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Dhungana R, Chalise M, Visick MK, Clark RB. A hybrid approach to skill retention following neonatal resuscitation training: Assessing effectiveness. J Neonatal Perinatal Med 2024:NPM230072. [PMID: 38788095 DOI: 10.3233/npm-230072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Perinatal death, a global health problem, can be prevented with simple resuscitation interventions that help the baby breathe immediately at birth. Latter-day Saint Charities (LDSC) and Safa Sunaulo Nepal (SSN) implemented a program to scale-up Helping Babies Breathe (HBB) training in Karnali Province, Nepal from January 2020-February 2021. The interventions were implemented using a hybrid approach with on-site mentoring in the pre/post COVID period combined with remote support and monitoring during the COVID period. This paper reports overall changes in newborn outcomes in relation to the unique implementation approach used. A prospective cohort design was used to compare outcomes of birth cohorts in 16 public health facilities in the first and last three months of program implementation. Results showed significant decreases in intrapartum stillbirths (23%), and neonatal deaths within (27%) and after (41.3%) 24 hours of life. The scale-up of HBB training resulted in 557 providers receiving training and mentoring support during the program period, half trained during the COVID period. Increased practice sessions, review meetings and debriefing meetings were reported during the COVID period compared to pre/post COVID period. The evaluation is suggestive of the potential of a hybrid approach for improved perinatal outcomes and scaling-up of newborn resuscitation trainings in health system facing disruptions.
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Affiliation(s)
| | - M Chalise
- Children's Medical Mission, Kathmandu, Nepal
| | - M K Visick
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - R B Clark
- Brigham Young University, Provo, UT, USA
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Dhungana R, Chalise M, Clark RB. An assessment of immediate newborn care readiness and availability in Nepal. Glob Health Action 2023; 16:2289735. [PMID: 38085010 PMCID: PMC10795551 DOI: 10.1080/16549716.2023.2289735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Global neonatal mortality necessitates access to immediate newborn care interventions. In Nepal, disparities persist in the readiness and availability of newborn care services within health facilities. OBJECTIVE This study aimed to assess this status and compare facilities that had implemented an intensive newborn resuscitation capacity building and retention programme in the past five years with those that had not. METHODS Our observational cross-sectional study involved 154 health facilities across Nepal. Through on-site inspections and maternal log reviews, we evaluated the immediate newborn care readiness and availability. RESULTS The mean immediate newborn care intervention availability score of 52.8% (SE = 21.5) and the readiness score averaged 79.6% (SE = 12.3). Encouragingly, 96% of facilities ensured newborns were dried and wrapped for warmth, and 69.9% provided newborn resuscitation. Practices such as delayed cord clamping (42.0%), skin-to-skin contact (28.6%), and early breastfeeding (63.5%) showed room for improvement. Only 16.1% of health facilities administered Vitamin K1 prophylaxis.Domain-specific scores demonstrated a high level of facility readiness in infrastructure (97.5%), medicine, equipment, and supplies (90.6%), and staff training (90.9%), but a lower score for neonatal resuscitation aids (28.8%). Disparities in readiness and availability were evident, with rural areas and the Madhesh province reporting lower scores. Variations among health facility types revealed provincial and private hospitals outperforming local-level facilities. A positive association was observed between the LDSC/SSN mentoring programme and both the readiness and availability of immediate newborn care services. CONCLUSION This study highlights the gap between healthcare facility readiness and the actual availability of immediate newborn care interventions in Nepal. Addressing disparities and barriers, particularly in rural areas and local-level facilities, is crucial for improving neonatal survival. The positive link between the LDSC/SSN programme and service availability and facility readiness emphasises the significance of targeted training and mentorship programmes in enhancing newborn care across Nepal.
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Affiliation(s)
| | | | - Robert B. Clark
- Department of Public Health, Brigham Young University, Provo, UT, USA
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Patel AB, Bang A, Kurhe K, Bhargav S, Hibberd PL. What Helping Babies Breathe knowledge and skills are formidable for healthcare workers? Front Pediatr 2022; 10:891266. [PMID: 36793503 PMCID: PMC9922883 DOI: 10.3389/fped.2022.891266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 12/30/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Most neonatal deaths occur in the first week of life, due to birth asphyxia. Helping Babies Breathe (HBB), is a simulation-based neonatal resuscitation training program to improve knowledge and skills. There is little information on which knowledge items or skill steps are challenging for the learners. METHODS We used training data from NICHD's Global Network study to understand the items most challenging for Birth Attendants (BA) to guide future curriculum modifications. HBB training was provided in 15 primary, secondary and tertiary level care facilities in Nagpur, India. Refresher training was provided 6 months later. Each knowledge item and skill step was ranked from difficulty level 1 to 6 based on whether 91%-100%, 81%-90%, 71%-80%, 61%-70%, 51%-60% or <50% of learners answered/performed the step correctly. RESULTS The initial HBB training was conducted in 272 physicians and 516 midwives of which 78 (28%) physicians and 161 (31%) midwives received refresher training. Questions related to timing of cord clamping, management of a meconium-stained baby, and steps to improve ventilation were most difficult for both physicians and midwives. The initial steps of Objective Structured Clinical Examination (OSCE)-A i.e. equipment checking, removing wet linen and immediate skin-to-skin contact were most difficult for both groups. Midwives missed stimulating newborns while physicians missed cord clamping and communicating with mother. In OSCE-B, starting ventilation in the first minute of life was the most missed step after both initial and 6 months refresher training for physicians and midwives. At the retraining, the retention was worst for cutting the cord (physicians level 3), optimal rate of ventilation, improving ventilation & counting heart rate (midwives level 3), calling for help (both groups level 3) and scenario ending step of monitoring the baby and communicating with mother (physicians level 4, midwives 3). CONCLUSION All BAs found skill testing more difficult than knowledge testing. The difficulty level was more for midwives than for physicians. So, the HBB training duration and frequency of retraining can be tailored accordingly. This study will also inform subsequent refinement in the curriculum so that both trainers and trainees will be able to achieve the required proficiency.
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Affiliation(s)
- Archana B Patel
- Research Unit, Lata Medical Research Foundation, Nagpur, India.,Department of Medical Research, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Akash Bang
- Department of Pediatrics, All India Institute of Medical Sciences, Nagpur, India
| | - Kunal Kurhe
- Research Unit, Lata Medical Research Foundation, Nagpur, India
| | - Savita Bhargav
- Research Unit, Lata Medical Research Foundation, Nagpur, India
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Schleiff MJ, Aitken I, Alam MA, Damtew ZA, Perry HB. Community health workers at the dawn of a new era: 6. Recruitment, training, and continuing education. Health Res Policy Syst 2021; 19:113. [PMID: 34641898 PMCID: PMC8506097 DOI: 10.1186/s12961-021-00757-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the sixth of our 11-paper supplement entitled "Community Health Workers at the Dawn of New Era". Expectations of community health workers (CHWs) have expanded in recent years to encompass a wider array of services to numerous subpopulations, engage communities to collaborate with and to assist health systems in responding to complex and sometimes intensive threats. In this paper, we explore a set of key considerations for training of CHWs in response to their enhanced and changing roles and provide actionable recommendations based on current evidence and case examples for health systems leaders and other stakeholders to utilize. METHODS We carried out a focused review of relevant literature. This review included particular attention to a 2014 book chapter on training of CHWs for large-scale programmes, a systematic review of reviews about CHWs, the 2018 WHO guideline for CHWs, and a 2020 compendium of 29 national CHW programmes. We summarized the findings of this latter work as they pertain to training. We incorporated the approach to training used by two exemplary national CHW programmes: for health extension workers in Ethiopia and shasthya shebikas in Bangladesh. Finally, we incorporated the extensive personal experiences of all the authors regarding issues in the training of CHWs. RESULTS The paper explores three key themes: (1) professionalism, (2) quality and performance, and (3) scaling up. Professionalism: CHW tasks are expanding. As more CHWs become professionalized and highly skilled, there will still be a need for neighbourhood-level voluntary CHWs with a limited scope of work. Quality and performance: Training approaches covering relevant content and engaging CHWs with other related cadres are key to setting CHWs up to be well prepared. Strategies that have been recently integrated into training include technological tools and provision of additional knowledge; other strategies emphasize the ongoing value of long-standing approaches such as regular home visitation. Scale-up: Scaling up entails reaching more people and/or adding more complexity and quality to a programme serving a defined population. When CHW programmes expand, many aspects of health systems and the roles of other cadres of workers will need to adapt, due to task shifting and task sharing by CHWs. CONCLUSION Going forward, if CHW programmes are to reach their full potential, ongoing, up-to-date, professionalized training for CHWs that is integrated with training of other cadres and that is responsive to continued changes and emerging needs will be essential. Professionalized training will require ongoing monitoring and evaluation of the quality of training, continual updating of pre-service training, and ongoing in-service training-not only for the CHWs themselves but also for those with whom CHWs work, including communities, CHW supervisors, and other cadres of health professionals. Strong leadership, adequate funding, and attention to the needs of each cadre of CHWs can make this possible.
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Affiliation(s)
- Meike J. Schleiff
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Iain Aitken
- Management Sciences for Health, Ministry of Public Health, Kabul, Afghanistan
| | | | | | - Henry B. Perry
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation. CHILDREN-BASEL 2021; 8:children8060526. [PMID: 34205496 PMCID: PMC8235222 DOI: 10.3390/children8060526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 01/01/2023]
Abstract
The initial bedside care of premature babies with an intact cord has been shown to reduce mortality; there is evidence that resuscitation of term babies with an intact cord may also improve outcomes. This process has been facilitated by the development of bedside resuscitation surfaces. These new devices are unaffordable, however, in most of sub-Saharan Africa, where 42% of the world’s 2.4 million annual newborn deaths occur. This paper describes the rationale and design of BabySaver, an innovative low-cost mobile resuscitation unit, which was developed iteratively over five years in a collaboration between the Sanyu Africa Research Institute (SAfRI) in Uganda and the University of Liverpool in the UK. The final BabySaver design comprises two compartments; a tray to provide a firm resuscitation surface, and a base to store resuscitation equipment. The design was formed while considering contextual factors, using the views of individual women from the community served by the local hospitals, medical staff, and skilled birth attendants in both Uganda and the UK.
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Hatamleh R, Abujilban S, Abuhammad S, Ariag DMA, Joseph RA. Effect of the Helping Babies Breathe Training Program: An Experimental Study on Jordanian Midwives' Knowledge and Skills. J Perinat Neonatal Nurs 2021; 35:E11-E17. [PMID: 32804875 DOI: 10.1097/jpn.0000000000000485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Helping Babies Breathe (HBB) training program trains providers in effective resuscitation of infants in developing countries. This study evaluated the effectiveness of the HBB training program on midwives' knowledge and skills in Northern Jordan. Using a nonequivalent control group design, 50 midwives (control, n = 25; experimental, n = 25) from 3 public hospitals in Northern Jordan were recruited and their knowledge and skills were evaluated before and after the training. The program has 3 aspects: 2 hours of teaching, 1 hour of testing, and 25 minutes of skills assessment per participant. The skills were tested individually for each participant, and they were reevaluated at 8 months after. The control and experimental groups significantly differed in posttest scores on knowledge, Objective Structured Clinical Examination A and B skills, and bag-mask application after adjusting for covariates. The HBB training program significantly enhanced knowledge of midwives in the experimental group (P < .05) and demonstrated skills. The HBB training program was helpful in improving midwives' knowledge and practices on immediate care of a newborn baby. Therefore, training midwives using the HBB training program can improve their knowledge and skills and thereby improve infant outcomes in Jordan.
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Affiliation(s)
- Reem Hatamleh
- Faculty of Nursing (Dr Hatamleh) and Maternal and Child Health Department (Dr Abuhammad), Jordan University of Science and Technology, Irbid, Jordan; Faculty of Nursing, Hashemite University, Zarqa, Jordan (Dr Abujilban); Jordan University of Science and Technology, Irbid, Jordan (Mr Ariag); and Liberty University, Lynchburg, Virginia (Dr Joseph)
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Huynh TK, Schoonover A, Harrod T, Bahr N, Guise JM. Characterizing prehospital response to neonatal resuscitation. Resusc Plus 2021; 5:100086. [PMID: 34223352 PMCID: PMC8244404 DOI: 10.1016/j.resplu.2021.100086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/08/2021] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate performance of initial steps of newborn resuscitation according to the American Heart Association and American Academy of Pediatrics' Neonatal Resuscitation Program (NRP) guidelines in the prehospital setting. Study Design Observational study of 265 paramedics and Emergency Medical Technicians (EMTs) from 45 EMS teams recruited from public fire and private transport agencies in a major metropolitan area. Participants completed a baseline questionnaire assessing demographics, experience, and comfort in caring for children. Simulations were conducted April 2015 to March 2016. Technical performance was evaluated by blinded video review. NRP actions were assessed using a structured performance tool. Results Two hundred sixty-five EMS providers responded to survey questions and participated in simulations. In total, 16% reported feeling very or extremely comfortable caring for children <30 days of age (vs. 71% for children aged 12-18 years). Among 45 EMS teams participating in simulations, 22% (n = 10) dried, 18% (n = 8) stimulated, and 2% (n = 1) warmed within 30 s from arrival and 11% (n = 5) provided BMV within 60 s from arrival, as recommended by NRP. All teams provided BMV. Eighty-eight percent bagged below NRP rate recommendations and 96% bagged with tidal volume exceeding guidelines. Looking over the entire 10-min simulation for ever performing measures, 73% started to dry the baby within a median of 51 (range 0-539) seconds from arrival, 38% started to stimulate the baby within a median of 34 s (range 0-181), and 44% started to warm the baby within a median 291 s (range 27-575 s). Conclusions These data from field simulations suggest NRP steps recommended for the first minute after birth are seldom performed in a timely manner and suggests opportunities for improvement.
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Affiliation(s)
- Trang Kieu Huynh
- Department of Pediatrics, Oregon Health and Science University, United States
| | - Amanda Schoonover
- Department of Obstetrics and Gynecology, Oregon Health and Science University, United States
| | - Tabria Harrod
- Department of Obstetrics and Gynecology, Oregon Health and Science University, United States
| | - Nathan Bahr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, United States
| | - Jeanne-Marie Guise
- Department of Obstetrics and Gynecology, Oregon Health and Science University, United States
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Odongkara B, Tylleskär T, Pejovic N, Achora V, Mukunya D, Ndeezi G, Tumwine JK, Nankabirwa V. Adding video-debriefing to Helping-Babies-Breathe training enhanced retention of neonatal resuscitation knowledge and skills among health workers in Uganda: a cluster randomized trial. Glob Health Action 2020; 13:1743496. [PMID: 32524895 PMCID: PMC7480409 DOI: 10.1080/16549716.2020.1743496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Skilled birth attendants must be competent to provide prompt resuscitation to save newborn lives at birth. Both knowledge and skills (competence) decline with time after training but the optimal duration for refresher training among frontline-skilled birth attendants in low-resource settings is unknown. Objectives We assessed the effect of an innovative Helping-Babies-Breathe simulation-based teaching method using video-debriefing compared to standard Helping-Babies-Breathe training on 1) neonatal resuscitation knowledge and skills attainment and 2) competence retention among skilled birth attendants in Northern Uganda. Methods A total of 26 health facilities with 86 birth attendants were equally randomised to intervention and control arms. The 2nd edition of the American Association of Pediatrics Helping-Babies-Breathe curriculum was used for training and assessment. Knowledge and skills were assessed pre- and post-training, and during follow-up at 6 months. A mixed effects linear regression model for repeated measures was used to assess the short and long-term effects of the intervention on neonatal resuscitation practices while accounting for clustering. Results Eighty-two (95.3%) skilled birth attendants completed follow-up at 6 months. Approximately 80% of these had no prior Helping-Babies-Breathe training and 75% reported practicing neonatal resuscitation routinely. Standard Helping-Babies-Breathe training with video-debriefing improved knowledge and skills attainment post-training [adjusted mean difference: 5.34; 95% CI: 0.82–10.78] and retention [adjusted mean difference: 2.97; 95% CI: 1.52–4.41] over 6 months post-training compared to standard training after adjusting for confounding and clustering. Factors that reduced knowledge and skills retention among birth attendants were monthly resuscitation of one neonate or more and being in service for more than 5 years. Conclusion Adding video-debriefing to standard Helping-Babies-Breathe training had an effect on birth attendants’ competence attainment and retention over 6 months in Uganda. However, more research is needed to justify the proposed intervention in this context.
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Affiliation(s)
- Beatrice Odongkara
- Department of Paediatrics and Child Health, Gulu University Faculty of Medicine , Gulu, Uganda.,Center for International Health, University of Bergen , Bergen, Norway.,College of Health Sciences, School of Medicine, Department of Paediatrics and Child Health, Makerere University , Kampala, Uganda
| | | | - Nicola Pejovic
- Center for International Health, University of Bergen , Bergen, Norway.,Department of Neonataology, Sachs' Children and Youth Hospital , Stockholm, Sweden
| | - Vincentina Achora
- Department of Paediatrics and Child Health, Gulu University Faculty of Medicine , Gulu, Uganda.,College of Health Sciences, School of Medicine, Department of Paediatrics and Child Health, Makerere University , Kampala, Uganda.,College of Health Sciences, School of Medicine, Department of Obstetrics and Gynaecology, Makerere University , Kampala, Uganda
| | - David Mukunya
- Center for International Health, University of Bergen , Bergen, Norway
| | - Grace Ndeezi
- College of Health Sciences, School of Medicine, Department of Paediatrics and Child Health, Makerere University , Kampala, Uganda
| | - James K Tumwine
- College of Health Sciences, School of Medicine, Department of Paediatrics and Child Health, Makerere University , Kampala, Uganda
| | - Victoria Nankabirwa
- Center for International Health, University of Bergen , Bergen, Norway.,College of Health Sciences, School of Medicine, Department of Paediatrics and Child Health, Makerere University , Kampala, Uganda.,College of Health Sciences, School of Public Health, Makerere University , Kampala, Uganda
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Valentine GC, Chiume M, Hagan J, Kazembe P, Aagaard KM, Patil M. Neonatal mortality rates and association with antenatal corticosteroids at Kamuzu Central Hospital. Early Hum Dev 2020; 151:105158. [PMID: 32871453 DOI: 10.1016/j.earlhumdev.2020.105158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/15/2020] [Accepted: 08/16/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Malawi has one of the highest child mortality rates in the world, and neonates account for nearly half of all under-five mortality. No previous study has reported neonatal outcomes in Malawi over 12 months. We aimed to evaluate outcomes in the neonatal intensive care unit (NICU) at Kamuzu Central Hospital (KCH) and to determine if there was an association between increased survival and antenatal corticosteroid (ACS) exposure. STUDY DESIGN We introduced a prospective, observational electronic database to collect 122 de-identified variables related to neonatal outcomes for all neonates admitted to the KCH NICU over 12 months. Patients with congenital anomalies were excluded. We compared neonatal mortality rates in neonates who were exposed to ACS compared to those who were not. Statistical methodology included the Wilcoxon rank sum test, Fisher's exact test, and logistic regression. RESULTS Of 2051 neonates admitted to the KCH NICU, the overall neonatal mortality rate was 23.1% and remained similar across 12 months. Mortality was inversely related to birth weight, and outborn neonates referred to KCH had the highest mortality rate (29%). After controlling for confounding covariates, inborn infants exposed to ACS had significantly lower odds of death compared to those without exposure to ACS (adjusted odds ratio = 0.46, 95% confidence interval: 0.24-0.88, p = 0.020). CONCLUSION Lower birth weight, outborn, and no ACS exposure were associated with increased mortality. ACS was associated with a 54% reduction in odds of mortality in inborn neonates highlighting the need for further evaluations of ACS use in resource-limited settings.
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Affiliation(s)
- Gregory C Valentine
- Department of Pediatrics, Division of Neonatology at University of Washington, United States of America; Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, United States of America; Department of Pediatrics at Baylor College of Medicine, United States of America; Section of Neonatology at Texas Children's Hospital, United States of America.
| | | | - Joseph Hagan
- Department of Pediatrics at Baylor College of Medicine, United States of America; Section of Neonatology at Texas Children's Hospital, United States of America
| | - Peter Kazembe
- Kamuzu Central Hospital, Lilongwe, Malawi; Baylor College of Medicine Children's Foundation, Malawi
| | - Kjersti M Aagaard
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, United States of America; Translational Biology & Molecular Medicine, Baylor College of Medicine, United States of America; Center for Microbiome and Metagenomics Research, Baylor College of Medicine, United States of America; Molecular & Human Genetics, Baylor College of Medicine, United States of America; Molecular & Cell Biology at Baylor College of Medicine, United States of America
| | - Monika Patil
- Department of Pediatrics at Baylor College of Medicine, United States of America; Section of Neonatology at Texas Children's Hospital, United States of America
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Keenan WJ, Niermeyer S, Af Ugglas A, Carlo WA, Clark R, Gardner MR, Kak LP, Laerdal T, Little GA, Patterson J, Schoen E, Silkoset U, Visick MK, Wall S, Wright LL. Helping Babies Breathe Global Development Alliance and the Power of Partnerships. Pediatrics 2020; 146:S145-S154. [PMID: 33004637 DOI: 10.1542/peds.2020-016915g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
The Helping Babies Breathe Global Development Alliance (GDA) was a public-private partnership created simultaneously with the launch of the educational program Helping Babies Breathe to accelerate dissemination and implementation of neonatal resuscitation in low- and middle-income countries with the goal of reducing the global burden of neonatal mortality and morbidity related to birth asphyxia. Representatives from 6 organizations in the GDA highlight the recognized needs that motivated their participation and how they built on one another's strengths in resuscitation science and education, advocacy, frontline implementation, health system strengthening, and implementation research to achieve common goals. Contributions of time, talent, and financial resources from the community, government, and private corporations and foundations powered an initiative that transformed the landscape for neonatal resuscitation in low- and middle-income countries. The organizations describe the power of partnerships, the challenges they faced, and how each organization was shaped by the collaboration. Although great progress was achieved, lessons learned through the GDA and additional efforts must still be applied to the remaining challenges of prevention, widespread implementation, improvement in the quality of care, and sustainable integration of neonatal resuscitation and essential newborn care into the fabric of health care systems.
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Affiliation(s)
- William J Keenan
- Department of Pediatrics, Saint Louis University, St Louis, Missouri.,International Pediatric Foundation, St Louis, Missouri
| | - Susan Niermeyer
- University of Colorado School of Medicine, Aurora, Colorado; .,Colorado School of Public Health, Aurora, Colorado
| | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert Clark
- Latter-day Saint Charities, Salt Lake City, Utah
| | | | - Lily P Kak
- US Agency for International Development, Washington, DC
| | | | - George A Little
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | | | | | | | | | | | - Linda L Wright
- National Institutes of Health (retired), Bethesda, Maryland
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11
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Versantvoort JMD, Kleinhout MY, Ockhuijsen HDL, Bloemenkamp K, de Vries WB, van den Hoogen A. Helping Babies Breathe and its effects on intrapartum-related stillbirths and neonatal mortality in low-resource settings: a systematic review. Arch Dis Child 2020; 105:127-133. [PMID: 31278145 DOI: 10.1136/archdischild-2018-316319] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND An important factor in worldwide neonatal mortality is the deficiency in neonatal resuscitation skills among trained professionals. 'Helping Babies Breathe' (HBB) is a simulation-based training course designed to train healthcare professionals in the initial steps of neonatal resuscitation in low-resource areas. The aim of this systematic review is to provide an overview of the available evidence regarding intrapartum-related stillbirths and neonatal mortality related to the HBB training and resuscitation method. DATA SOURCES Cochrane, CINAHL, Embase, PubMed and Scopus. STUDY ELIGIBILITY CRITERIA Conducted in low-resource settings focusing on the effects of HBB on intrapartum-related stillbirths and neonatal mortality. STUDY APPRAISAL Included studies were reviewed independently by two researchers in terms of methodological quality. DATA EXTRACTION Data were extracted by two independent reviewers and crosschecked by one additional reviewer. RESULTS Seven studies were included in this systematic review; the selected studies included a total of 230.797 neonates. Significant decreases were found after the implementation of HBB in one of two studies describing perinatal mortality (n=25 108, rate ratio (RR) 0.75; p<0.001), four out of six studies related to intrapartum-related stillbirths (n=125.720, RR 0.31-0.76), in four out of five studies focusing on 1 day neonatal mortality (n=111.289, RR 0.37-0.67), and one out of three studies regarding 7 day neonatal mortality (n=4.390, RR 0.32). No changes were seen in late neonatal mortality after HBB training and resuscitation method. LIMITATIONS Included studies in were predominantly of moderate quality, therefore no strong recommendations can be made. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Due to the heterogeneous quality of the studies, this systematic review showed moderate evidence for a decrease in intrapartum-related stillbirth and 1-day neonatal mortality rate after implementing the 'Helping Babies Breathe' training and resuscitation method. Further research is required to address the effects of simulation-based team training on morbidity and mortality beyond the initial neonatal period. PROSPERO REGISTRATION NUMBER CRD42018081141.
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Affiliation(s)
| | - Mirjam Y Kleinhout
- Department of Neonatology, Birth Center Wilhelmina's Children Hospital, Division Women and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henrietta D L Ockhuijsen
- Clinical Health Science, Utrecht University, Utrecht, The Netherlands
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Kitty Bloemenkamp
- Department of Obstetrics Birth Center Wilhelmina's Children Hospital, Division Women and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem B de Vries
- Department of Neonatology, Birth Center Wilhelmina's Children Hospital, Division Women and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Agnes van den Hoogen
- Clinical Health Science, Utrecht University, Utrecht, The Netherlands
- Department of Neonatology, Birth Center Wilhelmina's Children Hospital, Division Women and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
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Mersha A, Shibiru S, Gultie T, Degefa N, Bante A. Training and well-equipped facility increases the odds of skills of health professionals on helping babies breathe in public hospitals of Southern Ethiopia: cross-sectional study. BMC Health Serv Res 2019; 19:946. [PMID: 31818292 PMCID: PMC6902403 DOI: 10.1186/s12913-019-4772-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/22/2019] [Indexed: 11/19/2022] Open
Abstract
Background Health professionals equipped with the adequate skills of helping baby breath remain the backbone in the health system in improving neonatal outcomes. However, there is a great controversy between studies to show the proximate factors of the skills of health care providers in helping babies breathe. In Ethiopia, there is a paucity of evidence on the current status of health care provider’s skills of helping babies breathe despite the improvement in neonatal health care services. Therefore, this study intends to fill those gaps in assessing the skills of helping babies breathe and its associated factors among health professionals in public hospitals in Southern Ethiopia. Methods A facility-based cross-sectional study was conducted among 441 health professionals from March 10 to 30, 2019. A simple random sampling method was used to select the study participants. The data were collected through pre-tested interviewer-administered questionnaire and observational checklist. A binary logistic regression model was used to identify significant factors for the skills of helping babies breathe by using SPSS version 25. The P-value < 0.05 used to declare statistical significance. Results Overall, 71.1% (95%CI: 66.2, 75.4%) of health professionals had good skills in helping babies breathe. Age group from 25 to 34 (AOR = 2.24; 95%CI: 1.04, 4.81), training on helping babies breathe (AOR = 2.69; 95%CI: 1.49, 4.87), well-equipped facility (AOR = 2.15; 95%CI: 1.09, 4.25), and adequate knowledge on helping babies breathe (AOR = 2.21; 95%CI: 1.25, 3.89) were significantly associated with a health professionals good skill on helping babies breathe. Conclusions Even though a significant number of care providers had good skills in helping babies breathe, yet there is a need to further improve the skills of the provider in helping babies breathe. Hence, health facilities should be equipped with adequate materials and facilitate frequent training to the provider.
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Affiliation(s)
- Abera Mersha
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Shitaye Shibiru
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Teklemariam Gultie
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Nega Degefa
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Agegnehu Bante
- Department of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Patel A, Bang A, Kurhe K, Bhargav S, Prakash A, Arramraj S, Hibberd PL. Comparison of perinatal outcomes in facilities before and after Global Network's Helping Babies Breathe Implementation Study in Nagpur, India. BMC Pregnancy Childbirth 2019; 19:324. [PMID: 31484498 PMCID: PMC6724302 DOI: 10.1186/s12884-019-2480-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 08/27/2019] [Indexed: 11/14/2022] Open
Abstract
Background The Helping Babies Breathe (HBB) educational program focuses on training of first-level birth attendants in neonatal resuscitation skills for the first minute of life (The Golden Minute). Pre-post studies of HBB implementation in sub-Saharan Africa and Asia have shown reductions in facility-based very early neonatal mortality and stillbirth rates. However, the Global Network pre-post HBB Implementation Study (GN-HBB-IS) found no difference in day 7 perinatal mortality rates (PMR-D7) among births to women participating in the Global Network’s Maternal and Newborn Health Registry. To address potential differences in perinatal outcomes in births occurring in facilities that implemented HBB vs. all births occurring in the communities served by facilities that implemented HBB, we compared day-1 perinatal mortality rates (PMR-D1) among births occurring pre and post HBB implementation in facilities in Nagpur, India, one of the 3 sites participating in the GN-HBB-IS. Methods We hypothesized that there would be a 20% decrease in the Nagpur facility based PMR-D1 in the 12 months post GN HBB implementation from the pre-period. We explored pre-post differences in stillbirth rates (SBR) and day-1 neonatal mortality rates (NMR-D1). Results Of the 15 facilities trained for the GN-HBB-IS, 13 participated in the Nagpur HBB Facility Study (Nagpur-HBB-FS). There were 38,078 facility births in the 12 months before the GN-HBB-IS and 40,870 facility births in the 12 months after the GN-HBB-IS. There was 11% overlap between the registry births analyzed in the GN-HBB-IS and the facility births analyzed in the Nagpur-HBB-FS. In the Nagpur-HBB-FS, there was a pre-post reduction of 16% in PMR-D1 (p = 0.0001), a 14% reduction in SBR (p = 0.002) and a 20% reduction NMR-D1 (p = 0.006). Conclusions In the Nagpur-HBB-FS, PMR-D1, stillbirths and NMR-D1 were significantly lower after HBB implementation. These benefits did not translate to improvements in PMR-D7 in communities served by these facilities, possibly because facilities in which HBB was implemented covered an insufficient proportion of community births or because additional interventions are needed after day 1 of life. Further studies are needed to determine how to translate facility-based improvements in PMR-D1 to improved neonatal survival in the community. Trial registration The Global Network HBB Implementation Study (GN-HBB-IS) was registered at ClinicalTrials.gov: NCT01681017. Electronic supplementary material The online version of this article (10.1186/s12884-019-2480-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Akash Bang
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra State, 442102, India.
| | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, India
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Liechty EA. Introduction. Semin Perinatol 2019; 43:239-240. [PMID: 30979596 PMCID: PMC6746327 DOI: 10.1053/j.semperi.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shikuku DN, Milimo B, Ayebare E, Gisore P, Nalwadda G. Practice and outcomes of neonatal resuscitation for newborns with birth asphyxia at Kakamega County General Hospital, Kenya: a direct observation study. BMC Pediatr 2018; 18:167. [PMID: 29764391 PMCID: PMC5953400 DOI: 10.1186/s12887-018-1127-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/30/2018] [Indexed: 12/02/2022] Open
Abstract
Background About three – quarters of all neonatal deaths occur during the first week of life, with over half of these occurring within the first 24 h after birth. The first minutes after birth are critical to reducing neonatal mortality. Successful neonatal resuscitation (NR) has the potential to prevent these perinatal mortalities related to birth asphyxia. This study described the practice of NR and outcomes of newborns with birth asphyxia in a busy referral hospital. Methods Direct observations of 138 NRs by 28 healthcare providers (HCPs) were conducted using a predetermined checklist adapted from the national pediatric resuscitation protocol. Descriptive statistics were computed and chi – square tests were used to test associations between the newborn outcome at 1 h and the NR processes for the observed newborns. Logistic regression models assessed the relationship between the survival status at 1 h versus the NR processes and newborn characteristics. Results Nurses performed 72.5% of the NRs. A warm environment was maintained in 71% of the resuscitations. Airway was checked for almost all newborns (98%) who did not initiate spontaneous breathing after stimulation. However, only 40% of newborns were correctly cared for in case of meconium presence in airway. Bag and mask ventilation (BMV) was initiated in 100% of newborns who did not respond to stimulation and airway maintenance. About 86.2% of resuscitated newborns survived after 1 h. Removing wet cloth (P = 0.035, OR = 2.90, CI = 1.08–7.76), keeping baby warm (P = 0.018, OR = 3.30, CI = 1.22–8.88), meconium in airway (P = 0.042, OR = 0.34, CI = 0.12–0.96) and gestation age (P = 0.007, OR = 1.38, CI = 1.10–1.75) were associated with newborn outcome at 1 h. Conclusions Mentorship and regular cost – effective NR trainings with focus on maintaining the warm chain during NR, airway maintenance in meconium presence, BMV and care for premature babies are needed for HCPs providing NR. Electronic supplementary material The online version of this article (10.1186/s12887-018-1127-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duncan N Shikuku
- Department of Nursing, Makerere University, School of Health Sciences, Kampala, Uganda.
| | - Benson Milimo
- Department of Midwifery and Gender, Moi University, School of Nursing, Eldoret, Kenya
| | - Elizabeth Ayebare
- Department of Nursing, Makerere University, School of Health Sciences, Kampala, Uganda
| | - Peter Gisore
- Department of Child Health & Pediatrics, Moi University, School of Medicine, Eldoret, Kenya
| | - Gorrette Nalwadda
- Department of Nursing, Makerere University, School of Health Sciences, Kampala, Uganda
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Sami S, Kerber K, Tomczyk B, Amsalu R, Jackson D, Scudder E, Dimiti A, Meyers J, Kenneth K, Kenyi S, Kennedy CE, Ackom K, Mullany LC. "You have to take action": changing knowledge and attitudes towards newborn care practices during crisis in South Sudan. REPRODUCTIVE HEALTH MATTERS 2017; 25:124-139. [PMID: 29233074 DOI: 10.1080/09688080.2017.1405677] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Highest rates of neonatal mortality occur in countries that have recently experienced conflict. International Medical Corps implemented a package of newborn interventions in June 2016, based on the Newborn health in humanitarian settings: field guide, targeting community- and facility-based health workers in displaced person camps in South Sudan. We describe health workers' knowledge and attitudes toward newborn health interventions, before and after receiving clinical training and supplies, and recommend dissemination strategies for improved uptake of newborn guidelines during crises. A mixed methods approach was utilised, including pre-post knowledge tests and in-depth interviews. Study participants were community- and facility-based health workers in two internally displaced person camps located in Juba and Malakal and two refugee camps in Maban from March to October 2016. Mean knowledge scores for newborn care practices and danger signs increased among 72 community health workers (pre-training: 5.8 [SD: 2.3] vs. post-training: 9.6 [SD: 2.1]) and 25 facility-based health workers (pre-training: 14.2 [SD: 2.7] vs. post-training: 17.4 [SD: 2.8]). Knowledge and attitudes toward key essential practices, such as the use of partograph to assess labour progress, early initiation of breastfeeding, skin-to-skin care and weighing the baby, improved among skilled birth attendants. Despite challenges in conflict-affected settings, conducting training has the potential to increase health workers' knowledge on neonatal health post-training. The humanitarian community should reinforce this knowledge with key actions to shift cultural norms that expand the care provided to women and their newborns in these contexts.
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Affiliation(s)
- Samira Sami
- a Associate Faculty, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Kate Kerber
- b Senior Specialist, Newborn Health , Save the Children , Washington , DC , USA
| | - Barbara Tomczyk
- c Health Scientist, Office of the Director, Center for Global Health , US Centers for Disease Control and Prevention , Atlanta , GA , USA
| | - Ribka Amsalu
- d Senior Advisor, Emergency Health , Save the Children , San Francisco , CA , USA
| | - Debra Jackson
- e Senior Health Specialist , UNICEF , New York , NY , USA.,f Professor , University of the Western Cape , Cape Town , South Africa
| | - Elaine Scudder
- g Senior Program Officer, Newborn Health , Save the Children , Washington , DC , USA
| | - Alexander Dimiti
- h Director General, Directorate of Reproductive Health , Ministry of Health , Juba , Republic of South Sudan
| | - Janet Meyers
- i Reproductive Health in Emergencies Advisor , Save the Children , Washington , DC , USA
| | - Kemish Kenneth
- j Maternal and Newborn Health Officer , UNICEF , Juba , Republic of South Sudan
| | - Solomon Kenyi
- k Field Research Coordinator , International Medical Corps , Juba , Republic of South Sudan
| | - Caitlin E Kennedy
- l Associate Professor, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Kweku Ackom
- m Senior Health Advisor , International Medical Corps , London , UK
| | - Luke C Mullany
- n Professor, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Quality of Care during Neonatal Resuscitation in Kakamega County General Hospital, Kenya: A Direct Observation Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2152487. [PMID: 29214159 PMCID: PMC5682044 DOI: 10.1155/2017/2152487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 08/21/2017] [Accepted: 10/01/2017] [Indexed: 11/20/2022]
Abstract
Background Birth asphyxia is the leading cause of neonatal mortality in Kenya. Quality care during neonatal resuscitation (NR) can contribute to a reduction in neonatal mortality related to birth asphyxia by 30 percent. This study assessed the quality of care (QoC) during NR for newborns with birth asphyxia. Methods Direct observations of 138 newborn resuscitations were done in labor ward and maternity theatre. Twenty-eight healthcare providers were observed 3–5 times using a structured checklist. Descriptive and inferential statistics were calculated and quality of care scores computed. Ordered logistic regression model identified HCPs characteristics associated with the QoC scores during NR. Results Overall QoC scores were good for airway clearance (83%). Suctioning in meconium presence (40%) was poorly performed. Years of experience working in maternity were associated with good drying/stimulation (β = 1.86, P = 0.003, CI = 0.626–3.093) and airway maintenance (β = 1.887, P = 0.009, CI = 0.469–3.305); nurses were poor compared to doctors during initial bag and mask ventilation (β = −2.338, P = 0.05, CI = −4.732–0.056). Conclusion Key steps in NR are poorly performed during drying and warmth, airway maintenance in meconium presence, and ventilation. Mentorship with periodic refresher training can improve the care provided during NR.
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Kamath-Rayne BD, Berkelhamer SK, Kc A, Ersdal HL, Niermeyer S. Neonatal resuscitation in global health settings: an examination of the past to prepare for the future. Pediatr Res 2017; 82:194-200. [PMID: 28419084 DOI: 10.1038/pr.2017.48] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/23/2017] [Indexed: 11/09/2022]
Abstract
As rates of childhood mortality decline, neonatal deaths account for nearly half of under-5 deaths worldwide. Intrapartum-related events (birth asphyxia) contribute to approximately one-quarter of neonatal deaths, many of which can be prevented by simple resuscitation and newborn care interventions. This paper reviews various lines of research that have influenced the global neonatal resuscitation landscape. A brief situational analysis of asphyxia-related newborn mortality in low-resource settings is linked to renewed efforts to reduce neonatal mortality in the Every Newborn Action Plan. Possible solutions to gaps in care are identified. Building on international scientific evidence, tests of educational efficacy, and community-based trials established the feasibility and effectiveness of training in resource-limited settings and identified successful implementation strategies. Implementation of neonatal resuscitation programs has been shown to decrease intrapartum stillbirth rates and early neonatal mortality. Challenges remain with respect to provider competencies, coverage, and quality of interventions. The combination of resuscitation science, strategies to increase educational effectiveness, and implemention of interventions with high coverage and quality has resulted in reduced rates of asphyxia-related neonatal mortality. Further efforts to improve coverage and implementation of neonatal resuscitation will be necessary to meet the 2035 goal of eliminating preventable newborn deaths.
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Affiliation(s)
- Beena D Kamath-Rayne
- Perinatal Institute and Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Ashish Kc
- Health Section, UNICEF Nepal, Uppsala, Sweden
| | - Hege L Ersdal
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Susan Niermeyer
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Colorado School of Public Health, Aurora, Colorado
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Evaluating the effect of the Helping Mothers Survive Bleeding after Birth (HMS BAB) training in Tanzania and Uganda: study protocol for a randomised controlled trial. Trials 2017; 18:307. [PMID: 28683806 PMCID: PMC5501356 DOI: 10.1186/s13063-017-2056-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 06/20/2017] [Indexed: 11/12/2022] Open
Abstract
Background Postpartum haemorrhage complicates approximately 10% of all deliveries and contributes to at least a quarter of all maternal deaths worldwide. The competency-based Helping Mothers Survive Bleeding after Birth (HMS BAB) training was developed to support evidence-based management of postpartum haemorrhage. This one-day training includes low-cost MamaNatalie® birthing simulators and addresses both prevention and first-line treatment of haemorrhage. While evidence is accumulating that the training improves health provider’s knowledge, skills and confidence, evidence is missing as to whether this translates into improved practices and reduced maternal morbidity and mortality. This cluster-randomised trial aims to assess whether this training package — involving a one-day competency-based HMS BAB in-facility training provided by certified trainers followed by 8 weeks of in-service peer-based practice — has an effect on the occurrence of haemorrhage-related morbidity and mortality. Methods/design In Tanzania and Uganda we randomise 20 and 18 districts (clusters) respectively, with half receiving the training intervention. We use unblinded matched-pair randomisation to balance district health system characteristics and the main outcome, which is in-facility severe morbidity due to haemorrhage defined by the World Health Organizationation-promoted disease and management-based near-miss criteria. Data are collected continuously in the intervention and comparison districts throughout the 6-month baseline and the 9-month intervention phase, which commences after the training intervention. Trained facility midwives or clinicians review severe maternal complications to identify near misses on a daily basis. They abstract the case information from case notes and enter it onto programmed tablets where it is uploaded. Intention-to-treat analysis will be used, taking the matched design into consideration using paired t test statistics to compare the outcomes between the intervention and comparison districts. We also assess the impact pathway from the effects of the training on the health provider’s skills, care and interventions and health system readiness. Discussion This trial aims to generate evidence on the effect and limitations of this well-designed training package supported by birthing simulations. While the lack of blinding of participants and data collectors provides an inevitable limitation of this trial, the additional evaluation along the pathway of implementation will provide solid evidence on the effects of this HMS BAB training package. Trial registration Pan African Clinical Trials Registry, PACTR201604001582128. Registered on 12 April 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2056-7) contains supplementary material, which is available to authorized users.
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Patel A, Khatib MN, Kurhe K, Bhargava S, Bang A. Impact of neonatal resuscitation trainings on neonatal and perinatal mortality: a systematic review and meta-analysis. BMJ Paediatr Open 2017; 1:e000183. [PMID: 29637172 PMCID: PMC5862177 DOI: 10.1136/bmjpo-2017-000183] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Training of birth attendants in neonatal resuscitation is likely to reduce birth asphyxia and neonatal mortality. We performed a systematic review and meta-analysis to assess the impact of neonatal resuscitation training (NRT) programme in reducing stillbirths, neonatal mortality, and perinatal mortality. METHODS We considered studies where any NRT was provided to healthcare personnel involved in delivery process and handling of newborns. We searched MEDLINE, CENTRAL, ERIC and other electronic databases. We also searched ongoing trials and bibliographies of the retrieved articles, and contacted experts for unpublished work. We undertook screening of studies and assessment of risk of bias in duplicates. We performed review according to Cochrane Handbook. We assessed the quality of evidence using the GRADE approach. RESULTS We included 20 trials with 1 653 805 births in this meta-analysis. The meta-analysis of NRT versus control shows that NRT decreases the risk of all stillbirths by 21% (RR 0.79, 95% CI 0.44 to 1.41), 7-day neonatal mortality by 47% (RR 0.53, 95% CI 0.38 to 0.73), 28-day neonatal mortality by 50% (RR 0.50, 95% CI 0.37 to 0.68) and perinatal mortality by 37% (RR 0.63, 95% CI 0.42 to 0.94). The meta-analysis of pre-NRT versus post-NRT showed that post-NRT decreased the risk of all stillbirths by 12% (RR 0.88, 95% CI 0.83 to 0.94), fresh stillbirths by 26% (RR 0.74, 95% CI 0.61 to 0.90), 1-day neonatal mortality by 42% (RR 0.58, 95% CI 0.42 to 0.82), 7-day neonatal mortality by 18% (RR 0.82, 95% CI 0.73 to 0.93), 28-day neonatal mortality by 14% (RR 0.86, 95% CI 0.65 to 1.13) and perinatal mortality by 18% (RR 0.82, 95% CI 0.74 to 0.91). CONCLUSIONS Findings of this review show that implementation of NRT improves neonatal and perinatal mortality. Further good quality randomised controlled trials addressing the role of NRT for improving neonatal and perinatal outcomes may be warranted. TRIAL REGISTRATION NUMBER PROSPERO 2016:CRD42016043668.
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Affiliation(s)
- Archana Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis; School of Epidemiology and Public Health & Department of Physiology, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Savita Bhargava
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Akash Bang
- Department of Paediatrics, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
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Chaudhury S, Arlington L, Brenan S, Kairuki AK, Meda AR, Isangula KG, Mponzi V, Bishanga D, Thomas E, Msemo G, Azayo M, Molinier A, Nelson BD. Cost analysis of large-scale implementation of the 'Helping Babies Breathe' newborn resuscitation-training program in Tanzania. BMC Health Serv Res 2016; 16:681. [PMID: 27908286 PMCID: PMC5134300 DOI: 10.1186/s12913-016-1924-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 11/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Helping Babies Breathe (HBB) has become the gold standard globally for training birth-attendants in neonatal resuscitation in low-resource settings in efforts to reduce early newborn asphyxia and mortality. The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania. Methods We used activity-based costing to examine budget expense data during the two-month implementation and follow-up of HBB in one of the target regions. Activity-cost centers included administrative, initial training (including resuscitation equipment), and follow-up training expenses. Sensitivity analysis was utilized to project cost scenarios incurred to achieve countrywide expansion of the program across all mainland regions of Tanzania and to model costs of program maintenance over one and five years following initiation. Results Total costs for the Mbeya Region were $202,240, with the highest proportion due to initial training and equipment (45.2%), followed by central program administration (37.2%), and follow-up visits (17.6%). Within Mbeya, 49 training sessions were undertaken, involving the training of 1,341 health providers from 336 health facilities in eight districts. To similarly expand the HBB program across the 25 regions of mainland Tanzania, the total economic cost is projected to be around $4,000,000 (around $600 per facility). Following sensitivity analyses, the estimated total for all Tanzania initial rollout lies between $2,934,793 to $4,309,595. In order to maintain the program nationally under the current model, it is estimated it would cost $2,019,115 for a further one year and $5,640,794 for a further five years of ongoing program support. Conclusion HBB implementation is a relatively low-cost intervention with potential for high impact on perinatal mortality in resource-poor settings. It is shown here that nationwide expansion of this program across the range of health provision levels and regions of Tanzania would be feasible. This study provides policymakers and investors with the relevant cost-estimation for national rollout of this potentially neonatal life-saving intervention.
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Affiliation(s)
- Sumona Chaudhury
- Departments of Epidemiology and Global Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Lauren Arlington
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA
| | - Shelby Brenan
- Departments of Epidemiology and Global Health, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | | | - Amunga Robson Meda
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA
| | - Kahabi G Isangula
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA
| | | | | | | | - Georgina Msemo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Mary Azayo
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Alice Molinier
- Children's Investment Fund Foundation, London, W1S 2FT, UK
| | - Brett D Nelson
- Division of Global Health, MassGeneral Hospital for Children, Boston, MA, 02114, USA.,Departments of Pediatrics and Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 02115, USA
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Bang A, Patel A, Bellad R, Gisore P, Goudar SS, Esamai F, Liechty EA, Meleth S, Goco N, Niermeyer S, Keenan W, Kamath-Rayne BD, Little GA, Clarke SB, Flanagan VA, Bucher S, Jain M, Mujawar N, Jain V, Rukunga J, Mahantshetti N, Dhaded S, Bhandankar M, McClure EM, Carlo WA, Wright LL, Hibberd PL. Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time? BMC Pregnancy Childbirth 2016; 16:364. [PMID: 27875999 PMCID: PMC5120476 DOI: 10.1186/s12884-016-1141-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The first minutes after birth are critical to reducing neonatal mortality. Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation program for low resource settings. We studied the impact of initial HBB training followed by refresher training on the knowledge and skills of the birth attendants in facilities. METHODS We conducted HBB trainings in 71 facilities in the NICHD Global Network research sites (Nagpur and Belgaum, India and Eldoret, Kenya), with a 6:1 ratio of facility trainees to Master Trainers (MT). Because of staff turnover, some birth attendants (BA) were trained as they joined the delivery room staff, after the initial training was completed (catch-up initial training). We compared pass rates for skills and knowledge pre- and post- initial HBB training and following refresher training among active BAs. An Objective Structured Clinical Examination (OSCE) B tested resuscitation skill retention by comparing post-initial training performance with pre-refresher training performance. We identified factors associated with loss of skills in pre-refresher training performance using multivariable logistic regression analysis. Daily bag and mask ventilation practice, equipment checks and supportive supervision were stressed as part of training. RESULTS One hundred five MT (1.6 MT per facility) conducted initial and refresher HBB trainings for 835 BAs; 76% had no prior resuscitation training. Initial training improved knowledge and skills: the pass percentage for knowledge tests improved from 74 to 99% (p < 0.001). Only 5% could ventilate a newborn mannequin correctly before initial training but 97% passed the post-initial ventilation training test (p < 0.0001) and 99% passed the OSCE B resuscitation evaluation. During pre-refresher training evaluation, a mean of 6.7 (SD 2.49) months after the initial training, 99% passed the knowledge test, but the successful completion rate fell to 81% for the OSCE B resuscitation skills test. Characteristics associated with deterioration of resuscitation skills were BAs from tertiary care facilities, no prior resuscitation training, and the timing of training (initial vs. catch-up training). CONCLUSIONS HBB training significantly improved neonatal resuscitation knowledge and skills. However, skills declined more than knowledge over time. Ongoing skills practice and monitoring, more frequent retesting, and refresher trainings are needed to maintain neonatal resuscitation skills. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01681017 ; 04 September 2012, retrospectively registered.
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Affiliation(s)
- Akash Bang
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | | | - Roopa Bellad
- KLE University's JN Medical College, Belgaum, India
| | - Peter Gisore
- Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | | | - Fabian Esamai
- Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | | | | | | | | | | | | | | | | | | | - Sherri Bucher
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Manish Jain
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, India
| | | | - Vinita Jain
- Daga Memorial Government Women's Hospital, Nagpur, India
| | - Janet Rukunga
- Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | | | | | | | | | | | - Linda L Wright
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD, USA. .,George Washington University, 5800 Nicholson Lane, #1206, Rockville, MD, 20852, USA.
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Kassick ME, Chinbuah MA, Serpa M, Mazia G, Tang AM, Sagoe-Moses I, Taylor M, Dwomo-Fokuo A, Salifu N, Arhinful DK, Engmann C, Burke TF, Cofie P, Nelson BD. Evaluating a novel neonatal-care assessment tool among trained delivery attendants in a resource-limited setting. Int J Gynaecol Obstet 2016; 135:285-289. [PMID: 27599603 DOI: 10.1016/j.ijgo.2016.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/28/2016] [Accepted: 08/10/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To validate a novel objective structured clinical examination (OSCE) tool for assessing neonatal care skills among delivery attendants trained as part of the Essential Care for Every Baby (ECEB) program and to assess ECEB training effectiveness. METHODS Between August 1 and September 30, 2015, a cross-sectional study enrolled ECEB-trained healthcare providers who attended deliveries from the Brong Ahafo and Eastern regions of Ghana. Participants completed a previously developed 21-item OSCE tool that assessed neonatal-care competency. Participant performance was scored independently by regional trainers and national master trainers. The inter-rater scoring reliability was assessed using the Cohen kappa coefficient and performance was compared across participant characteristics. RESULTS The study enrolled 57 trained delivery attendants from 12 district hospitals. Inter-rater agreement was perfect (kappa 1.00) or almost perfect (kappa 0.81-0.99) for nine OSCE items, substantial (kappa 0.61-0.80) or moderate (kappa 0.41-0.60) for 11 items, and fair (kappa 0.21-0.40) for one item. Differences in OSCE-item performance were recorded based on participants' regions, facility type, age, and education level (P<0.05). CONCLUSIONS In a resource-limited setting, the OSCE tool demonstrated substantial reliability and ECEB-trained healthcare practitioners exhibited satisfactory performance. The OSCE tool could be useful in similar settings and could have potential for up-scaled use in assessing neonatal-management skills.
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Affiliation(s)
- Megan E Kassick
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Alice M Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | | | | | | | | | | | - Cyril Engmann
- PATH, Accra, Ghana; Division of Neonatal Perinatal Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Thomas F Burke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Brett D Nelson
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Bellad RM, Bang A, Carlo WA, McClure EM, Meleth S, Goco N, Goudar SS, Derman RJ, Hibberd PL, Patel A, Esamai F, Bucher S, Gisore P, Wright LL. A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: does Helping Babies Breathe training save lives? BMC Pregnancy Childbirth 2016; 16:222. [PMID: 27527831 PMCID: PMC5477802 DOI: 10.1186/s12884-016-0997-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 07/29/2016] [Indexed: 12/05/2022] Open
Abstract
Background Whether facility-based implementation of Helping Babies Breathe (HBB) reduces neonatal mortality at a population level in low and middle income countries (LMIC) has not been studied. Therefore, we evaluated HBB implementation in this context where our study team has ongoing prospective outcome data on all pregnancies regardless of place of delivery. Methods We compared outcomes of birth cohorts in three sites in India and Kenya pre-post implementation of a facility-based intervention, using a prospective, population-based registry in 52 geographic clusters. Our hypothesis was that HBB implementation would result in a 20 % decrease in the perinatal mortality rate (PMR) among births ≥1500 g. Results We enrolled 70,704 births during two 12-month study periods. Births within each site did not differ pre-post intervention, except for an increased proportion of <2500 g newborns and deliveries by caesarean section in the post period. There were no significant differences in PMR among all registry births; however, a post-hoc analysis stratified by birthweight documented improvement in <2500 g mortality in Belgaum in both registry and in HBB-trained facility births. No improvement in <2500 g mortality measures was noted in Nagpur or Kenya and there was no improvement in normal birth weight survival. Conclusions Rapid scale up of HBB training of facility birth attendants in three diverse sites in India and Kenya was not associated with consistent improvements in mortality among all neonates ≥1500 g; however, differential improvements in <2500 g survival in Belgaum suggest the need for careful implementation of HBB training with attention to the target population, data collection, and ongoing quality monitoring activities. Trial registration The study was registered at ClinicalTrials.gov: NCT01681017.
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Affiliation(s)
- Roopa M Bellad
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Akash Bang
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
| | | | | | | | | | | | - Richard J Derman
- Department of Obstetrics and Gynecology, Christiana Care Health Services, Newark, DE, USA
| | | | - Archana Patel
- Lata Medical Research Foundation, Nagpur, India.,Indira Gandhi Government Medical College, Nagpur, India
| | - Fabian Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Sherri Bucher
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Peter Gisore
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Linda L Wright
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA. .,, 5800 Nicholson Lane, #1206, Rockville, MD, 20852, USA.
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Bucher S, Konana O, Liechty E, Garces A, Gisore P, Marete I, Tenge C, Shipala E, Wright L, Esamai F. Self-reported practices among traditional birth attendants surveyed in western Kenya: a descriptive study. BMC Pregnancy Childbirth 2016; 16:219. [PMID: 27514379 PMCID: PMC4981994 DOI: 10.1186/s12884-016-1007-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 08/04/2016] [Indexed: 11/21/2022] Open
Abstract
Background The high rate of home deliveries conducted by unskilled birth attendants in resource-limited settings is an important global health issue because it is believed to be a significant contributing factor to maternal and newborn mortality. Given the large number of deliveries that are managed by unskilled or traditional birth attendants outside of health facilities, and the fact that there is on-going discussion regarding the role of traditional birth attendants in the maternal newborn health (MNH) service continuum, we sought to ascertain the practices of traditional birth attendants in our catchment area. The findings of this descriptive study might help inform conversations regarding the roles that traditional birth attendants can play in maternal-newborn health care. Methods A structured questionnaire was used in a survey that included one hundred unskilled birth attendants in western Kenya. Descriptive statistics were employed. Results Inappropriate or outdated practices were reported in relation to some obstetric complications and newborn care. Encouraging results were reported with regard to positive relationships that traditional birth attendants have with their local health facilities. Furthermore, high rates of referral to health facilities was reported for many common obstetric emergencies and similar rates for reporting of pregnancy outcomes to village elders and chiefs. Conclusions Potentially harmful or outdated practices with regard to maternal and newborn care among traditional birth attendants in western Kenya were revealed by this study. There were high rates of traditional birth attendant referrals of pregnant mothers with obstetric complications to health facilities. Policy makers may consider re-educating and re-defining the roles and responsibilities of traditional birth attendants in maternal and neonatal health care based on the findings of this survey. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1007-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sherri Bucher
- Department of Pediatrics, Section of Neonatal-Perinatal Medicine, Indiana University School of Medicine, 699 Riley Hospital Drive, RR208, Indianapolis, IN, 46202-5119, USA.
| | - Olive Konana
- Department of Pediatrics, Section of Neonatal-Perinatal Medicine, Indiana University School of Medicine, 699 Riley Hospital Drive, RR208, Indianapolis, IN, 46202-5119, USA
| | - Edward Liechty
- Department of Pediatrics, Section of Neonatal-Perinatal Medicine, Indiana University School of Medicine, 699 Riley Hospital Drive, RR208, Indianapolis, IN, 46202-5119, USA
| | | | - Peter Gisore
- Department Child Health and Paediatrics, Moi University School of Medicine, Moi University, Eldoret, Kenya
| | - Irene Marete
- Department Child Health and Paediatrics, Moi University School of Medicine, Moi University, Eldoret, Kenya
| | - Constance Tenge
- Department Child Health and Paediatrics, Moi University School of Medicine, Moi University, Eldoret, Kenya
| | | | - Linda Wright
- Center for Research for Mothers and Children, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Fabian Esamai
- Department Child Health and Paediatrics, Moi University School of Medicine, Moi University, Eldoret, Kenya
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Moores A, Puawe P, Buasi N, West F, Samor MK, Joseph N, Rumsey M, Dawson A, Homer CSE. Education, employment and practice: Midwifery graduates in Papua New Guinea. Midwifery 2016; 41:22-29. [PMID: 27498185 DOI: 10.1016/j.midw.2016.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/20/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Papua New Guinea has a very high maternal mortality rate (773/100,000), low rates of supervised births and a critical shortage of skilled midwives. A midwifery education initiative commenced in 2012, funded by the Australian Government and led by the National Department of Health. One specific objective of the initiative was to improve the standard of clinical teaching and practice in four schools of midwifery. There were 394 midwives educated over the 4 year period (2012-2015) representing half of all midwives in Papua New Guinea. A study was undertaken to describe the educational programme, employment, practices and experiences of graduates who studied midwifery in 2012 and 2013 as part of the initiative. OBJECTIVE the aim of this paper is to explore the education, employment and practice of newly graduated midwives in Papua New Guinea. DESIGN a mixed methods descriptive study design was used. Surveys and focus groups were used to gather data. Ethical approval was granted by the relevant Human Research Ethics Committees. SETTING AND PARTICIPANTS all midwifery graduates in 2012 and 2013 from the four midwifery schools in Papua New Guinea were included in the study and almost 80% were contacted. FINDINGS nearly 90% of graduates were working as midwives, with an additional 3% working as midwifery or nursing educators. This study discovered that graduates exhibited increased skills acquisition and confidence, leadership in maternal and newborn care services and a marked improvement in the provision of respectful care to women. The graduates faced challenges to implement evidence based care with barriers including the lack of appropriate resources and differences of opinion with senior staff. CONCLUSIONS factors affecting the quality of midwifery education will need to be addressed if Papua New Guinea is to continue to improve the status of maternal and newborn health. Specifically, the length of the midwifery education, the quality of clinical practice and the exposure to rural and remote area practice need addressing in many contexts like Papua New Guinea.
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Affiliation(s)
- Alison Moores
- WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia.
| | - Paula Puawe
- Faculty of Health and Behavioural Sciences, University of Goroka, Goroka, EHP, Papua New Guinea
| | - Nancy Buasi
- Division of Nursing, School of Medical and Health Sciences, University of Papua New Guinea, NCD, Papua New Guinea
| | - Florence West
- WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia
| | - Mary K Samor
- National Department of Health, Port Moresby, NCD, Papua New Guinea
| | - Nina Joseph
- Papua New Guinea Nursing Council, Port Moresby, NCD, Papua New Guinea
| | - Michele Rumsey
- WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia
| | - Angela Dawson
- WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia
| | - Caroline S E Homer
- WHO Collaborating Centre, University of Technology Sydney, UTS Building 10, P.O. Box 123, Broadway, Sydney, 2007 NSW, Australia
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Frøen JF, Myhre SL, Frost MJ, Chou D, Mehl G, Say L, Cheng S, Fjeldheim I, Friberg IK, French S, Jani JV, Kaye J, Lewis J, Lunde A, Mørkrid K, Nankabirwa V, Nyanchoka L, Stone H, Venkateswaran M, Wojcieszek AM, Temmerman M, Flenady VJ. eRegistries: Electronic registries for maternal and child health. BMC Pregnancy Childbirth 2016; 16:11. [PMID: 26791790 PMCID: PMC4721069 DOI: 10.1186/s12884-016-0801-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/07/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women's, Children's and Adolescent's Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to seamlessly follow individuals along the continuum of care and across disconnected cadres of care providers. Second, real-time public health surveillance and monitoring of intervention coverage, and third, feedback of information to individuals, care providers and the public for transparent accountability. This series on eRegistries presents frameworks and tools to facilitate the development and secure operation of eRegistries for maternal and child health. METHODS In this first paper of the eRegistries Series we have used WHO frameworks and taxonomy to map how eRegistries can support commonly used electronic and mobile applications to alleviate health systems constraints in maternal and child health. A web-based survey of public health officials in 64 low- and middle-income countries, and a systematic search of literature from 2005-2015, aimed to assess country capacities by the current status, quality and use of data in reproductive health registries. RESULTS eRegistries can offer support for the 12 most commonly used electronic and mobile applications for health. Countries are implementing health registries in various forms, the majority in transition from paper-based data collection to electronic systems, but very few have eRegistries that can act as an integrating backbone for health information. More mature country capacity reflected by published health registry based research is emerging in settings reaching regional or national scale, increasingly with electronic solutions. 66 scientific publications were identified based on 32 registry systems in 23 countries over a period of 10 years; this reflects a challenging experience and capacity gap for delivering sustainable high quality registries. CONCLUSIONS Registries are being developed and used in many high burden countries, but their potential benefits are far from realized as few countries have fully transitioned from paper-based health information to integrated electronic backbone systems. Free tools and frameworks exist to facilitate progress in health information for women and children.
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Affiliation(s)
- J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Sonja L Myhre
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Michael J Frost
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- John Snow, Inc., Boston, MA, USA.
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Garrett Mehl
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Socheat Cheng
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ingvild Fjeldheim
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Ingrid K Friberg
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Steve French
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Jagrati V Jani
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Jane Kaye
- HeLEX - Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - John Lewis
- Health Information System Programme (HISP) Vietnam, Ho Chí Minh, Vietnam.
- Department of Informatics, University of Oslo, Oslo, Norway.
| | - Ane Lunde
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Kjersti Mørkrid
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Victoria Nankabirwa
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Department of Epidemiology and Biostatics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Linda Nyanchoka
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Hollie Stone
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
| | - Mahima Venkateswaran
- Department of International Public Health, Norwegian Institute of Public Health, Pb 4404 Nydalen, N-0403, Oslo, Norway.
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland, Brisbane, Australia.
- International Stillbirth Alliance, Millburn, NJ, USA.
| | | | - Vicki J Flenady
- Mater Research Institute, The University of Queensland, Brisbane, Australia.
- International Stillbirth Alliance, Millburn, NJ, USA.
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Pammi M, Dempsey EM, Ryan CA, Barrington KJ. Newborn Resuscitation Training Programmes Reduce Early Neonatal Mortality. Neonatology 2016; 110:210-24. [PMID: 27222260 DOI: 10.1159/000443875] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/08/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Substantial health care resources are expended on standardised formal neonatal resuscitation training (SFNRT) programmes, but their effectiveness has not been proven. OBJECTIVES To determine whether SFNRT programmes reduce neonatal mortality and morbidity, improve acquisition and retention of knowledge and skills, or change teamwork and resuscitation behaviour. METHODS We searched CENTRAL, MEDLINE, PREMEDLINE, EMBASE, CINAHL, Web of Science and the Oxford Database of Perinatal Trials, ongoing trials and conference proceedings in April 2015, and included randomised or quasi-randomised trials that reported at least one of our specified outcomes. RESULTS SFNRT in low- and middle-income countries decreased early neonatal mortality [risk ratio (RR) 0.85 (95% CI 0.75-0.96)]; the number needed to treat for benefit [227 (95% CI 122-1,667; 3 studies, 66,162 participants, moderate-quality evidence)], and 28-day mortality [RR 0.55 (95% CI 0.33-0.91); 1 study, 3,355 participants, low-quality evidence]. Decreasing trends were noted for late neonatal mortality [RR 0.47 (95% CI 0.20-1.11)] and perinatal mortality [RR 0.94 (95% CI 0.87-1.00)], but there were no differences in fresh stillbirths [RR 1.05 (95% CI 0.93-1.20)]. Teamwork training with simulation increased the frequency of teamwork behaviour [mean difference (MD) 2.41 (95% CI 1.72-3.11)] and decreased resuscitation duration [MD -149.54 (95% CI -214.73 to -84.34); low-quality evidence, 2 studies, 130 participants]. CONCLUSIONS SFNRT in low- and middle-income countries reduces early neonatal mortality, but its effects on birth asphyxia and neurodevelopmental outcomes remain uncertain. Follow-up studies suggest normal neurodevelopment in resuscitation survivors.
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Affiliation(s)
- Mohan Pammi
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex., USA
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Koso-Thomas M, McClure EM. The Global Network for Women's and Children's Health Research: A model of capacity-building research. Semin Fetal Neonatal Med 2015; 20:293-9. [PMID: 26043962 PMCID: PMC4780224 DOI: 10.1016/j.siny.2015.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In response to the global effort to accelerate progress towards the Millennium Development Goals 4 and 5, a partnership was created between the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Bill and Melinda Gates Foundation to establish the Global Network for Women's and Children's Health Research (Global Network) in 2000. The Global Network was developed with a goal of building local maternal and child health research capacity in resource-poor settings. The objective of the network was to conduct research focused on several high-need areas, such as preventing life-threatening obstetric complications, improving birth weight and infant growth, and improving childbirth practices in order to reduce mortality. Scientists from developing countries, together with peers in the USA, lead research teams that identify and address population needs through randomized clinical trials and other research studies. Global Network projects develop and test cost-effective, sustainable interventions for pregnant women and newborns and provide guidance for national policy and for the practice of evidence-based medicine. This article reviews the results of the Global Network's research, the impact on policy and practice, and highlights the capacity-building efforts and collaborations developed since its inception.
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Affiliation(s)
- Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA.
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Niermeyer S. From the Neonatal Resuscitation Program to Helping Babies Breathe: Global impact of educational programs in neonatal resuscitation. Semin Fetal Neonatal Med 2015; 20:300-8. [PMID: 26265602 DOI: 10.1016/j.siny.2015.06.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Two educational programs in neonatal resuscitation, the Neonatal Resuscitation Program (NRP) and Helping Babies Breathe (HBB) have found widespread acceptance globally as practical tools to improve newborn survival and reduce death from perinatal asphyxia. The programs share a common scientific evidence base and both employ adult education principles with an emphasis on building skills. However, they differ in their target audience and context, their core content, and the methods used for knowledge translation. This review describes how the design of NRP transported it outside the USA to countries around the globe and how the program has contributed to improvements in care at multiple levels from the bedside to guidelines and research. It examines the gaps in the reach of NRP that stimulated the development of HBB and helped shape a different approach to education of health care providers in resource-limited settings. Implementation of HBB is summarized to date, and evidence provided of its effectiveness in reducing neonatal death and stillbirth. Finally, consideration of how the programs function together suggests their future potential to strengthen health systems and maximize the impact on the health of newborns.
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Affiliation(s)
- Susan Niermeyer
- University of Colorado School of Medicine, Section of Neonatology, Aurora, CO, USA.
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Dempsey E, Pammi M, Ryan AC, Barrington KJ. Standardised formal resuscitation training programmes for reducing mortality and morbidity in newborn infants. Cochrane Database Syst Rev 2015; 2015:CD009106. [PMID: 26337958 PMCID: PMC9219024 DOI: 10.1002/14651858.cd009106.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Approximately 10% of all newborns require resuscitation at birth. Training healthcare providers in standardised formal neonatal resuscitation training (SFNRT) programmes may improve neonatal outcomes. Substantial healthcare resources are expended on SFNRT. OBJECTIVES To determine whether SFNRT programmes reduce neonatal mortality and morbidity, improve acquisition and retention of knowledge and skills, or change teamwork and resuscitation behaviour. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PREMEDLINE, EMBASE, CINAHL, Web of Science and the Oxford Database of Perinatal Trials, ongoing trials and conference proceedings in April 2014 and updated in March 2015. SELECTION CRITERIA Randomised or quasi-randomised trials including cluster-randomised trials, comparing a SFNRT with no SFNRT, additions to SFNRT or types of SFNRT, and reporting at least one of our specified outcomes. DATA COLLECTION AND ANALYSIS Two authors extracted data independently and performed statistical analyses including typical risk ratio (RR), risk difference (RD), mean difference (MD), and number needed to treat for an additional beneficial outcome (NNTB) or an additional harmful outcome (NNTH) (all with 95% confidence intervals (CI)). We analysed cluster-randomised trials using the generic inverse variance and the approximate analysis methods. MAIN RESULTS We identified two community-based and three manikin-based trials that assessed the effect of SFNRT compared with no SFNRT. Very low quality evidence from one study suggested improvement in acquisition of knowledge (RR 5.96, 95% CI 3.60 to 9.87) and skills (RR 170, 95% CI 10.8 to 2711) and retention of knowledge (RR 3.60, 95% CI 2.43 to 5.35) and the other study suggested improvement in resuscitation and behavioural scores.We identified three community-based cluster-randomised trials in developing countries comparing SFNRT with basic resuscitation training (Early Newborn Care). In this setting, there was moderate quality evidence that SFNRT decreased early neonatal mortality (typical RR 0.88, 95% CI 0.78 to 1.00; 3 studies, 66,162 neonates) and when analysed by the approximate analysis method (typical RR 0.85, 95% CI 0.75 to 0.96; RD -0.0044, 95% CI -0.0082 to -0.0006; NNTB 227, 95% CI 122 to 1667). Low quality evidence from one trial showed that SFNRT may decrease 28-day mortality (typical RR 0.55, 95% CI 0.33 to 0.91) but the effect on late neonatal mortality was more uncertain (typical RR 0.47, 95% CI 0.20 to 1.11). None of our a priori defined neonatal morbidities were reported. We did not identify any randomised studies in the developed world.We identified two trials that compared SFNRT with team training to SFNRT. Teamwork training of physician trainees with simulation may increase any teamwork behaviour (assessed by frequency) (MD 2.41, 95% CI 1.72 to 3.11) and decrease resuscitation duration (MD -149.54, 95% CI -214.73 to -84.34) but may lead to little or no difference in Neonatal Resuscitation Program (NRP) scores (MD 1.40, 95% CI -2.02 to 4.82; 98 participants, low quality evidence).We identified two trials that compared SFNRT with booster courses to SFNRT. It is uncertain whether booster courses improve retention of resuscitation knowledge (84 participants, very low quality evidence) but may improve procedural and behavioural skills (40 participants, very low quality evidence).We identified two trials on decision support tools, one on a cognitive aid that did not change resuscitation scores and the other on an electronic decision support tool that improved the frequency of correct decision making on positive pressure ventilation, cardiac compressions and frequency of fraction of inspired oxygen (FiO2) adjustments (97 participants, very low quality evidence). AUTHORS' CONCLUSIONS SFNRT compared to basic newborn care or basic newborn resuscitation, in developing countries, results in a reduction of early neonatal and 28-day mortality. Randomised trials of SFNRT should report on neonatal morbidity including hypoxic ischaemic encephalopathy and neurodevelopmental outcomes. Innovative educational methods that enhance knowledge and skills and teamwork behaviour should be evaluated.
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Affiliation(s)
- Eugene Dempsey
- Cork University Maternity HospitalNeonatologyWiltonIreland
- University College CorkDepartment of Paediatrics and Child HealthCorkIreland
| | - Mohan Pammi
- Baylor College of MedicineSection of Neonatology, Department of Pediatrics6621, Fannin, MC.WT 6‐104HoustonTXUSA77030
| | - Anthony C Ryan
- Cork University Maternity HospitalNeonatologyWiltonIreland
- University College CorkDepartment of Paediatrics and Child HealthCorkIreland
| | - Keith J Barrington
- CHU Ste‐JustineDepartment of Pediatrics3175 Cote Ste CatherineMontrealQCCanadaH3T 1C5
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Somannavar MS, Goudar SS, Revankar AP, Moore JL, McClure EM, Destefanis P, DeCain M, Goco N, Wright LL. Evaluating time between birth to cry or bag and mask ventilation using mobile delivery room timers in India: the NICHD Global Network's Helping Babies Breathe Trial. BMC Pediatr 2015; 15:93. [PMID: 26245688 PMCID: PMC4527321 DOI: 10.1186/s12887-015-0408-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 07/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Golden Minute®, the first minute following birth of a newborn, is a critical period for establishing ventilation after delivery, as emphasized in the Helping Babies Breathe® and other resuscitation training programs. Previous studies have reinforced training through observers' evaluation of this time period; although observation is useful for research, it may not be a sustainable method to support resuscitation practice in low-resource settings where few birth attendants are available. In order to reinforce resuscitation within The Golden Minute®, we sought to develop a simple mobile delivery-room timer on an Android cell phone platform for birth attendants to use at the time of delivery. METHODS We developed and evaluated a mobile delivery room timer to document the time interval from birth to the initiation of newborn crying/spontaneous respiration or bag and mask ventilation in a convenience sample of women who delivered in five hospitals in Karnataka, India. The mobile delivery room timer is an Android cell phone-based application that recorded key events including crowning, delivery, and crying/spontaneous respiration or bag and mask ventilation. The mobile delivery room timer recorded the birth attendant verbally indicating the time of crowning, birth-(defined as when the entire baby was delivered), crying/spontaneous respiration or bag and mask ventilation. The mobile delivery room timer results were validated in a subsample by a trained observer (nurse) who independently recorded the time between delivery and initiation of crying/spontaneous respiration or bag and mask ventilation. RESULTS Of the total 4,597 deliveries, 2,107 (46%) were timed; a sample (n = 438) of these deliveries was also observed by a trained nurse. There was high concordance between the mobile delivery room timer and observed time elapsed between birth and crying/spontaneous respiration or ventilation (correlation =0.94, p < 0.0001). The majority of neonates in both groups cried/breathed spontaneously or received bag and mask ventilation by 1 min (430/438 by the timer vs. 433/438 for observer). CONCLUSIONS We demonstrated that a simple mobile delivery room timer application was feasible to use during delivery and provided valid observations of the time to crying/spontaneous respiration or bag and mask ventilation. This type of tool may be useful in reinforcing neonatal resuscitation training and the need to ensure spontaneous or assisted ventilation by The Golden Minute®.
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Affiliation(s)
| | | | - Amit P Revankar
- KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
| | | | | | | | | | | | - Linda L Wright
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
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Patel AB, Meleth S, Pasha O, Goudar SS, Esamai F, Garces AL, Chomba E, McClure EM, Wright LL, Koso-Thomas M, Moore JL, Saleem S, Liechty EA, Goldenberg RL, Derman RJ, Hambidge KM, Carlo WA, Hibberd PL. Impact of exposure to cooking fuels on stillbirths, perinatal, very early and late neonatal mortality - a multicenter prospective cohort study in rural communities in India, Pakistan, Kenya, Zambia and Guatemala. Matern Health Neonatol Perinatol 2015; 1:18. [PMID: 27057335 PMCID: PMC4823690 DOI: 10.1186/s40748-015-0019-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/25/2015] [Indexed: 01/03/2023] Open
Abstract
Background Consequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on neonatal deaths and stillbirths is poorly understood. In a large multi-country observational study, we examined whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20 and deaths through day 7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal mortality (day 0–2) and later neonatal mortality (day 3–28). Questions addressing household fuel use were asked at pregnancy, delivery, and neonatal follow-up visits in a prospective cohort study of pregnant women in rural communities in five low and lower middle income countries participating in the Global Network for Women and Children’s Health’s Maternal and Newborn Health Registry. The study was conducted between May 2011 and October 2012. Polluting fuels included kerosene, charcoal, coal, wood, straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG), natural gas and biogas. Results We studied the outcomes of 65,912 singleton pregnancies, 18 % from households using clean fuels (59 % LPG) and 82 % from households using polluting fuels (86 % wood). Compared to households cooking with clean fuels, there was an increased risk of perinatal mortality among households using polluting fuels (adjusted relative risk (aRR) 1.44, 95 % confidence interval (CI) 1.30-1.61). Exposure to HAP increased the risk of having a macerated stillbirth (adjusted odds ratio (aOR) 1.66, 95%CI 1.23-2.25), non-macerated stillbirth (aOR 1.43, 95 % CI 1.15-1.85) and very early neonatal mortality (aOR 1.82, 95 % CI 1.47-2.22). Conclusions Perinatal mortality was associated with exposure to HAP from week 20 of pregnancy through at least day 2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels on global perinatal mortality may have previously been underestimated. Trial registration ClinicalTrials.gov NCT01073475
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Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra 440022 India
| | - Sreelatha Meleth
- RTI International, Research Triangle Park, North Carolina, 27709 USA
| | - Omrana Pasha
- Department of Community Health Sciences & Family Medicine, Aga Khan University, Karachi, Pakistan
| | | | | | - Ana L Garces
- IMSALUD, San Carlos University, Guatemala City, Guatemala
| | | | | | - Linda L Wright
- Center for Research of Mothers and Children, NIH, Rockville, MD 20852 USA
| | - Marion Koso-Thomas
- Center for Research of Mothers and Children, NIH, Rockville, MD 20852 USA
| | - Janet L Moore
- RTI International, Research Triangle Park, North Carolina, 27709 USA
| | - Sarah Saleem
- Department of Community Health Sciences & Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Edward A Liechty
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Robert L Goldenberg
- Department of Obstetrics/Gynecology, Columbia University, New York, NY 10032 USA
| | | | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Patricia L Hibberd
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114 USA
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Patel A, Bucher S, Pusdekar Y, Esamai F, Krebs NF, Goudar SS, Chomba E, Garces A, Pasha O, Saleem S, Kodkany BS, Liechty EA, Kodkany B, Derman RJ, Carlo WA, Hambidge K, Goldenberg RL, Althabe F, Berrueta M, Moore JL, McClure EM, Koso-Thomas M, Hibberd PL. Rates and determinants of early initiation of breastfeeding and exclusive breast feeding at 42 days postnatal in six low and middle-income countries: A prospective cohort study. Reprod Health 2015; 12 Suppl 2:S10. [PMID: 26063291 PMCID: PMC4464210 DOI: 10.1186/1742-4755-12-s2-s10] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Early initiation of breastfeeding after birth and exclusive breastfeeding through six months of age confers many health benefits for infants; both are crucial high impact, low-cost interventions. However, determining accurate global rates of these crucial activities has been challenging. We use population-based data to describe: (1) rates of early initiation of breastfeeding (defined as within 1 hour of birth) and of exclusive breastfeeding at 42 days post-partum; and (2) factors associated with failure to initiate early breastfeeding and exclusive breastfeeding at 42 days post-partum. Methods Prospectively collected data from women and their live-born infants enrolled in the Global Network’s Maternal and Newborn Health Registry between January 1, 2010-December 31, 2013 included women-infant dyads in 106 geographic areas (clusters) at 7 research sites in 6 countries (Kenya, Zambia, India [2 sites], Pakistan, Argentina and Guatemala). Rates and risk factors for failure to initiate early breastfeeding were investigated for the entire cohort and rates and risk factors for failure to maintain exclusive breastfeeding was assessed in a sub-sample studied at 42 days post-partum. Result A total of 255,495 live-born women-infant dyads were included in the study. Rates and determinants for the exclusive breastfeeding sub-study at 42 days post-partum were assessed from among a sub-sample of 105,563 subjects. Although there was heterogeneity by site, and early initiation of breastfeeding after delivery was high, the Pakistan site had the lowest rates of early initiation of breastfeeding. The Pakistan site also had the highest rate of lack of exclusive breastfeeding at 42 days post-partum. Across all regions, factors associated with failure to initiate early breastfeeding included nulliparity, caesarean section, low birth weight, resuscitation with bag and mask, and failure to place baby on the mother’s chest after delivery. Factors associated with failure to achieve exclusive breastfeeding at 42 days varied across the sites. The only factor significant in all sites was multiple gestation. Conclusions In this large, prospective, population-based, observational study, rates of both early initiation of breastfeeding and exclusive breastfeeding at 42 days post-partum were high, except in Pakistan. Factors associated with these key breastfeeding indicators should assist with more effective strategies to scale-up these crucial public health interventions. Trial registration Registration at the Clinicaltrials.gov website (ID# NCT01073475).
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McClure EM, Saleem S, Goudar SS, Moore JL, Garces A, Esamai F, Patel A, Chomba E, Althabe F, Pasha O, Kodkany BS, Bose CL, Berreuta M, Liechty EA, Hambidge K, Krebs NF, Derman RJ, Hibberd PL, Buekens P, Manasyan A, Carlo WA, Wallace DD, Koso-Thomas M, Goldenberg RL. Stillbirth rates in low-middle income countries 2010 - 2013: a population-based, multi-country study from the Global Network. Reprod Health 2015; 12 Suppl 2:S7. [PMID: 26063292 PMCID: PMC4464024 DOI: 10.1186/1742-4755-12-s2-s7] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stillbirth rates remain nearly ten times higher in low-middle income countries (LMIC) than high income countries. In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented characteristics or care for mothers with stillbirths. Non-macerated stillbirths, those occurring around delivery, are generally considered preventable with appropriate obstetric care. METHODS We undertook a prospective, population-based observational study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). Staff collected demographic and health care characteristics with outcomes obtained at delivery. RESULTS From 2010 through 2013, 269,614 enrolled women had 272,089 births, including 7,865 stillbirths. The overall stillbirth rate was 28.9/1000 births, ranging from 13.6/1000 births in Argentina to 56.5/1000 births in Pakistan. Stillbirth rates were stable or declined in 6 of the 7 sites from 2010-2013, only increasing in Pakistan. Less educated, older and women with less access to antenatal care were at increased risk of stillbirth. Furthermore, women not delivered by a skilled attendant were more likely to have a stillbirth (RR 2.8, 95% CI 2.2, 3.5). Compared to live births, stillbirths were more likely to be preterm (RR 12.4, 95% CI 11.2, 13.6). Infants with major congenital anomalies were at increased risk of stillbirth (RR 9.1, 95% CI 7.3, 11.4), as were multiple gestations (RR 2.8, 95% CI 2.4, 3.2) and breech (RR 3.0, 95% CI 2.6, 3.5). Altogether, 67.4% of the stillbirths were non-macerated. 7.6% of women with stillbirths had cesarean sections, with obstructed labor the primary indication (36.9%). CONCLUSIONS Stillbirth rates were high, but with reductions in most sites during the study period. Disadvantaged women, those with less antenatal care and those delivered without a skilled birth attendant were at increased risk of delivering a stillbirth. More than two-thirds of all stillbirths were non-macerated, suggesting potentially preventable stillbirth. Additionally, 8% of women with stillbirths were delivered by cesarean section. The relatively high rate of cesarean section among those with stillbirths suggested that this care was too late or not of quality to prevent the stillbirth; however, further research is needed to evaluate the quality of obstetric care, including cesarean section, on stillbirth in these low resource settings. STUDY REGISTRATION Clinicaltrials.gov (ID# NCT01073475).
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Goudar SS, Stolka KB, Koso-Thomas M, Honnungar NV, Mastiholi SC, Ramadurg UY, Dhaded SM, Pasha O, Patel A, Esamai F, Chomba E, Garces A, Althabe F, Carlo WA, Goldenberg RL, Hibberd PL, Liechty EA, Krebs NF, Hambidge MK, Moore JL, Wallace DD, Derman RJ, Bhalachandra KS, Bose CL. Data quality monitoring and performance metrics of a prospective, population-based observational study of maternal and newborn health in low resource settings. Reprod Health 2015; 12 Suppl 2:S2. [PMID: 26062714 PMCID: PMC4464020 DOI: 10.1186/1742-4755-12-s2-s2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background To describe quantitative data quality monitoring and performance metrics adopted by the Global Network’s (GN) Maternal Newborn Health Registry (MNHR), a maternal and perinatal population-based registry (MPPBR) based in low and middle income countries (LMICs). Methods Ongoing prospective, population-based data on all pregnancy outcomes within defined geographical locations participating in the GN have been collected since 2008. Data quality metrics were defined and are implemented at the cluster, site and the central level to ensure data quality. Quantitative performance metrics are described for data collected between 2010 and 2013. Results Delivery outcome rates over 95% illustrate that all sites are successful in following patients from pregnancy through delivery. Examples of specific performance metric reports illustrate how both the metrics and reporting process are used to identify cluster-level and site-level quality issues and illustrate how those metrics track over time. Other summary reports (e.g. the increasing proportion of measured birth weight compared to estimated and missing birth weight) illustrate how a site has improved quality over time. Conclusion High quality MPPBRs such as the MNHR provide key information on pregnancy outcomes to local and international health officials where civil registration systems are lacking. The MNHR has measures in place to monitor data collection procedures and improve the quality of data collected. Sites have increasingly achieved acceptable values of performance metrics over time, indicating improvements in data quality, but the quality control program must continue to evolve to optimize the use of the MNHR to assess the impact of community interventions in research protocols in pregnancy and perinatal health. Trial registration number NCT01073475
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