Strengths and limitations
A significant strength of this study is the video as a data source,
allowing the definition of birth care in the time resolution of seconds
and perhaps reducing the Hawthorne effect of an observer being present.47 Another strength is the study of four moderate
volume district hospitals, as most of the research from LMIC is from
high volume tertiary hospitals. This study, however, also has
limitations. Our enrolment rate was 66 % and the ethical consent
procedures did not include a waiver of consent. Seven women who were
enrolled before birth and suffered an immediate neonatal death did not
want to participate with further information. Another limitation was
that our study’s village follow-up component was made impossible by
Covid-19, resulting in a nearly 40% loss-to-follow-up to 28 days.
Finally, 61 resuscitations were not captured on video. Reasons hereof
have been listed previously. 33