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Achieving Country-Wide Scale for Helping Babies Breathe and Helping Babies Survive
Jeffrey M Perlman1, Sithembiso Velaphi2, Augustine Massawe3
1Weill Cornell Medicine and New York-Presbyterian Komansky Children's Hospital, New York, New York; jmp2007@med.cornell.edu.
Insights
The Helping Babies Breathe (HBB) program significantly reduced neonatal mortality by 5.34% in Africa and Nepal. Frequent refresher training is crucial for maintaining provider skills and improving newborn survival rates.
Area of Science:
- Global Health
- Neonatal Resuscitation
- Medical Education
Background:
- The Helping Babies Breathe (HBB) program, initiated in 2009, aims to decrease neonatal mortality (NM).
- HBB has expanded into the Helping Babies Survive suite, training over 850,000 providers in 80 countries since 2010.
- While initial training improves knowledge and skills, refresher training is needed to address skill decay.
Purpose of the Study:
- To evaluate the large-scale impact of skilled birth attendant training on neonatal mortality rates.
- To assess the correlation between skilled birth attendants and reductions in neonatal mortality, stillbirth, and perinatal mortality.
- To highlight the success of HBB and the need for sustained implementation and innovative training tools.
Main Methods:
- Analysis of neonatal mortality rates in 11 sub-Saharan African countries and Nepal between 2009 and 2018.
- Examination of the correlation between the number of skilled birth attendants and mortality rates.
- Development and evaluation of novel training tools, including a resuscitation trainer and a mobile application (HBB Prompt).
Main Results:
- A consistent reduction in 28-day neonatal mortality was observed, averaging 5.34% across the study regions.
- Increased numbers of skilled birth attendants showed a significant correlation with reduced neonatal mortality, fresh stillbirth, and perinatal mortality.
- New training tools demonstrated potential for increasing knowledge and skills through simulation-based practice.
Conclusions:
- The HBB program and the growth of skilled birth attendants are associated with significant reductions in neonatal mortality.
- Frequent refresher training is essential for skills retention and sustained impact.
- Continued efforts, innovative strategies, and resources are vital for sustaining newborn programming and improving outcomes.
Abstract:
Helping Babies Breathe (HBB) was piloted in 2009 as a program targeted to reduce neonatal mortality (NM). The program has morphed into a suite of programs termed Helping Babies Survive that includes Essential Care for Every Baby. Since 2010, the HBB and Helping Babies Survive training programs have been taught to >850 000 providers in 80 countries. Initial HBB training is associated with a significant improvement in knowledge and skills. However, at refresher training, there is a knowledge-skill gap evident, with a falloff in skills. Accumulating evidence supports the role for frequent refresher resuscitation training in facilitating skills retention. Beyond skill acquisition, HBB has been associated with a significant reduction in early NM (<24 hours) and fresh stillbirth rates. To evaluate the large-scale impact of the growth of skilled birth attendants, we analyzed NM rates in sub-Saharan Africa (n = 11) and Nepal (as areas of growing HBB implementation). All have revealed a consistent reduction in NM at 28 days between 2009 and 2018; a mean reduction of 5.34%. The number of skilled birth attendants, an indirect measure of HBB sustained rollout, reveals significant correlation with NM, fresh stillbirth, and perinatal mortality rates, highlighting HBB's success and the need for continued efforts to train frontline providers. A novel live newborn resuscitation trainer as well as a novel app (HBB Prompt) have been developed, increasing knowledge and skills while providing simulation-based repeated practice. Ongoing challenges in sustaining resources (financial and other) for newborn programming emphasize the need for innovative implementation strategies and training tools.
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