Stillbirth and Newborn Mortality in India After Helping Babies Breathe Training
- 1 February 2013
- journal article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 131 (2), e344-e352
- https://doi.org/10.1542/peds.2012-2112
Abstract
OBJECTIVE: This study evaluated the effectiveness of Helping Babies Breathe (HBB) newborn care and resuscitation training for birth attendants in reducing stillbirth (SB), and predischarge and neonatal mortality (NMR). India contributes to a large proportion of the worlds annual 3.1 million neonatal deaths and 2.6 million SBs. METHODS: This prospective study included 4187 births at >28 weeks’ gestation before and 5411 births after HBB training in Karnataka. A total of 599 birth attendants from rural primary health centers and district and urban hospitals received HBB training developed by the American Academy of Pediatrics, using a train-the-trainer cascade. Pre-post written trainee knowledge, posttraining provider performance and skills, SB, predischarge mortality, and NMR before and after HBB training were assessed by using χ2 and t-tests for categorical and continuous variables, respectively. Backward stepwise logistic regression analysis adjusted for potential confounding. RESULTS: Provider knowledge and performance systematically improved with HBB training. HBB training reduced resuscitation but increased assisted bag and mask ventilation incidence. SB declined from 3.0% to 2.3% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59–0.98) and fresh SB from 1.7% to 0.9% (OR 0.54, 95% CI 0.37–0.78) after HBB training. Predischarge mortality was 0.1% in both periods. NMR was 1.8% before and 1.9% after HBB training (OR 1.09, 95% CI 0.80–1.47, P = .59) but unknown status at 28 days was 2% greater after HBB training (P = .007). CONCLUSIONS: HBB training reduced SB without increasing NMR, indicating that resuscitated infants survived the neonatal period. Monitoring and community-based assessment are recommended.This publication has 21 references indexed in Scilit:
- Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000The Lancet, 2012
- The effect of providing skilled birth attendance and emergency obstetric care in preventing stillbirthsBMC Public Health, 2011
- Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effectBMC Public Health, 2011
- Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled studyBMJ, 2011
- Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4The Lancet, 2010
- Newborn-Care Training and Perinatal Mortality in Developing CountriesThe New England Journal of Medicine, 2010
- Two million intrapartum-related stillbirths and neonatal deaths: Where, why, and what can be done?International Journal of Gynecology & Obstetrics, 2009
- Neonatal resuscitation in low-resource settings: What, who, and how to overcome challenges to scale up?International Journal of Gynecology & Obstetrics, 2009
- Newborn resuscitation in resource-limited settingsSeminars in Fetal and Neonatal Medicine, 2008
- Effect of WHO Newborn Care Training on Neonatal Mortality by EducationAmbulatory Pediatrics, 2008