Assessing the effectiveness of newborn resuscitation training and skill retention program on neonatal outcomes in Madhesh Province, Nepal

Abstract

AbstractBackgroundIntrapartum events leading to asphyxia at birth is one of the leading causes of neonatal morbidity and mortality in Nepal. In response to this, the Nepal Ministry of Health and Population adopted Helping Babies Breathe (HBB) as a tool to improve neonatal resuscitation. The effectiveness of HBB trainings in developing newborn resuscitation knowledge and skills of service providers have been well established. However, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN), with support from LDS Charities designed an initiative for scaling up newborn resuscitation training and maintaining skills over time. This paper reports on the implementation of SSN’s model of newborn resuscitation trainings and skill retention, and changes in perinatal outcomes that occurred during the program.MethodsThe program capacitated facility-based trainers for scale up and maintaining resuscitation skills in 20 facilities in Madhesh Province, Nepal. A single external mentor coached and assisted the facility-based trainers, provided general support, and monitored progress. Prospective outcome monitoring tracked changes in health metrics for a period of 14 months. To analyze changes over the time, the neonatal mortality, morbidity, and stillbirths at the baseline (first two months) of the program was compared with the endline (last two months) measures.ResultsData was gathered on neonatal health outcomes of 68,435 vaginal deliveries and 9,253 cesarean sections. Results indicate decreases in <24 hours neonatal deaths (p<0.001), intrapartum stillbirths (p<0.001), and number of sick newborns transferred from the maternity unit (p<0.001). During the program, facility-based trainers taught resuscitation skills to 231 medical personnel and supported skill retention.ConclusionsSSN’s model is a low-cost, evidence-based program focusing on facility-based trainers, who are mentored and supported to scale-up and sustain resuscitation skills over time. Findings from the report are suggestive that the model had a substantial influence on critical neonatal outcomes. Future programs focused on improving neonatal outcomes may benefit by incorporating program elements of SSN model.