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Designing and Implementing the Helping Babies Breathe Program in Tanzania
Jeffrey M Perlman1, Georgina Msemo2, Hege Ersdal3
1Division of Newborn Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, United States.
Insights
The Helping Babies Breathe program significantly reduced newborn deaths and stillbirths in Tanzania by improving resuscitation techniques. This evidence-based educational initiative trained thousands of birth attendants, making neonatal survival a national health priority.
Area of Science:
- Neonatal resuscitation
- Global health initiatives
- Evidence-based education
Background:
- Intrapartum-related neonatal deaths pose a significant risk, with 60-70% occurring within 24 hours of birth.
- Birth asphyxia (BA) is a major contributor to neonatal mortality, accounting for 27-30% of deaths.
- Limited-resource settings face challenges in neonatal care and resuscitation.
Purpose of the Study:
- To evaluate the impact of the Helping Babies Breathe (HBB) program on neonatal mortality and stillbirths in Tanzania.
- To assess changes in neonatal resuscitation practices following HBB implementation.
- To identify key strategies contributing to the program's success.
Main Methods:
- Implementation of the evidence-based Helping Babies Breathe (HBB) educational program in Tanzania starting in 2009.
- Training of birth attendants in neonatal resuscitation techniques.
- Monitoring of neonatal mortality and fresh stillbirth rates pre- and post-implementation.
- Assessment of changes in the use of stimulation, suctioning, and bag-mask ventilation.
Main Results:
- A significant 47% reduction in early neonatal mortality (from 13.4 to 7.1 per 1,000 live births).
- A significant 24% reduction in fresh stillbirths (from 19.0 to 14.4 per 1,000 births).
- Increased use of stimulation and suctioning, with a significant decrease in the need for bag-mask ventilation.
Conclusions:
- The Helping Babies Breathe program is effective in reducing neonatal mortality and stillbirths in resource-limited settings.
- Key success factors include national prioritization, strong leadership, local ownership, comprehensive training, equipment provision, and data review.
- The program demonstrates the potential of evidence-based education to improve neonatal survival outcomes.
Abstract:
The first day and especially the first hour are critical to newborn survival with the highest risk of intrapartum-related neonatal deaths, from 60 to 70%, occurring within 24 hours of birth. Birth asphyxia (BA) or failure to initiate or sustain spontaneous breathing at birth contributes to approximately 27 to 30% of neonatal deaths. In 2009, Helping Babies Breathe (HBB), an evidence-based educational program developed to teach neonatal resuscitation techniques in limited-resource setting, was introduced and piloted in Tanzania. HBB resulted in a significant 47% reduction in early neonatal mortality from 13.4 to 7.1 per 1,000 live-born deliveries ( p < 0.0001) and a significant reduction (24%) in fresh stillbirths from 19.0 per 1,000 preimplementation to 14.4 per 1,000 births postimplementation ( p = 0.001). The use of stimulation and suctioning increased, whereas the need for bag mask ventilation decreased significantly post-HBB. This success was attributed to several key strategies including elevating BA as a national priority in health care, identification of a primary person (a pediatrician) at the ministerial level who assumed ownership of the program, local site ownership by a midwife, a commitment to train all birth attendants in the current health workforce in HBB, a commitment to provide required resuscitation equipment at all levels, and periodic review of the data (biannually) at a centralized meeting, under the direction of the Ministry of Health, involving all stakeholders to instill a sense of accountability. A national rollout of provider training is almost complete with almost 15,000 already trained.
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