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The use of ultrasound to determine gestational age is fundamental to the optimum management of pregnancy and is recommended for all women by the World Health Organization. However, this modality remains unavailable to many women in low-income countries where trained practitioners are scarce. Although previous initiatives have demonstrated efficacy in training midwives and technicians to perform antenatal ultrasound, these programs have often been too long and too complex to be realistic within the specific constraints of this context, highlighting the need for a novel and pragmatic approach. We describe the development and piloting of a bespoke course to teach midwives 3 fundamental components of early antenatal ultrasound scanning: (1) to identify the number of fetuses, (2) to confirm fetal viability, and (3) to determine gestational age. Having established that 5 days is insufficient, we propose that the minimum duration required to train ultrasound-naive midwives to competency is 10 days. Our completed program therefore consists of one and one-half days of didactic teaching, followed by 8 and one-half days of supervised hands-on practical training in which trainees are assessed on their skills. This package has subsequently been successfully implemented across 6 sites in Malawi, where 28 midwives have achieved competency. By describing the processes involved in our cross-continental collaboration, we explain how unexpected challenges helped shape and improve our program, demonstrating the value of preimplementation piloting and a pragmatic and adaptive approach., (© 2022 by the American College of Nurse-Midwives.)

Objective: The global research group, DIPLOMATIC (Using eviDence, Implementation science, and a clinical trial PLatform to Optimise MATernal and newborn health in low Income Countries), aims to reduce stillbirths and preterm births and optimise outcomes for babies born preterm. Minimum datasets for routine data collection in healthcare facilities participating in DIPLOMATIC (initially in Malawi) were designed to assist understanding of baseline maternal and neonatal care processes and outcomes, and facilitate evaluation of improvement interventions and pragmatic clinical trials., Design: Published and grey literature was reviewed alongside extensive in-country consultation to define relevant clinical best practice guidance, and the existing local data and reporting infrastructure, to identify requirements for the minimum datasets. Data elements were subjected to iterative rounds of consultation with topic experts in Malawi and Scotland, the relevant Malawian professional bodies and the Ministry of Health in Malawi to ensure relevance, validity and feasibility., Setting: Antenatal, maternity and specialist neonatal care in Malawi., Results: The resulting three minimum datasets cover the maternal and neonatal healthcare journey for antenatal, maternity and specialist neonatal care, with provision for effective linkage of records for mother/baby pairs. They can facilitate consistent, precise recording of relevant outcomes (stillbirths, preterm births, neonatal deaths), risk factors and key care processes., Conclusions: Poor quality routine data on care processes and outcomes constrain healthcare system improvement. The datasets developed for implementation in DIPLOMATIC partner facilities reflect, and hence support delivery of, internationally agreed best practice for maternal and newborn care in low-income settings. Informed by extensive consultation, they are designed to integrate with existing local data infrastructure and reporting as well as meeting research data needs. This work provides a transferable example of strengthening data infrastructure to underpin a learning healthcare system approach in low-income settings.DIPLOMATIC is funded by the UK National Institute for Health Research., Competing Interests: Competing interests: SJS reports grants from NIHR HTA, non-financial support from HOLOGIC, non-financial support from PARSAGEN, non-financial support from MEDIX BIOCHEMICA, during the conduct of the study; and SJS declares being a member of the HTA general committee. JN reports membership of the following NIHR boards: Commissioning Priority Review decision-making committee (2015); Health Technology Assessment (HTA) Commissioning Board (2010–2016); HTA Commissioning Sub-Board (Expression of Interest) (2014); HTA Funding Boards Policy Group (2016–2019); HTA General Board (2016–2019); HTA Post-Board funding teleconference (2016–2019); NIHR Clinical Trials Unit Standing Advisory Committee (2018–present); NIHR HTA and Efficacy and Mechanism Evaluation Editorial Board (2014–2019); Pre-exposure Prophylaxis Impact Review Panel (2017). JEN reports being named as Principal Investigator on government and charitable research grants to her institution which aim to improve pregnancy outcome. In the last 3 years, she has provided consultancy to Pharma companies GSK and Dilafor: her institution was remunerated for this. Her institution has received travel and subsistence expenses from Merck to facilitate her speaking at a Merck-sponsored symposium on metformin. She is on Subpanel A1 for REF, and on a Wellcome Trust Science interview panel, and receive personal remuneration for each., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)