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The Projahnmo study group is a collaboration of the Ministry of Health and Family Welfare of the Government of Bangladesh, the International Centre for Diarrheal Disease Research-Bangladesh, Shimantik nongovernmental organization, Child Health Research Foundation, Brigham and Women’s Hospital/Harvard Medical School, and the Johns Hopkins Bloomberg School of Public Health.The population has an annual birth cohort of 15 000, with high baseline rates of home birth (∼90%) and neonatal mortality (36.8/1000 live births).Additionally, neurologic examinations may be influenced by other morbidities, such as birth asphyxia, infection, or congenital anomalies.Simplified methods to identify premature infants that rely on fewer characteristics, have been described and developed for lower resource settings.= 710), the mean ultrasound GA was 39.3 weeks (SD 1.6) (8.3% preterm) and by Ballard scoring the mean GA was 38.9 weeks (SD 1.7) (12.9% preterm).The average bias of the Ballard was –0.4 weeks; however, 95% limits of agreement were wide (–4.7 to 4.0 weeks) and the accuracy for identifying preterm infants was low (sensitivity 16%, specificity 87%).

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A study ultrasonographer (medical physician with ultrasound certification) was trained and standardized in early pregnancy biometry for pregnancy dating, and scans were performed in the field clinic by using a portable Nanomax Sonosite ultrasound machine (Fuji Sonosite, Inc, Bothell, WA).The scoring system included 5 physical characteristics categorized into 3 GA categories (red zone: A total of 24 CHWs were trained and standardized in the newborn assessment (detailed in the text of the Supplemental Information). A home visit was conducted by the CHW as soon as possible after delivery notification.