The study was undertaken within the framework of the assessment of the community effectiveness of Intermittent Preventative Treatment in Infants (IPTi), part of the IPTi Consortium (
www.ipti-malaria.org, clinical trial number NCT00152204). We received ethical approval from local and national institutional review boards (Ifakara Health Institute and the National Tanzania Medical Research Co-coordinating Committee) through the Tanzania Commission for Science and Technology. Ethical and research clearance was also obtained from the London School of Hygiene and Tropical Medicine, UK, and the Ethics Commission of the Cantons of Basel-Stadt and Basel-Land, Switzerland. During field work, information sheets in Swahili about the study were given out, explaining why it was being done, by whom, and what it would involve. Consent to participate was obtained in writing from household heads and orally from women answering questions about their pregnancies. Confidentiality of all study participants was assured.
The study was conducted in the districts of Nachingwea, Lindi Rural, Ruangwa, Tandahimba and Newala Districts in Southern Tanzania, which had a total population of over 800,000 people in 2007. The study setting and field methods from a similar survey have been described in detail elsewhere [15] , [16] (
link) so the key aspects are summarised here. The area has a wide mix of ethnic groups, including the Makonde, Mwera, Yao. Although most people speak the language of their own ethnic group, Swahili is also widely spoken. The most common occupations are subsistence farming, fishing and small scale trading. Cashew nuts, sesame and groundnuts are the major cash crops while food crops are cassava, maize, sorghum and rice. Most people live in mud-walled and thatched-roof houses; a few houses have corrugated iron roofs. Common water supplies are hand-dug wells which rely on seasonal rain, communal boreholes, natural springs and river water. Most rural roads are unpaved: some are not passable during rainy seasons while others are too steep for vehicles to pass. In 2000–2001 39% of households lived below the poverty line in Lindi and Mtwara regions [27] . The HIV prevalence rates (categorized) for adults age 15–49 years in Lindi and Mtwara regions were estimated to be 4–6% and 7–10% respectively in 2003/4 [27] .
The public health system comprises a network of dispensaries, health centres and hospitals offering a varying quality of care [15] . Nearly all (99%) pregnant women attend antenatal care at least once, and around half of women deliver with a skilled attendant [14] .
Between June and October 2007, a survey team of over 200 field staff visited all 243,612 households in the five study districts. Household heads were asked to give their written consent to participate. In a few households (15,823, 7%), nobody could be found on the day of the survey despite repeat visits by interviewers within the day. Over 99% (225,980) agreed to take part. Female participants age 13–49 who had had a live birth in the year before the survey were then separately asked for written consent to participate and were asked questions relating to use of antenatal care, intrapartum care (such as place of childbirth and birth attendant) and postpartum care including essential newborn care indicators, for the most recent birth. Some questions were only asked to women who had had a non-facility delivery.
The questionnaire was administered in Swahili using handheld computers (personal digital assistants or PDA) to capture responses [28] (
link). Standard range, consistency and completeness checks were carried out in the field. Analysis was conducted in Stata version 10 [29] .
Penfold S., Hill Z., Mrisho M., Manzi F., Tanner M., Mshinda H., Schellenberg D, & Armstrong Schellenberg J.R. (2010). A Large Cross-Sectional Community-Based Study of Newborn Care Practices in Southern Tanzania. PLoS ONE, 5(12), e15593.