Setting
Pemba is an island in the Zanzibar archipelago with approximately 450.000 inhabitants. 34 35 There are four district hospitals assisting a total of 11.000 births each year.35 The facility rate for births is increasing, with 67.6% of all births taking place in health facilities in 2019.35 Human resources are scarce, and only a few medical doctors or clinical of­ficers are available at each hospital. The nurse/midwife-to-labouring women ratio is between 1:2 and 1:4, depending on the time of the day. All hospitals have access to instrumental assisted birth and caesarean section. The NR guidelines available in facilities are an HBB poster and guidelines provided by the Ministry of Health and WHO. 18 The available equipment for the management of the newborn consists of a resuscitation table in three out of four hospitals, gloves, bulb suction, a self-inflating bag and mask, and an oxygen source (not always available). Traditional clothes, called a kanga, brought by the women in labour are available for wrapping, drying, and preventing heat loss of the newborn.