Safer Births Bundle of Care reduces perinatal mortality in Tanzania

1. In this prospective cohort study, implementation of the Safer Births Bundle of Care program was associated with a significant reduction in perinatal mortality.

2. The Safer Births Bundle of Care program was linked to a decline in neonatal deaths within the first 24 hours of life.

Evidence Rating Level: 2 (Good)

Study Rundown: Birth-related mortality remains a significant global health concern despite being largely preventable with appropriate medical care. Low- and middle-income countries bear a disproportionate burden, with 60% of birth-related deaths occurring in just ten countries, including Tanzania. To address this issue, the Safer Births Bundle of Care was developed, focusing on four key pillars: enhanced medical training, continuous quality improvement initiatives, improved fetal and neonatal heart rate monitoring, and strategies to ensure program sustainability. This study evaluated the program’s effectiveness in reducing birth-related mortality across 30 healthcare facilities in Tanzania. Following implementation, the program was associated with a significant decrease in overall perinatal deaths, defined as the combined incidence of stillbirths and neonatal deaths within 24 hours of life. However, results varied considerably between facilities. Although the overall incidence of stillbirths did not significantly change, a reduction in neonatal deaths within the first 24 hours of life was observed. Importantly, no serious adverse events were reported following the program’s implementation. The study was limited by a brief baseline assessment period, incomplete secondary outcome data, suspected underreporting of perinatal deaths, and the staggered rollout of the intervention. Despite these challenges, the findings suggest that the Safer Births program shows promise in reducing perinatal mortality in resource-limited settings.

Click here to read the study in NEJM

Relevant Reading: Early Detection and Bundled Treatment for Postpartum Hemorrhage

In-Depth [prospective cohort]: This prospective cohort study evaluated the effectiveness of implementing the Safer Births Bundle of Care in Tanzania. The study included five regions of Tanzania, each containing six healthcare facilities. Facilities were selected based on the following inclusion criteria: a consistently high number of perinatal deaths (e.g., stillbirths, maternal mortality, or neonatal deaths), a high patient volume, and designation as a Comprehensive Emergency Obstetric and Newborn Care facility. The final analysis of this study involved a total of 281,165 mothers and 277,734 babies. The primary outcome was perinatal death, defined as either stillbirth or neonatal death within the first 24 hours of life. Following program implementation, perinatal mortality decreased from 15.3 deaths per 1,000 births to 12.5 deaths per 1,000 births (adjusted relative risk [aRR], 0.82; 95% confidence interval [CI], 0.73 to 0.92; p=0.001). However, this reduction was not consistent across all study sites. For instance, while no change was observed in Tabora, Mwanza experienced a 49% increase in perinatal mortality post-implementation. Despite this variability, the program was estimated to have saved approximately 580 lives in the perinatal period (95% CI, 225 to 935). Additionally, perinatal mortality within the first week postpartum decreased from 16.6 to 13.9 deaths per 1,000 births (aRR, 0.84; 95% CI, 0.75 to 0.94). In-hospital maternal deaths within the first week postpartum also declined, from 240 to 60 deaths per 100,000 births (aRR, 0.25; 95% CI, 0.14 to 0.46). Overall, this study demonstrated that the Safer Births Bundle of Care was effective in reducing perinatal mortality across multiple sites in Tanzania.

Image: PD

©2025 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.