O0240 Oct.5: 9:17am - Trends in Fresh Stillbirth Rates and Neonatal Mortality Rates after five years of Helping Babies Breathe Program implementation in Eastern Cape, South Africa

Background: More than 75% of births in EC, South Africa take place in a facility; nevertheless, neonatal deaths and FSBR remain high due to an inability to perform timely cesarean sections. Improving and maintaining neonatal resuscitation (NR) skills among providers can also decrease intrapartum FSBR and increase neonatal survival. HBB is an evidenced-based, simulation-based NR curriculum, and has been shown to reduce FSBR and NMR in low resource settings.

Objective: To evaluate trends in FSBR and NMR following the implementation of HBB training coupled with ongoing, on-site simulation practice and clinical mentorship in a low-resource setting.

Design/

Methods: Data were collected on number of total births, fresh stillbirths and early neonatal deaths ( <7days) from 2015 to 2019 at five hospitals offering different levels of care in the OR Tambo District of the EC. In 2019 ambulances capable of transporting high-risk maternal and neonatal patients coupled with trained emergency medical service (EMS) providers capable of providing advanced life support were instituted.

Results: The five study hospitals vary in type (2 regional, 2 district, 1 referral), services offered and annual births. There was an overall reduction of 26% in FSBR with the largest reduction observed in 2019 versus 2018 [relative risk (RR) 0.75 (95% confidence interval (CI) 0.60-0.94; p=0.01] (Table 1). This appears to have coincided with the introduction of the ambulance service, with maternal patients accounting for 85% of all transports. There was a 21% reduction in NMR between 2015-2019, with the most striking reduction noted for 2015-2016, the year HBB training and mentorship began [RR 0.84 (95% CI 0.73-0.96); p=0.01]. The perinatal mortality rate decreased from 53.8 to 42/1000 births between 2015-2019 [RR 0.78 (95% CI 0.69-0.88); p<0.01].

Conclusion: A comprehensive intervention approach consisting of on-site HBB training coupled with ongoing provider practice and mentorship contributed to an initial striking reduction in NMR that has been sustained over subsequent years. Beyond training, improving access to care through introduction of an ambulance service dedicated to maternal and neonatal patients contributed to significant reduction (25%) in FSBR. Reducing NMR in a low-resource setting is complex, multifactorial and involves targeting the mother in labor and early interventions such as HBB in the delivery room.