Transcript Russia - Helping Babies Breathe

When The Baby Doesn’t Breathe, and
There Is No Skilled Birth Attendant
Annie Clark, URC Sr. QI Advisor MNCH
1
Controversy- Implementing Basic Neonatal
Resuscitation at Community Level
• Issues with maintaining equipment & skills
among non-SBAs given rare need for ventilation
• Cost of intervention compared to coverage
concern
• Given the relatively small effect size, the
infrequent occurrence, and the challenges of
methodology and data collection, difficult to
demonstrate benefit in a trial
• Some country Ministries do not permit training
of non-SBAs in ventilation (i.e. Uganda)
USAID HEALTH CARE IMPROVEMENT PROJECT
Controversy- Implementing Basic Neonatal
Resuscitation at Community Level
On the other hand, there may be a role:
 in some high mortality settings where most births
occur at home
 skilled attendance is not achievable in the
foreseeable future
 alternative cadres already attend the majority of
deliveries
 case load per attendant is high enough to justify the
training, equipment inputs and skill maintenance
USAID HEALTH CARE IMPROVEMENT PROJECT
Neonatal resuscitation and immediate newborn assessment
and stimulation for the prevention of neonatal deaths: a
systematic review, meta-analysis and Delphi estimation of
mortality effect-Lee, et al. BMCPH 2011
• 24 studies found that reported the impact of
neonatal resuscitation training on mortality
outcomes: 16 studies in facilities, and 8 studies
in community settings
• Delphi panel of 18 experts estimated that
immediate newborn assessment and
stimulation would reduce both intrapartumrelated and preterm deaths by 10%
• Facility-based resuscitation would prevent a
further 10% of preterm deaths
• Community-based resuscitation would prevent
further 20% of intrapartum-related and 5% of
preterm deaths.
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LUNESP Study Results
• Among 3,497 deliveries, mortality in the first 24
hours of life was significantly lower for those
delivered by trained non-SBAs -- 7.8 deaths per
1,000 live births, compared to 19.9 per 1,000
births for the non-trained group.
• Deaths due to birth asphyxia reduced by 63
percent among infants delivered by the trained
non-SBAs
Basic neonatal resuscitation effect on
stillbirths in community-based studies
• In the First Breath study, the stillbirth rate was
reduced by 31% after the intervention
•
In the SEARCH study, the fresh stillbirth rate
was 32% lower during the period of bag-mask
compared to tube-mask resuscitation(p< 0.09).
• In the LUNESP study, there was no significant
effect of the intervention on stillbirth rate.
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Conclusions reached by TWG based on findings
reported by the Community Based Newborn
Care Project (CBNCP) in Nepal
• Very low “capture rate” by Female Community
Health Visitors (FCHVs) and Health Facilities.
Data quality acceptable.
• Issues with maintaining equipment & skills
among FCHVs given rare practice
• Cost of intervention compared to coverage is of
concern
• Low rates of service provision call viability of
intervention (particularly bag-and-mask) into
question
• As institutional delivery rate increases, need for
Birth Aasphyxia management at community
level may further decline
USAID HEALTH CARE IMPROVEMENT PROJECT
Individuals and Projects Taking Initiatives
without HBB GDA Guidance-Example Casa Colibri
What will the HBB GDA Partners
Recommend Regarding Newborn
Resuscitation at Community Level?
1) No recommendation for NB resuscitation at
community level
2) Advocate teaching first five steps (dry, warm,
position, suction, stimulate) only
3) Respond per request of MoH
4) Advocate mouth-to-mouth ventilation when no
alternative available (counsel re: associated
theoretical risks)
5) Advocate simple tube and mask ventilation
6) Advocate bag and mask ventilation
7) Conduct further research
8) Other
USAID HEALTH CARE IMPROVEMENT PROJECT