Reducing Intrapartum-Related Neonatal Deaths in Low- and Middle-Income Countries—What Works?

Wall, Stephen; Lee, Anne C C; Carlo, Waldemar A.; Goldenberg, Robert L.; Niermeyer, Susan; Darmstadt, Gary L.; Keenan, William; Bhutta, Zulfiqar Ahmed; Perlman, Jeffrey M.; Lawn, Joy E

doi:10.1053/j.semperi.2010.09.009

Cited by 199 publications

(146 citation statements)

References 78 publications

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“…Regarding the impact of training on mortality in the first 24 hours of life, the result that 5.0% of the newborns in our study required bag-mask ventilation in order to survive is consistent with World Health Organization global estimates [2]. Since none of the midwives participating in this study had been trained in newborn resuscitation and did not own bag-mask ventilation devices before taking the Helping Babies Breathe course, it is reasonable to assume that the training prevented the death of at least some of the 118 newborns who were provided with BMV.…”

Section: Discussionsupporting

confidence: 88%

“…The WHO estimates that while 5–10% of newborns worldwide require some level of resuscitation to initiate respirations, including 3–6% who require bag-mask ventilation, less than 0.1% of neonates require advanced resuscitation techniques such as chest compressions and vasoactive medications [2]. Furthermore, infants requiring such efforts to survive the immediate post-delivery period would likely require ongoing support not readily available in regions targeted by HBB.…”

Section: Introductionmentioning

confidence: 99%

“…However, although some of these studies included low-volume rural clinics, the majority of births evaluated in these studies occurred in hospitals or larger clinics staffed full-time by physicians. Due to a higher relative birth rate and less direct involvement of physicians in the labor and delivery process, rural areas served only by small clinics suffer a greater burden of neonatal mortality from birth asphyxia [1,2]. …”

Section: Introductionmentioning

confidence: 99%

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Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

Eblovi

Kelly

Afua

et al. 2017

Global Health Action

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Background: The Helping Babies Breathe (HBB) program teaches basic newborn resuscitation techniques to birth attendants in low-resource settings. Previous studies have demonstrated a decrease in mortality following training, mostly in large hospitals. However, low-volume clinics in rural regions with no physician immediately available likely experience a greater relative burden of newborn mortality. This study aimed to determine the impact of HBB trainings provided to rural Ghanaian midwives on their skills retention and on first 24 hour mortality of the newborns they serve. Methods: American Acadamy of Paediatrics (AAP)-trained Master Trainers conducted two 2-day HBB trainings and 2-day refresher courses one year later for 48 midwives from Ghanaian rural health clinics. Trainee skills were evaluated by Objective Structured Clinical Examination (OSCE) at three time points: immediately after training, four months after training, and four months after the refresher. Midwives recorded the single highest level of resuscitation performed on each newborn delivered for one year. Results: 48 midwives attended the two trainings, 32 recorded data from 2,383 deliveries, and 13 completed OSCE simulations at all three time points. The midwives’ OSCE scores decreased from immediately after training (94.9%) to four months later (81.2%, p < 0.00001). However, four months following the refresher course, scores improved to the same high level attained initially (92.7%, p = 0.0013). 5.0% of neonates required bag-mask ventilation and 0.71% did not survive, compared with a nationwide first 24 hour mortality estimate of 1.7%. Conclusions: The midwives’ performance on the simulation exercise indicates that an in-depth refresher course provided one year after the initial training likely slows the decay in skills that occurs after initial training. Our finding that 5.0% of newborns required bag-mask ventilation is consistent with global estimates. Our observed first 24 hour mortality rate of 0.71% is lower than nationwide estimates, indicating the training likely prevented deaths due to birth asphyxia.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

Eblovi

Kelly

Afua

et al. 2017

Global Health Action

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“…In particular, the fi ndings about the use of community workers to diagnose and treat common infectious diseases in neonates and under 5s are robust, with consistent improvements in various settings. [10][11][12][13][14][15][16][17] Additionally, shifting of delivery of a range of services from doctors to nurse practitioners, or from health workers to lay providers (who have received only short periods of formal training), can eff ectively expand coverage without jeopardising chil dren's survival, health, and nutrition. [29][30][31][32] These fi ndings are particularly important in view of the absence of robust evidence for interventions that aim to improve the distribution and retention of health professionals in rural areas, and are in line with the principle that services should be delivered at the lowest eff ective level of care.…”

Section: Discussionmentioning

confidence: 99%

“…For example, training of traditional birth attendants and other community-based workers to dispense simple immediate preventive and curative actions for neonate care, includ ing neonatal resuscitation and injectable antibiotics, has signifi cantly reduced stillbirths and perinatal mortality in various settings. 10,11 Additional evidence [12][13][14] suggests that community health workers can eff ectively provide treat ments and care to reduce morbidity and mortality perinatally and in under 5s. More recent evidence 15,16 for the eff ect of communitybased malaria treatment on child health outcomes suggests a reduction in malaria prevalence and a fall in under-5 mortality when combined with delivery of insecticide-treated nets and antimalarial chemoprophylaxis.…”

Section: Lay Health Workersmentioning

confidence: 99%

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

et al. 2012

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Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the eff ective coverage of essential interventions. First, we identify four diff erent intervention delivery channels-ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions' deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to eff ective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of eff ective interventionsand, in some cases, health outcomes in children-including expanded roles for lay health workers, task shifting, reduction of fi nancial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources.

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Trends in Term Intrapartum Stillbirth in Norway

Murzakanova,

Räisänen,

Jacobsen

et al. 2023

JAMA Netw Open

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ImportanceFetal death during labor at term is a complication that is rarely studied in high-income countries. There is a need for large population-based studies to examine the rate of term intrapartum stillbirth in high-income countries and the factors associated with its occurrence.ObjectiveTo evaluate trends in term intrapartum stillbirth over time and to investigate the association between the trends and term intrapartum stillbirth risk factors from 1999 to 2018 in Norway.Design, Setting, and ParticipantsThis cohort study used data from the Medical Birth Registry of Norway from 1999 to 2018 to examine rates of term intrapartum stillbirth and risk factors associated with this event. A population of 1 021 268 term singleton pregnancies without congenital anomalies or antepartum stillbirths was included in analyses, which were performed from September 2022 to February 2023.ExposureThe main exposure variable was time, which was divided into four 5-year periods: 1999 to 2003, 2004 to 2008, 2009 to 2013, and 2014 to 2018.Main Outcomes and MeasuresThe primary study outcome was term intrapartum stillbirth. Risk ratios were calculated, and multivariable logistic regression analyses were conducted to identify factors associated with secular trends of term intrapartum stillbirth.ResultsThe study population consisted of 1 021 268 term singleton births (maternal mean [SD] age, 29.72 [5.01] years; mean [SD] gestational age, 39.69 [1.27] weeks). During the study period, there were 95 term intrapartum stillbirths (0.09 per 1000 births). Maternal age, the proportion of individuals born in a country other than Norway, and the prevalence of gestational diabetes, labor induction, operative vaginal delivery, and previous cesarean delivery increased over the course of the study period. Conversely, the prevalence of infants large for gestational age, hypertensive disorder in pregnancy, and spontaneous vaginal delivery and the proportion of individuals who smoked decreased. The term intrapartum stillbirth rate decreased by 87% (95% CI, 68%-95%) from 0.15 per 1000 births in 1999 to 2008 to 0.02 per 1000 births in 2014 to 2018. Three in 4 term intrapartum stillbirths (70 of 95) occurred during intrapartum operative deliveries. The increased prevalence of older maternal age and obstetric risk factors were not associated with the variation in intrapartum stillbirth rates among the time periods. The prevalence of term intrapartum stillbirth was higher for individuals who gave birth in maternity units with fewer than 3000 annual births (adjusted odds ratio, 1.67; 95% CI, 1.07-2.61) than for those who gave birth in units with 3000 or more annual births.Conclusions and RelevanceFindings of this study suggest that, despite increases in maternal and obstetric risk factors, term intrapartum stillbirth rates substantially decreased during the study period. Reasons for this decrease may be due to improvements in intrapartum care.

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Reducing Intrapartum-Related Neonatal Deaths in Low- and Middle-Income Countries—What Works?

Cited by 199 publications

References 78 publications

Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

Retention and use of newborn resuscitation skills following a series of helping babies breathe trainings for midwives in rural Ghana

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

Trends in Term Intrapartum Stillbirth in Norway

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