Project Summary This application provides evidence that the Principal and International Principal Investigators leading the UAB-Zambia team have an established record of major accomplishments in the Global Network, including the design, implementation, and publication of single site and common protocol clinical trials and studies that led to major international and national guidelines and improved care practices. The UAB-Zambia team has access to a stable set of geographically distinct rural clusters and urban delivery facilities where the team has conducted research over the last 19 years. The international partner, University Teaching Hospital/University of Zambia, and a multi-disciplinary team consisting of specialists in obstetrics, pediatrics, and public health in Lusaka, Zambia have collaborated in research, training, education, and implementation/scale-up of state-of-the-art research targeted to the most common causes of maternal and neonatal/infant/child mortality and severe morbidities. The exceptional organizational capabilities and local support facilitate full participation in all Global Network trials and studies, including high recruitment and over 99% follow-up rates. The administrative teams at UAB and Zambia provide all the necessary support for the success of all grant activities. All Zambian staff members have a record of excellent performance and accomplishments in the Network, including most working with the team since the first cycle of the Global Network. The proposed team of investigators have collaborated for over 19 years and will continue to work with the NICHD and other sites of the Global Network to lead innovative and impactful randomized trials and observational studies that transform the care of mothers and infants. The UAB-Zambia team has designed major transformative studies including the FIRST BREATH, BRAIN-HIT, and A-PLUS trials as well as the Predictive Modeling for Perinatal Mortality in Resource-Limited Settings database study. The qualifications and unequivocal commitment of the investigators the Zambian staff, as well as the full endorsement of the Government of Zambia, University Teaching Hospital (Zambia), University of Zambia, and the University of Alabama at Birmingham will ensure superior performance if this site is granted participation in the Network. The long-term objective is to improve local health care systems with education, training, research, implementation, and sustainability of programs to decrease preventable maternal and child mortality and morbidities.