation in the NITTANY trial
* Residence outside of the coverage area for the Visiting Nurses Association (VNA) of Central Pennsylvania
* Family with no active telephone number (home or cellular)
* Infant being put up for adoption
* Non-English speaking mother
* Family requiring a home visit due to Social Work or other staff request/order
* Triplets or higher order gestation
C: Inclusion Criteria:

* Pregnant women living in the study area

Exclusion Criteria:

* Unwilling to participate
D: Inclusion Criteria:

* Mothers of children born during the study period (6 months)
* Mothers who come to the health centre on 1st visit (child attention programme)
* Mothers who give their consent to participate.

Exclusion Criteria:

* Breastfeeding Contraindications

Answer: C