Stillbirth and Newborn Mortality in India After Helping Babies Breathe Training

Departments of Physiology.
PEDIATRICS (Impact Factor: 5.47). 01/2013; 131(2). DOI: 10.1542/peds.2012-2112
Source: PubMed


This study evaluated the effectiveness of Helping Babies Breathe (HBB) newborn care and resuscitation training for birth attendants in reducing stillbirth (SB), and predischarge and neonatal mortality (NMR). India contributes to a large proportion of the worlds annual 3.1 million neonatal deaths and 2.6 million SBs.

This prospective study included 4187 births at >28 weeks' gestation before and 5411 births after HBB training in Karnataka. A total of 599 birth attendants from rural primary health centers and district and urban hospitals received HBB training developed by the American Academy of Pediatrics, using a train-the-trainer cascade. Pre-post written trainee knowledge, posttraining provider performance and skills, SB, predischarge mortality, and NMR before and after HBB training were assessed by using χ(2) and t-tests for categorical and continuous variables, respectively. Backward stepwise logistic regression analysis adjusted for potential confounding.

Provider knowledge and performance systematically improved with HBB training. HBB training reduced resuscitation but increased assisted bag and mask ventilation incidence. SB declined from 3.0% to 2.3% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.98) and fresh SB from 1.7% to 0.9% (OR 0.54, 95% CI 0.37-0.78) after HBB training. Predischarge mortality was 0.1% in both periods. NMR was 1.8% before and 1.9% after HBB training (OR 1.09, 95% CI 0.80-1.47, P = .59) but unknown status at 28 days was 2% greater after HBB training (P = .007).

HBB training reduced SB without increasing NMR, indicating that resuscitated infants survived the neonatal period. Monitoring and community-based assessment are recommended.

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Available from: Manjunath Somannavar, Feb 20, 2014
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    • "In conjunction with Laerdal Global Health, Jhpiego has designed a training series entitled Helping Mothers Survive (HMS). The first training module in this series is Bleeding after Birth (BAB), which is patterned after the Helping Babies Breathe training in newborn resuscitation [14]. The BAB module had not previously been validated in the "
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    ABSTRACT: Objective To validate a new training module for skilled and semiskilled birth attendants authorized to provide care at birth—Helping Mothers Survive: Bleeding After Birth (HMS:BAB)—aimed at reducing postpartum hemorrhage, the leading cause of maternal mortality worldwide. BAB training involves single-day, facility-based training that emphasizes simulation of scenarios related to prevention, detection, and management of postpartum hemorrhage. Methods A total of 155 skilled and semiskilled birth attendants participated in training in India, Malawi, and Zanzibar, Tanzania. Knowledge and confidence were assessed before and after training. Skills and acceptability were assessed after training. Results Knowledge and confidence scores improved significantly from pre- to post-training among all cadres in all three countries. The proportion of providers with passing knowledge scores increased significantly from pre- to post-training among all cadres except for those already high at baseline. On three post-training skills tests the overall proportion of individuals with a passing score ranged from 83% to 89%. Conclusion BAB training in prevention and management of postpartum hemorrhage increased knowledge and confidence among skilled and semiskilled birth attendants. Further studies are needed to determine the impact of this training on skills retention and clinical outcomes following postpartum hemorrhage, after broader implementation of the training program. Synopsis This study provides evidence that a new training module supports knowledge and skills development in birth attendants for the prevention and management of postpartum hemorrhage.
    Full-text · Article · Sep 2014 · International Journal of Gynecology & Obstetrics
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    • "In one study done in Tanzania, researchers found that HBB implementation resulted in a significant reduction of neonatal deaths (Msemo et al., 2013). In another study conducted in India , a country with one of the highest rates of neonatal deaths, researchers learned that HBB training reduced the number of stillbirths (Goudar et al., 2013). There were also significant reductions in stillbirth rates after implementation of the HBB program. "
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    ABSTRACT: Abstract This research is important for those interested in the health of women and children in Africa, specifically the country of Uganda. Maternal and infant mortality rates in Uganda, especially northern Uganda are very high. Many health providers from resource rich countries are interested to partner with health providers in low-resource countries such as Uganda to improve maternal and infant mortality, yet they know very little about the traditional and indigenous beliefs and practices and how these factors contribute to success of intervention programs. It is essential that cultural considerations be included in interventions. In this article researchers from the United States provide the perspectives of providers in Uganda regarding an intervention program in which the Americans participated.
    Full-text · Article · Aug 2014 · Health Care For Women International
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    • "What a priceless gift of life can be provided to a child born in potentially life-threatening circumstances. Recent clinical studies conducted in Tanzania and India build on earlier studies that document signifi cant reductions in fresh stillbirth and newborn mortality rates within 24 hours following birth (Goudar et al., 2013; Msemo et al., 2013). Richards- Kortum and Oden (2013) call for the development of devices for lowresource care rather than sophisticated medical technologies used in highresource settings, which assume that basic infrastructures exist everywhere. "

    Full-text · Article · Jul 2014 · MCN The American Journal of Maternal/Child Nursing
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