Transcript Slide 1

Scaling Up Interventions to
Manage Birth Asphyxia in
Bangladesh
Prof. (Dr.) Mohammod Shahidullah
Chairman, Dept. of Neonatology
and
Pro-Vice Chancellor,
Bangabandhu Sheikh Mujib Medical University
(BSMMU)
Dhaka, Bangladesh
BSMMU
Where do newborn babies die?
1.5 million (38% of
all newborn
deaths) occur in
4 countries of
South Asia
99% of newborn deaths are in low/middle income countries
BSMM
U in Africa and South Asia
66%
4 million newborn deaths – Why?
almost all are due to preventable conditions
BSMMU
Global situation
• 3% of all newborns in developing countries
suffer from birth asphyxia, of which 23% die
within neonatal period & an equal number
develop neurological sequelae (WHO).
• More than two-thirds of all newborn deaths (2.7
million out of 4 million each year) occur in just
10 countries.
• Many of these countries have very large
populations (such as India and China) others
have very high percentage of newborns dying
(such as Afghanistan, Congo and Tanzania)
countries
BSMMU
Bangaldesh situation:
Trends-Child, Infant, Neonatal mortality rates
1993
1997
2001
2004
2007
2010
MDG Target
180
Significant Reduction in U-5 and Infant
Mortality, NMR Stagnant since Mid-90s
160
U-5 MR per 1000 LB
140
133
116
120
100
87
94
82
80
60
52
48
88
66
65
42
41
40
65
52
37
52
31
20
50
31
25
0
U-5 mortality
BSMMU
IMR
Newborn mortality
Source: BDHS 1993 - 2007
Bangladesh situation:
Neonatal mortality
• Neonatal deaths- 57% of all <5 deaths
• One neonate dies every 3-4 minutes
• Neonatal death per year is 120,000
BSMMU
Bangladesh situation:
Causes of neonatal deaths
Undetermined
Unspecified
Others 3%
4%
2%
Cong. Abnorm
5%
Possible Serious
Infections
34%
Birth Injury
4%
LBW/PMB
11%
ARI
10%
Birth Asphyxia
21%
N. Tetanus
4%
BSMMU
Diarrhoea
ARI+Diarr 1%
1%
BDHS:2004
Most newborn mortality occurs in first 7
days of life – up to 50% in first 24 hours
Asphyxia
Infection
LBW
400
Number of deaths
100
300
60
200
40
100
20
0
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
Age at death (day)
South Asia Newborn Health Investigators Group (Unpublished)
BSMMU
80
Cumulative frequency (%)
500
Bangladesh situation
•3.8 million babies born/yr in Bangladesh of
which 120000 die in the first 28 days of life.
•85% of these deaths are due to perinatal
asphyxia, low birth weight (LBW) and neonatal
sepsis
•Hospital based study in Bangladesh -- 30 to
50% of total Neonatal admission and over 50%
of deaths are related to birth asphyxia.
BSMMU
Bangladesh National Neonatal Health
Strategies and Guidelines (NNHS)
• Formulated in a participatory manner
• Endorsed by the MOH&FW in May 2009
• Focused on –
– Coverage and capacity
– Management of infection, asphyxia and LBW
– Stronger systems to facilitate community and facility
level implementation of interventions
– Ensure policy and resource commitment
• Now in the process of developing the action plan
BSMMU
Addressing birth asphyxia in NNHS
• Key strategies –
– Increase capacity for identification
– Strengthening awareness on risk factors and
preventive measures
– Increase coverage and quality of ANC and
identification of high risk cases
– Increase capacity for early management
– Improve post resuscitation referral and
management
BSMMU
Addressing birth asphyxia in NNHS
Key actions –
• For all levels:
–
–
–
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Increased coverage of skilled birth attendance
Establish referral linkage
Improve GO-NGO partnership
Develop comprehensive BCC plan
• For community level:
–
–
–
–
BSMMU
Raise awareness
Build family capacity
Training of community based workers
First line eclampsia management
Addressing birth asphyxia in NNHS
Key actions –
• For facility levels
– Enhance capacity for initial and prompt
management
– Enhance capacity for management for
antenatal and obstetric complications
– Enhance capacity for post complication
management
BSMMU
Addressing birth asphyxia in NNHS
HBB Initiative:
A feasibility study in building skill in
birth asphyxia management
BSMMU
HBB: Background
• A training module (for resuscitation) has been developed
by AAP (American Academy of Pediatrics)
• Application was called to test the module: Proposal
submitted from BSMMU
• Initially two countries ware selected- India and Kenya
• AAP proposed to arrange grant from other source;
USAID supported through field funding
• Local management support will be given through Save
the Children USA through MCHIP(MaMoni)
BSMMU
HBB: Goal
• The goal of this HBB initiative is to improve the
knowledge and skill of the skilled birth attendant
(doctors, nurses, FWVs, FWAs, paramedics) to
identify and manage the newborn having birth
asphyxia.
• It ultimately will help to reduce neonatal mortality
due to birth asphyxia.
BSMMU
HBB: Objectives
• To achieve the above goal the following objectives are
identified:
• To train the service providers (doctors, nurses, FWVs,
FWAs, Paramedics) of selected Government and nongovernment hospitals on essential newborn care and
newborn resuscitation
• To train skilled birth attendant (FWV, FWA, Female
health assistant) working at community level on
Essential Newborn Care (ENC) and newborn
resuscitation
BSMMU
HBB: Objectives
• To increase the capacity of skilled birth attendants
(SBA) for identification of new-born having birth
asphyxia
• To increase the capacity for bag and mask and
mouth to mouth resuscitation measures for the SBA
involved in neonatal care
• To improve post-resuscitation referral and care.
BSMMU
HBB: Interventions
• Adaptation, test and introduction of standard HBB
curriculum on Essential newborn care and neonatal
resuscitation
• Setting up of a system of training , supervision,
monitoring and referral for different level health system
• To train master trainers and trainers on HBB curriculum
(Two master trainers trained in India)
• To train service providers (doctors, nurses, FWVs,
FWAs, Paramedics) on essential new-born care (ENC)
and newborn resuscitation in target areas
BSMMU
HBB: Scaling up through NNHS
• In NNHS there is provision for operation
research on Birth Asphyxia management,
sepsis management, management of Pre-term
and LBW both in facilities and community.
• Considering the above point this HBB study
finding can be used for scaling up of Birth
asphyxia management as per provision of
NNHS.
•The HBB Technical Advisory Group (TAG) will
act as an interface and advocate for scale up at
a national level
BSMMU
Thank You
BSMMU