Newborn Resuscitation

Birth asphyxia, failure to breathe at birth, kills an estimated 717,000 newborn infants every year, about 23% of the global burden of newborn deaths. MCHIP has provided direct technical and/or financial support to ministries of health and their implementing partners in 23 countries to train skilled birth attendants to acquire the knowledge and skills, using Helping Babies Breathe, needed to assist babies not breathing at birth to initiate breathing immediately after childbirth.  In addition, MCHIP has trained MNH Africa Regional Champions to advocate for and promote these MNH practices including HBB in their respective countries. Recognizing the need for the next generation of health workers to graduate from pre-service institutions with newborn resuscitation competencies ready to help babies breathe, MCHIP has worked with selected countries including Ghana, Malawi, and Bangladesh to integrate HBB into various pre-service curricula.

Evidence-based Interventions to Prevent  and Treat Birth Asphyxia
Regular monitoring of fetal heart and taking prompt corrective action, including assisted delivery would prevent a significant number of birth asphyxia cases and fresh stillbirths.  Through training and program support, including the use of SBM/R tools, the MCHIP ensures that birth attendants have the requisite knowledge and skills to ensure better labor practices, including fetal monitoring during labor, and appropriate management of maternal complications such as eclampsia and abruption placentae to prevent birth asphyxia. The primary focus of the newborn team is ensuring birth attendants have the skills and equipment to successfully resuscitate babies who do not breathe at birth using the HBB learning materials and training methodology.

In-country Helping Babies Breathe (HBB) Activities

The goal for the MCHIP newborn team is to assist countries to have birth attendants skilled in newborn resuscitation and with the necessary functioning equipment at all birthing units, with the primary target being the public health facilities, to assist asphyxiated babies to breathe within the first golden minute of life.  Bangladesh is one such country supported by MCHIP.  With the MOH &FW in the lead, MCHIP in collaboration with UNICEF, Laerdal Medical Foundation, BSMMU, Save the Children\Saving Newborn Lives and ICDDRB, has put Bangladesh on the pathway to achieve national coverage with HBB training ensuring that all service providers attending childbirth or providing care for newborn infants are trained on HBB and equipped to save asphyxiated babies.

In addition, in Latin America & the Caribbean (LAC), MCHIP leads the dissemination of HBB for the region, including translation of materials into Spanish (such as the HBB implementation guide).

Key HBB activities include:
Bangladesh

  • HBB materials were adapted into the local language, Bangla, and a successful pilot study that was used as advocacy for the country to adopt and scale-up HBB.  A strong political commitment by the Minister of Health who during the dissemination workshop of the pilot project findings, in May 2010, authorized the adoption and scale-up of HBB.  This led to the development of a MOH&FW led scale-up.
  • Cascade HBB training starting with national HBB master trainers to district and Upazilla level trainers, followed by training of service providers working in health facilities or community at the district level in phases was initiated in June 2011.  All sub-national HBB training is supervised from national level using standardized checklist.
  • Equipping of medical colleges, all district and Upazilla hospitals, and Union Health and Family Welfare Centers (UH&FWCs) with childbirth services.  Also equipping of community Skilled Birth Attendants (CSBAs).
  • Post-training supportive supervision by MOH&FW, BSMMU and MCHIP staff from national level combined with supervision from district and upazilla officers.
  • Baseline and endline facility assessment with observation of childbirth services to evaluate impact of HBB training on childbirth practices particularly newborn resuscitation.

LAC   

  • Dissemination of the science in regional meetings of members of the LAC Neonatal Alliance, such as those of professional associations (pediatric, ob/gyn, nursing, midwifery).
  • Trainings of LAC regional Master Trainers during the same events with partners of the LAC Neonatal Alliance.
  • Technical assistance to Ministry of Health and other partners for implementation at country levels.

Results
In Bangladesh, HBB protocol has been included in the Standard Operation Procedure for newborn Health Care in all primary and secondary health facilities. HBB training has been completed in 45 of the country’s 64 districts and about 1,700 health facilities have been equipped with resuscitation equipment (such as ambu bags and face masks for term and preterm babies, and suction devices, penguins). In addition, 443 health facilities (including Medical College and district hospitals, Upazilla Health Complexes and Maternal and Child Welfare Centers) received a complete set of HBB training materials to use for refresher training and/or skills maintenance practices. Almost 2,600 CSBAs have received resuscitation equipment. HBB has been integrated into the pre-service curricula for doctors, nurses, midwives, FWVs, private paramedics and CSBAs. The results from the HBB evaluation planned to be released soon will provide information on how the training has impacted on childbirth practices of the service providers.

In Colombia, HBB has been integrated into the Integrated Management of Childhood Illness national program, and in 8 of the country’s 9 health regions in collaboration with USAID bilateral (Abt Associates).