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American Academy of Pediatrics
Article

Newborn Mortality and Fresh Stillbirth Rates in Tanzania After Helping Babies Breathe Training

Georgina Msemo, Augustine Massawe, Donan Mmbando, Neema Rusibamayila, Karim Manji, Hussein Lesio Kidanto, Damas Mwizamuholya, Prisca Ringia, Hege Langli Ersdal and Jeffrey Perlman
Pediatrics February 2013, 131 (2) e353-e360; DOI: https://doi.org/10.1542/peds.2012-1795
Georgina Msemo
aMinistry of Health and Social Welfare, Dar es Salaam, Tanzania;
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Augustine Massawe
bPaediatrics and Child Health, School of Medicine, and
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Donan Mmbando
aMinistry of Health and Social Welfare, Dar es Salaam, Tanzania;
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Neema Rusibamayila
aMinistry of Health and Social Welfare, Dar es Salaam, Tanzania;
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Karim Manji
bPaediatrics and Child Health, School of Medicine, and
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Hussein Lesio Kidanto
cObstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;
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Damas Mwizamuholya
dPaediatrics, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania;
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Prisca Ringia
eDivision of Obstetric Nursing, Weill Bugando Hospital, Mwanza, Tanzania;
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Hege Langli Ersdal
fDepartment of Anaesthesiology and Intensive Care, Stavanger University Hospital, Norway and Haydom Lutheran Hospital, Tanzania;
gSAFER (Stavanger Acute medicine Foundation for Education and Research), Stavanger University Hospital, Stavanger, Norway; and
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Jeffrey Perlman
hDepartment of Pediatrics, Division of Newborn Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
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Abstract

BACKGROUND: Early neonatal mortality has remained high and unchanged for many years in Tanzania, a resource-limited country. Helping Babies Breathe (HBB), a novel educational program using basic interventions to enhance delivery room stabilization/resuscitation, has been developed to reduce the number of these deaths.

METHODS: Master trainers from the 3 major referral hospitals, 4 associated regional hospitals, and 1 district hospital were trained in the HBB program to serve as trainers for national dissemination. A before (n = 8124) and after (n = 78 500) design was used for implementation. The primary outcomes were a reduction in early neonatal deaths within 24 hours and rates of fresh stillbirths (FSB).

RESULTS: Implementation was associated with a significant reduction in neonatal deaths (relative risk [RR] with training 0.53; 95% confidence interval [CI] 0.43–0.65; P ≤ .0001) and rates of FSB (RR with training 0.76; 95% CI 0.64–0.90; P = .001). The use of stimulation increased from 47% to 88% (RR 1.87; 95% CI 1.82–1.90; P ≤ .0001) and suctioning from 15% to 22% (RR 1.40; 95% CI 1.33–1.46; P ≤ .0001) whereas face mask ventilation decreased from 8.2% to 5.2% (RR 0.65; 95% CI 0.60–0.72; P ≤ .0001).

CONCLUSIONS: HBB implementation was associated with a significant reduction in both early neonatal deaths within 24 hours and rates of FSB. HBB uses a basic intervention approach readily applicable at all deliveries. These findings should serve as a call to action for other resource-limited countries striving to meet Millennium Development Goal 4.

KEY WORDS
  • Helping Babies Breathe
  • neonatal mortality
  • fresh stillbirths
  • premature infants
  • birth asphyxia
  • Abbreviations:
    BA —
    birth asphyxia
    BW —
    birth weight
    CI —
    confidence interval
    ENM —
    early neonatal mortality (within 24 hours)
    FMV —
    face mask ventilation
    FSB —
    fresh stillbirths
    GA —
    gestational age
    HBB —
    Helping Babies Breathe
    MDG —
    Millennium Development Goal
    ND —
    neonatal deaths
    RR —
    relative risk
    • Accepted October 4, 2012.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Vol. 131, Issue 2
    1 Feb 2013
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    Newborn Mortality and Fresh Stillbirth Rates in Tanzania After Helping Babies Breathe Training
    Georgina Msemo, Augustine Massawe, Donan Mmbando, Neema Rusibamayila, Karim Manji, Hussein Lesio Kidanto, Damas Mwizamuholya, Prisca Ringia, Hege Langli Ersdal, Jeffrey Perlman
    Pediatrics Feb 2013, 131 (2) e353-e360; DOI: 10.1542/peds.2012-1795

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    Newborn Mortality and Fresh Stillbirth Rates in Tanzania After Helping Babies Breathe Training
    Georgina Msemo, Augustine Massawe, Donan Mmbando, Neema Rusibamayila, Karim Manji, Hussein Lesio Kidanto, Damas Mwizamuholya, Prisca Ringia, Hege Langli Ersdal, Jeffrey Perlman
    Pediatrics Feb 2013, 131 (2) e353-e360; DOI: 10.1542/peds.2012-1795
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    Subjects

    • Pulmonology
      • Pulmonology
    • Fetus/Newborn Infant
      • Fetus/Newborn Infant
      • Neonatology

    Keywords

    • Helping Babies Breathe
    • neonatal mortality
    • fresh stillbirths
    • premature infants
    • birth asphyxia
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