O0239 Oct.5: 9:11am - Helping Babies Breathe – A 6-Year Evaluation of Program Effectiveness in Rural Gujarat, India

Background: A major challenge in India is a persistently elevated neonatal mortality rate (NMR), which is among the worst in the world. The NMR in rural India is 33 per 1000 live births which is double the rate of 16 in urban India. Birth asphyxia is a significant cause of neonatal morbidity and mortality. Helping Babies Breathe (HBB) is a protocol designed for health workers to successfully reduce asphyxia-related deaths.
HBB is designed in partnership by the AAP and WHO for low-resource settings
The protocol designates how to successfully navigate the “Golden Minute” to reduce asphyxia-related deaths.
Study

Aim: To evaluate the effectiveness of Helping Babies Breathe in reducing neonatal mortality in rural Gujarat, India.
Study Team: University of Utah faculty, students and local staff. All birth attendants completed a standardized HBB training in 2014 and a refresher course annually. Trained observers measured HBB compliance
Measures for outcome: 1. Hospital staff present during delivery 2. Resuscitation care provided 3. Record of stillbirths and neonatal death
Data Collection Tools included previously evaluated HBB survey for rural India and the hospital death registrar
This study took place in the Mota Fofalia Pediatric Center in Gujarat, India between April 2014 and July 2019.
Data collection method: HBB observers measured HBB compliance during delivery. Observers were instructed not to intervene in local staff actions during the delivery. A retrospective review was completed of the hospital death registrar from 2014-2019

Results: The total number of deliveries observed varied from 49 deliveries in 2014 to 25 deliveries in 2019, with the average being 23 observed deliveries each year. There was a decreasing trend from suctioning observed 100% to 50%. There was a change in proportion of doctors being present at delivery from 29% to 44% and an increasing trend in midwives caring for newborn at time of delivery from 0 to 36%.
There were a total number of 2395 births from 2014 to 2018.
1. There was a decreasing trend in stillbirths was found from 10.47 to 1.46 per thousand live births in the four-year period, with an overall decline in stillbirths of 2 per 1000 each year (R2=0.42) was noted.
2. Perinatal mortality rate (PMR): decreased from 13.09 to 10.19.
3. Neonatal mortality rate (NMR): increased from 2.62 to 8.73 per thousand live births
Implementation of the HBB training program has led to a reduction in stillbirths from 2014 to 2018 lending to the idea that deaths due to previous “stillbirths” may have been due to secondary apnea and not true still births. Increase in protocol compliance as reflected by use of bag and mask, presence of doctors at delivery and care of newborns by midwives could also account for the reduced rate in stillbirths.