BACKGROUND:
Sub-Saharan Africa and South Asia bear a disproportionate burden of ≈ 79% of global neonatal mortality. Major causes include preterm birth, infection, intrapartum complications and congenital abnormalities. Involving parents in the care of hospitalised small and sick infants is acknowledged to improve outcomes for families, but there have been few studies to develop and evaluate models reflecting the cultural, social and health system context in low and middle-income countries.

OBJECTIVES:
To co-develop and assess the feasibility of context-specific parent-partnership interventions in India, Pakistan and Tanzania.

METHODS:
A two-phase, sequential mixed-methods study in neonatal facilities in Karnataka State, India, Sindh Province, Pakistan and Mwanza Region, Tanzania, guided by participatory action research. Following synthesis of literature and qualitative data, a co-production process involving stakeholders and community engagement groups in each country was initiated to reach consensus on intervention components. The feasibility of implementation and a full-scale effectiveness evaluation is being assessed in a pre-post cohort (60 mother and baby dyads per country). Key feasibility outcomes include recruitment and retention, acceptability of the intervention and research processes for mothers, families and health workers.

RESULTS:
Similar intervention components were prioritised across all countries and included communication training for health workers, parent admission information resources and valuing staff activities. Recruitment was completed on target (187 mother-baby dyads) and participant follow-up will conclude in June 2025. Findings will be available in autumn 2025.

CONCLUSIONS:
This study will finalise an acceptable parental involvement intervention to improve neonatal care in India, Pakistan and Tanzania, and will inform the design of a full-scale evaluation.

KEY MESSAGE:
Beyond feasibility, this study will increase understanding of key influences on the success of strategies to increase parental involvement in neonatal care in resource-limited contexts. Ethics: Approvals from LSTM, UK, KMCRI (Hubli), India, National Bioethics Committee, Pakistan, National Institute for Medical Research, Tanzania. Newborn 1