Temporally regulated cell migration is sensitive to variation in body size.

Few studies have measured the robustness to perturbations of the final position of a long-range migrating cell. In the nematode Caenorhabditis elegans, the QR neuroblast migrates anteriorly, while undergoing three division rounds. We study the final position of two of its great-granddaughters, the end of migration of which was previously shown to depend on a timing mechanism. We find that the variance in their final position is similar to that of other long-range migrating neurons. As expected from the timing mechanism, the position of QR descendants depends on body size, which we varied by changing maternal age or using body size mutants. Using a mathematical model, we show that body size variation is partially compensated for. Applying environmental perturbations, we find that the variance in final position increased following starvation at hatching. The mean position is displaced upon a temperature shift. Finally, highly significant variation was found among C. elegans wild isolates. Overall, this study reveals that the final position of these neurons is quite robust to stochastic variation, shows some sensitivity to body size and to external perturbations, and varies in the species.This article has an associated 'The people behind the papers' interview.

Appraising LaQshya's potential in measuring quality of care for mothers and newborns: a comprehensive review of India's Labor Room Quality Improvement Initiative.

BACKGROUND: Poor intrapartum care in India contributes to high maternal and newborn mortality. India's Labor Room Quality Improvement Initiative (LaQshya) launched in 2017, aims to improve intrapartum care by minimizing complications, enforcing protocols, and promoting respectful maternity care (RMC). However, limited studies pose a challenge to fully examine its potential to assess quality of maternal and newborn care. This study aims to bridge this knowledge gap and reviews LaQshya's ability to assess maternal and newborn care quality. Findings will guide modifications for enhancing LaQshya's effectiveness. METHODS: We reviewed LaQshya's ability to assess the quality of care through a two-step approach: a comprehensive descriptive analysis using document reviews to highlight program attributes, enablers, and challenges affecting LaQshya's quality assessment capability, and a comparison of its measurement parameters with the 352 quality measures outlined in the WHO Standards for Maternal and Newborn Care. Comparing LaQshya with WHO standards offers insights into how its measurement criteria align with global standards for assessing maternity and newborn care quality. RESULTS: LaQshya utilizes several proven catalysts to enhance and measure quality- institutional structures, empirical measures, external validation, certification, and performance incentives for high-quality care. The program also embodies contemporary methods like quality circles, rapid improvement cycles, ongoing facility training, and plan-do-check, and act (PDCA) strategies for sustained quality enhancement. Key drivers of LaQshya's assessment are- leadership, staff mentoring, digital infrastructure and stakeholder engagement from certified facilities. However, governance issues, understaffing, unclear directives, competency gaps, staff reluctance towards new quality improvement approaches inhibit the program, and its capacity to enhance quality of care. LaQshya addresses 76% of WHO's 352 quality measures for maternal and newborn care but lacks comprehensive assessment of crucial elements: harmful labor practices, mistreatment of mothers or newborns, childbirth support, and effective clinical leadership and supervision. CONCLUSION: LaQshya is a powerful model for evaluating quality of care, surpassing other global assessment tools. To achieve its maximum potential, we suggest strengthening district governance structures and offering tailored training programs for RMC and other new quality processes. Furthermore, expanding its quality measurement metrics to effectively assess provider accountability, patient outcomes, rights, staff supervision, and health facility leadership will increase its ability to assess quality improvements.

Simulation study of membrane bending by protein crowding: a case study with the epsin N-terminal homology domain.

The mechanisms by which peripheral membrane proteins generate curvature is currently an active area of research. One of the proposed mechanisms is amphipathic insertion or the 'wedge' mechanism in which the protein shallowly inserts an amphipathic helix inside the membrane to drive the curvature. However, recent experimental studies have challenged the efficiency of the 'wedge' mechanism as it requires unusual protein densities. These studies proposed an alternative mechanism, namely 'protein-crowding', in which the lateral pressure generated by the random collisions among the membrane bound proteins drives the bending. In this study, we employ atomistic and coarse-grained molecular dynamics simulations to investigate the effects of amphipathic insertion and protein crowding on the membrane surface. Considering epsin N-terminal homology (ENTH) domain as a model protein, we show that amphipathic insertion is not essential for membrane bending. Our results suggest that ENTH domains can aggregate on the membrane surface by employing another structured region (H3 helix). And this protein crowding decreases the cohesive energy of the lipid tails which causes a significant decrease in the membrane bending rigidity. The ENTH domain can generate a similar degree of membrane curvature irrespective of the activity of its H0 helix. Our results are consistent with the recent experimental results.

Numerical and experimental investigation of static wetting morphologies of aqueous drops on lubricated slippery surfaces using a quasi-static approach.

The static wetting behavior of drops on surfaces with thin lubricating films is very different compared to solid surfaces. Due to the slow dynamics of the wetting ridge, it is challenging to predict the apparent contact angles of such drops. It is hypothesized that for a sinking drop on a lubricated surface, quasi-static wetting morphology can be numerically computed from the knowledge of interfacial energies, lubricant thickness, and drop volume. In this study, we use Surface Evolver to numerically compute the static wetting morphology for the four-phase system using a quasi-static approach with a sinking time similar to the early-intermediate times, and the results agree well with the corresponding experiments. We find that the apparent contact angles depend significantly on the lubricant thickness and substrate wettability compared to other parameters.

Origin of the nonlinear structural and mechanical properties in oppositely curved lipid mixtures.

Structural and mechanical properties of membranes such as thickness, tail order, bending modulus and curvature energetics play crucial role in controlling various cellular functions that depend on the local lipid organization and membrane reshaping. While behavior of these biophysical properties are well understood in single component membranes, very little is known about how do they change in the mixed lipid membranes. Often various properties of the mixed lipid bilayers are assumed to change linearly with the mole fractions of the constituent lipids which, however, is true for "ideal" mixing only. In this study, using molecular dynamics simulations, we show that structural and mechanical properties of binary lipid mixture change nonlinearly with the lipid mole fractions, and the strength of the nonlinearity depends on two factors - spontaneous curvature difference and locally inhomogeneous interactions between the lipid components.

Exploring the factors that affect user experience in mobile-health applications: A text-mining and machine-learning approach.

Recent years have witnessed an increased demand for mobile health (mHealth) platforms owing to the COVID-19 pandemic and preference for doorstep delivery. However, factors impacting user experiences and satisfaction levels across these platforms, using customer reviews, are still largely unexplored in academic research. The empirical framework we proposed in this paper addressed this research gap by analysing unmonitored user comments for some popular mHealth platforms. Using topic-modelling techniques, we identified the impacting factors (predictors) and categorised them into two major dimensions based on strategic adoption and motivational association. Findings from our study suggest that time and money, convenience, responsiveness, and availability emerge as significant predictors for delivering a positive user experience on m-health platforms. Next, we identified substantial moderating effects of review polarity on the predictors related to brand association and hedonic motivation, such as online booking and video consultation. Further, we also identified the top predictors for successful user experience across these platforms. Recommendations from our study will benefit business managers by offering an improved service design leading to higher user satisfaction across these m-health platforms.

Simulation study of domain formation in a model bacterial membrane.

Recent experimental studies revealed that functional membrane microdomains (FMMs) are formed in prokaryotic cells which are structurally and functionally similar to the lipid rafts formed in eukaryotic cells. In this study, we employ coarse-grained molecular dynamics simulations to investigate the mechanism of domain formation and its physiochemical properties in a model methicillin-resistant staphylococcus aureus (MRSA) cell membrane. We find that domains are formed through lateral segregation of staphyloxanthin (STX), a carotenoid which shields the bacteria from the host's immune because of its antioxidant nature. Simulation results suggest that membrane integrity increases with the size of the domain, which is assessed by computing bond order parameter of the lipid tails, membrane expansion modulus and water permeability across the membrane. Various membrane domain proteins such as flotillin-like protein floA and penicillin binding protein (PBP2a) preferentially bind with the STX and accumulate in the membrane domain which is consistent with the recent experimental results.

Has Covid-19 accelerated opportunities for digital entrepreneurship? An Indian perspective.

Covid-19 has challenged many businesses to orient themselves towards digital solutions for their survival. Due to the rising digital wave during Covid-19, there has been a plethora of opportunities for aspiring entrepreneurs to enter the market. Hence, this study focuses on understanding emerging areas and technologies for digital entrepreneurship. This study adopted a qualitative approach with semi-structured interviews through the lens of the diffusion of innovations theory. A total of 23 entrepreneurs responded and presented their views on Covid-19-induced opportunities for digital entrepreneurship. A structured process of open, axial, and selective coding was adopted for the thematic analysis. The study presents a framework based on four promising propositions. Results of the thematic analysis indicate the emergence of digital entrepreneurship opportunities in technology (EdTech, FinTech, cybersecurity), healthcare (diagnostics, virtual care, fitness), entertainment (over the top, gaming, social media), and e-commerce (contactless delivery, payment methods, augmented reality). In this study, entrepreneurs presented their views based on their experience with the platform or technology they operated. To this end, the present study offers implications both for scholars and entrepreneurs working in and aspiring to digital entrepreneurship along with future scope of research.

Protein-Sugar-Glass Nanoparticle Platform for the Development of Sustained-Release Protein Depots by Overcoming Protein Delivery Challenges.

Therapeutic protein depots have limited clinical success because of the presence of critical preparation barriers such as low encapsulation, uncontrolled release, and activity loss during processing and storage. In the present study, we used our novel protein-nanoencapsulation (into sugar-glass nanoparticle; SGnP) platform to prepare a protein depot to overcome the abovementioned formidable challenges. The SGnP-mediated microparticle protein depot has been validated using four model proteins (bovine serum albumin, horseradish peroxidase, fibroblastic growth factor, and epidermal growth factor) and model biodegradable poly(lactic-co-glycolic acid) polymer system. The results show that our protein-nanoencapsulation-mediated platform provides a new generic platform to prepare a protein depot through the conventional emulsion method of any polymer and single/multiple protein systems. This protein depot has the required pharmaceutical properties such as high encapsulation efficiency, burst-free sustained release, and protein preservation during processing and storage, making it suitable for off-the-shelf use in therapeutic protein delivery and tissue engineering applications.

Paper Versus Digital Data Collection Methods for Road Safety Observations: Comparative Efficiency Analysis of Cost, Timeliness, Reliability, and Results.

BACKGROUND: Roadside observational studies play a fundamental role in designing evidence-informed strategies to address the pressing global health problem of road traffic injuries. Paper-based data collection has been the standard method for such studies, although digital methods are gaining popularity in all types of primary data collection. OBJECTIVE: This study aims to understand the reliability, productivity, and efficiency of paper vs digital data collection based on three different road user behaviors: helmet use, seatbelt use, and speeding. It also aims to understand the cost and time efficiency of each method and to evaluate potential trade-offs among reliability, productivity, and efficiency. METHODS: A total of 150 observational sessions were conducted simultaneously for each risk factor in Mumbai, India, across two rounds of data collection. We matched the simultaneous digital and paper observation periods by date, time, and location, and compared the reliability by subgroups and the productivity using Pearson correlations (r). We also conducted logistic regressions separately by method to understand how similar results of inferential analyses would be. The time to complete an observation and the time to obtain a complete dataset were also compared, as were the total costs in US dollars for fieldwork, data entry, management, and cleaning. RESULTS: Productivity was higher in paper than digital methods in each round for each risk factor. However, the sample sizes across both methods provided a precision of 0.7 percentage points or smaller. The gap between digital and paper data collection productivity narrowed across rounds, with correlations improving from r=0.27-0.49 to 0.89-0.96. Reliability in risk factor proportions was between 0.61 and 0.99, improving between the two rounds for each risk factor. The results of the logistic regressions were also largely comparable between the two methods. Differences in regression results were largely attributable to small sample sizes in some variable levels or random error in variables where the prevalence of the outcome was similar among variable levels. Although data collectors were able to complete an observation using paper more quickly, the digital dataset was available approximately 9 days sooner. Although fixed costs were higher for digital data collection, variable costs were much lower, resulting in a 7.73% (US $3011/38,947) lower overall cost. CONCLUSIONS: Our study did not face trade-offs among time efficiency, cost efficiency, statistical reliability, and descriptive comparability when deciding between digital and paper, as digital data collection proved equivalent or superior on these domains in the context of our project. As trade-offs among cost, timeliness, and comparability-and the relative importance of each-could be unique to every data collection project, researchers should carefully consider the questionnaire complexity, target sample size, implementation plan, cost and logistical constraints, and geographical contexts when making the decision between digital and paper.

Temporal precision of regulated gene expression.

Important cellular processes such as migration, differentiation, and development often rely on precise timing. Yet, the molecular machinery that regulates timing is inherently noisy. How do cells achieve precise timing with noisy components? We investigate this question using a first-passage-time approach, for an event triggered by a molecule that crosses an abundance threshold and that is regulated by either an accumulating activator or a diminishing repressor. We find that either activation or repression outperforms an unregulated strategy. The optimal regulation corresponds to a nonlinear increase in the amount of the target molecule over time, arises from a tradeoff between minimizing the timing noise of the regulator and that of the target molecule itself, and is robust to additional effects such as bursts and cell division. Our results are in quantitative agreement with the nonlinear increase and low noise of mig-1 gene expression in migrating neuroblast cells during Caenorhabditis elegans development. These findings suggest that dynamic regulation may be a simple and powerful strategy for precise cellular timing.

Paper Versus Digital Data Collection for Road Safety Risk Factors: Reliability Comparative Analysis From Three Cities in Low- and Middle-Income Countries.

BACKGROUND: Rapid advances in mobile technologies and applications and the continued growth in digital network coverage have the potential to transform data collection in low- and middle-income countries. A common perception is that digital data collection (DDC) is faster and quickly adaptable. OBJECTIVE: The objective of this study was to test whether DDC is faster and more adaptable in a roadside environment. We conducted a reliability study comparing digital versus paper data collection in 3 cities in Ghana, Vietnam, and Indonesia observing road safety risk factors in real time. METHODS: Roadside observation of helmet use among motorcycle passengers, seat belt use among 4-wheeler passengers, and speeding was conducted in Accra, Ghana; Ho Chi Minh City (HCMC), Vietnam; and Bandung, Indonesia. Two independent data collection teams were deployed to the same sites on the same dates and times, one using a paper-based data collection tool and the other using a digital tool. All research assistants were trained on paper-based data collection and DDC. A head-to-head analysis was conducted to compare the volume of observations, as well as the prevalence of each risk factor. Correlations (r) for continuous variables and kappa for categorical variables are reported with their level of statistical significance. RESULTS: In Accra, there were 119 observation periods (90-min each) identical by date, time, and location during the helmet and seat belt use risk factor data collection and 118 identical periods observing speeding prevalence. In Bandung, there were 150 observation periods common to digital and paper data collection methods, whereas in HCMC, there were 77 matching observation periods for helmet use, 82 for seat belt use, and 84 for speeding. Data collectors using paper tools were more productive than their DDC counterparts during the study. The highest mean volume per session was recorded for speeding, with Bandung recording over 1000 vehicles on paper (paper: mean 1092 [SD 435]; digital: mean 807 [SD 261]); whereas the lowest volume per session was from HCMC for seat belts (paper: mean 52 [SD 28]; digital: mean 62 [SD 30]). Accra and Bandung showed good-to-high correlation for all 3 risk factors (r=0.52 to 0.96), with higher reliability in speeding and helmet use over seat belt use; HCMC showed high reliability for speeding (r=0.99) but lower reliability for helmet and seat belt use (r=0.08 to 0.32). The reported prevalence of risk factors was comparable in all cities regardless of the data collection method. CONCLUSIONS: DDC was convenient and reliable during roadside observational data collection. There was some site-related variability in implementing DDC methods, and generally the productivity was higher using the more familiar paper-based method. Even with low correlations between digital and paper data collection methods, the overall reported population prevalence was similar for all risk factors.

A Low-Cost Open Hardware System for Collecting Traffic Data Using Wi-Fi Signal Strength.

Road traffic and its impacts affect various aspects of wellbeing with safety, congestion and pollution being of significant concern in cities. Although there have been a large number of works done in the field of traffic data collection, there are several barriers which restrict the collection of traffic data at higher resolution in the cities. Installation and maintenance costs can act as a disincentive to use existing methods (e.g., loop detectors, video analysis) at a large scale and hence limit their deployment to only a few roads of the city. This paper presents an approach for vehicle counting using a low cost, simple and easily installable system. In the proposed system, vehicles (i.e., bicycles, cars, trucks) are counted by means of variations in the WiFi signals. Experiments with the developed hardware in two different scenarios-low traffic (i.e., 400 objects) and heavy traffic roads (i.e., 1000 objects)-demonstrate its ability to detect cars and trucks. The system can be used to provide estimates of vehicle numbers for streets not covered by official traffic monitoring techniques in future smart cities.

The prevalence of disrespect and abuse during facility-based maternity care in Malawi: evidence from direct observations of labor and delivery.

BACKGROUND: There is increasing evidence throughout the world that the negative treatment of pregnant women during labor and delivery can be a barrier to seeking skilled maternity care. At this time, there has been little quantitative evidence published on disrespect and abuse (D&A) in Malawi. The objective of this research is to describe the prevalence of disrespect and abuse during labor and delivery through the secondary analysis of direct clinical observations and to describe the association between the observation of D&A items with the place of delivery and client background characteristics. METHODS: As part of the evaluation of the Helping Babies Breathe intervention, direct observations of labor and delivery were conducted in August 2013 from 27 out of the 28 districts in Malawi. Frequencies of disrespect and abuse items organized around the Bowser and Hill categories of disrespect and abuse and presented in the White Ribbon Alliance's Universal Rights of Childbearing Women Framework were calculated. Bivariate analysis was done to assess the association between selected client background characteristics and the place of delivery with the disrespect and use during childbirth. RESULTS: A total of 2109 observations were made across 40 facilities (12 health centers and 28 hospitals) in Malawi. The results showed that while women were frequently greeted respectfully (13.9% were not), they were often not encouraged to ask the health provider questions (73.1%), were not given privacy (58.2%) and were not encouraged to have a support person present with them (83.2%). Results from the bivariate analysis did not show a consistent relationship between place of delivery and D&A items, where the odds of being shouted at was lower in a health center when compared to a hospital (OR: 0.19; CI: 0.59-0.62) while there was a higher odds of clients not being asked if they have any concerns if they were in a health center when compared to a hospital (OR: 2.40; CI: 1.06-5.44). Women who were HIV+ had significantly lower odds of not having audio and visual privacy (OR: 0.34, CI: 0.12-0.97), of not being asked about her preferred delivery position (OR: 0.17, CI: 0.05-0.65) and of not being asked if she has any other problems she is concerned about (OR 0.38, CI:0.15-0.96). CONCLUSION: This study is among the first to quantify the prevalence of disrespect and abuse during labor and delivery in Malawi through direct clinical observations. Measurement of the poor treatment of women during childbirth is essential for understanding the scope of the problem and how to address this issue.

Primary health care workers' views of motivating factors at individual, community and organizational levels: a qualitative study from Nasarawa and Ondo states, Nigeria.

BACKGROUND: Current efforts to motivate primary health workers in Nigeria focus on better financial incentives, and the role of other motivating factors has received less attention. The aim of this study is to explore individual and organizational determinants, their interactions and effects on motivation. METHODS: Exploratory qualitative research, involving semi-structured interviews with 29 primary health workers (doctors, nurses, midwives and community health workers), was conducted in Nasarawa and Ondo states in Nigeria. Nine key informant interviews were conducted with government officials. Interviews were digitally recorded, transcribed and coded. Thematic analysis was conducted to identify common themes, as well as unique narratives. RESULTS: Results from this study suggest that health workers are motivated by individual (vocation, religion, humanity and self-efficacy) and organizational (monetary incentives, good working environment) factors and community recognition. Supervision and leadership provided by the officer in charge as compared with that by external agencies appeared to have a positive effect on motivation. CONCLUSIONS: Policy makers and donor agencies should take into account a broader range of factors while designing strategies to motivate the health workforce. The study also underscores how officer in charges with enhanced skills are likely to motivate health workers by creating a more supportive environment.

Providing antenatal corticosteroids for preterm birth: a quality improvement initiative in Cambodia and the Philippines.

OBJECTIVE: To determine whether a simple quality improvement initiative consisting of a technical update and regular audit and feedback sessions will result in increased use of antenatal corticosteroids among pregnant women at risk of imminent preterm birth delivering at health facilities in the Philippines and Cambodia. DESIGN: Non-randomized, observational study using a pre-/post-intervention design conducted between October 2013 and June 2014. SETTING: A total of 12 high volume facilities providing Emergency Obstetric and Newborn Care services in Cambodia (6) and Philippines (6). INTERVENTION: A technical update on preterm birth and use of antenatal corticosteroids, followed by monthly audit and feedback sessions. MAIN OUTCOME MEASURE: The proportion of women at risk of imminent preterm birth who received at least one dose of dexamethasone. RESULTS: Coverage of at least one dose of dexamethasone increased from 35% at baseline to 86% at endline in Cambodia (P < 0.0001) and from 34% at baseline to 56% at endline in the Philippines (P < 0.0001), among women who had births at 24-36 weeks. In both settings baseline coverage and magnitude of improvement varied notably by facility. Availability of dexamethasone, knowledge of use and cost were not major barriers to coverage. CONCLUSIONS: A simple quality improvement strategy was feasible and effective in increasing use of dexamethasone in the management of preterm birth in 12 hospitals in Cambodia and Philippines.

Determinants of postnatal care use at health facilities in rural Tanzania: multilevel analysis of a household survey.

BACKGROUND: Postnatal care (PNC) for the mother and infant is a neglected area, even for women who give birth in a health facility. Currently, there is very little evidence on the determinants of use of postnatal care from health facilities in Tanzania. METHODS: This study examined the role of individual and community-level variables on the use of postnatal health services, defined as a check up from a heath facility within 42 days of delivery, using multilevel logistic regression analysis. We analyzed data of 1931 women, who had delivered in the preceding 2-14 months, from a two-stage household survey in 4 rural districts of Morogoro region, Tanzania. Individual level explanatory variables included i) Socio-demographic factors: age, birth order, education, and wealth, ii) Factors related to pregnancy: frequency of antenatal visits, history of complications, mode of delivery, place of delivery care, and counseling received. Community level variables included community levels of family planning, health service utilization, trust, poverty and education, and distance to health facility. RESULTS: Less than one in four women in Morogoro reported having visited a health facility for postnatal care. Individual-level attributes positively associated with postnatal care use were women's education of primary level or higher [Odds Ratio (OR) 1.37, 95 % Confidence Interval (CI) 1.04-1.81], having had a caesarean section or forceps delivery (2.95, 1.8-4.81), and being counseled by a community health worker to go for postnatal care at a health facility (2.3, 1.36-3.89). Other positive associations included those recommended HIV testing for baby (1.94, 1.19-3.15), and whose partners tested for HIV (1.41, 1.07-1.86). High community levels of postpartum family planning usage (2.48, 1.15-5.37) and high level of trust in health system (1.77, 1.12-2.79) were two significant community-level predictors. Lower postnatal care use was associated with having delivered at a hospital (0.5, 0.33-0.76), health center (0.57, 0.38-0.85), or dispensary (0.48, 0.33-0.69), and having had severe swelling of face and legs during pregnancy (0.65, 0.43-0.97). CONCLUSIONS: In the context of low postnatal care use in a rural setting, programs should direct efforts towards reaching women who do not avail themselves of postnatal care as identified in our study.

Profile, knowledge, and work patterns of a cadre of maternal, newborn, and child health CHWs focusing on preventive and promotive services in Morogoro Region, Tanzania.

BACKGROUND: Despite impressive decreases in under-five mortality, progress in reducing maternal and neonatal mortality in Tanzania has been slow. We present an evaluation of a cadre of maternal, newborn, and child health community health worker (MNCH CHW) focused on preventive and promotive services during the antenatal and postpartum periods in Morogoro Region, Tanzania. Study findings review the effect of several critical design elements on knowledge, time allocation, service delivery, satisfaction, and motivation. METHODS: A quantitative survey on service delivery and knowledge was administered to 228 (of 238 trained) MNCH CHWs. Results are compared against surveys administered to (1) providers in nine health centers (n = 88) and (2) CHWs (n = 53) identified in the same districts prior to the program's start. Service delivery outputs were measured by register data and through a time motion study conducted among a sub-sample of 33 randomly selected MNCH CHWs. RESULTS: Ninety-seven percent of MNCH CHWs (n = 228) were interviewed: 55% male, 58% married, and 52% with secondary school education or higher. MNCH CHWs when compared to earlier CHWs were more likely to be unmarried, younger, and more educated. Mean MNCH CHW knowledge scores were <50% for 8 of 10 MNCH domains assessed and comparable to those observed for health center providers but lower than those for earlier CHWs. MNCH CHWs reported covering a mean of 186 households and were observed to provide MNCH services for 5 h weekly. Attendance of monthly facility-based supervision meetings was nearly universal and focused largely on registers, yet data quality assessments highlighted inconsistencies. Despite program plans to provide financial incentives and bicycles for transport, only 56% of CHWs had received financial incentives and none received bicycles. CONCLUSIONS: Initial rollout of MNCH CHWs yields important insights into addressing program challenges. The social profile of CHWs was not significantly associated with knowledge or service delivery, suggesting a broader range of community members could be recruited as CHWs. MNCH CHW time spent on service delivery was limited but comparable to the financial incentives received. Service delivery registers need to be simplified to reduce inconsistencies and yet expanded to include indicators on the timing of antenatal and postpartum visits.