Newborn Care Training of Midwives and Neonatal and Perinatal Mortality Rates in a Developing Country

Abstract

WHAT'S KNOWN ON THIS SUBJECT:The majority of infant deaths occur during the neonatal period. Educational programs available to train neonatal health care workers are effective in improving knowledge and skills, but there are limited data on their effects on neonatal mortality rates. WHAT THIS STUDY ADDS:Training midwives in neonatal care reduces early neonatal mortality rates for infants born in lowrisk, first-level facilities. abstract + OBJECTIVE: This study was designed to test the hypothesis that 2 training programs would reduce incrementally 7-day neonatal mortality rates for low-risk institutional deliveries. METHODS:Using a train-the-trainer model, certified research midwives sequentially trained the midwives who performed deliveries in low-risk, first-level, urban, community health clinics in 2 cities in Zambia in the protocol and data collection, in the World Health Organization Essential Newborn Care (ENC) course (universal precautions and cleanliness, routine neonatal care, resuscitation, thermoregulation, breastfeeding, kangaroo care, care of small infants, and common illnesses), and in the American Academy of Pediatrics Neonatal Resuscitation Program (in-depth basic resuscitation). Data were collected during 3 periods, after implementation of each training course. RESULTS:A total of 71 689 neonates were enrolled in the 3 study periods. All-cause, 7-day neonatal mortality rates decreased from 11.5 deaths per 1000 live births to 6.8 deaths per 1000 live births after ENC training (relative risk: 0.59 [95% confidence interval: 0.48 -0.77]; P Ͻ .001), because of decreases in rates of deaths attributable to birth asphyxia and infection. Perinatal mortality rates but not stillbirth rates decreased. The 7-day neonatal mortality rate was decreased further after Neonatal Resuscitation Program training, after correction for loss to follow-up monitoring.CONCLUSIONS: ENC training for midwives reduced 7-day neonatal mortality rates in low-risk clinics. Additional in-depth basic training in neonatal resuscitation may reduce mortality rates further. Pediatrics

Cost-effectiveness of Essential Newborn Care Training in Urban First-Level Facilities

“…The pre-ENC and post-ENC populations were comparable, as reported in a previous publication. 9 This population comprised 98% of all the neonates born with low-risk institutional deliveries in the 2 cities. All-cause 7-day neonatal mortality decreased from 11.5 per 1000 to 6.8 per 1000 after ENC training (relative risk: 0.59; confidence interval: 0.48 -0.77; P Ͻ .001) and was associated with a decrease in deaths caused by birth asphyxia (3.4 -1.9 per 1000; P ϭ .02) and infection (2.1-1.0 per 1000; P ϭ .02).…”

“…9 This cost analysis documents the cost-effectiveness and relatively low cost of the ENC educational intervention compared with other interventions aimed at reducing neonatal mortality in developing countries.…”

“…10,11 This study was performed to evaluate the effectiveness of the training of midwives who worked in first-level (primary care, low-risk) health facilities in Zambia and participated in the WHO ENC course on 7-day neonatal mortality. 9 …”

“…Therefore, we sought to evaluate the cost per life saved and cost per disability-adjusted life-year (DALY) by using data from a large study in which ENC training reduced all-cause early neonatal mortality in births that occurred in first-level facilities. 9 …”

Accuracy of a Novel System for Oxygen Delivery to Small Children

“…However, room air resuscitation can reduce neonatal mortality 29 and has been done without oxygen blending in large clinical studies. 30,31 In clinical studies, hypopharyngeal oxygen concentrations have been shown to be reliable measures of the actual inspired oxygen concentrations. [32][33][34][35][36][37][38] If hypopharyngeal oxygen concentrations need to be decreased from those achieved with the 100% oxygen source, an entrainment device would be useful in those situations.…”