P0259 - Helping Babies Breathe (HBB): A veritable tool in reducing asphyxia related neonatal morbidity and mortality in hospitals in Ikorodu, Lagos state, Nigeria.

BACKGROUND
Neonatal deaths account for 45% of under-five mortality globally. Nigeria has a Neonatal Mortality Rate (NMR) of 39/1000 live births (NDHS 2018). Asphyxia related deaths account for a third of all neonatal mortality in Nigeria.
Lagos state of Nigeria has a high neonatal mortality {NMR of 35/1000 live birth (NDHS 2018)} and Ikorodu Local Government area (LGA) has one of the highest neonatal mortality rates in the state. Asphyxia related deaths account for 35.8% of all neonatal deaths in Lagos (NHQI).
The reduction of asphyxia related morbidity and mortality is the focus of the Helping Babies Breath (HBB) curriculum, a component of the Essential Newborn Care Course (ENCC) adapted from WHO and AAP (American Academy of Pediatrics) for community health care workers (HCWS).
Our aims were:
- Capacity building in neonatal resuscitation for 1,200 HCWs at primary and secondary health care facilities in Ikorodu LGA
- Assess knowledge and skill retention rates of trained HCWs one year after training
- Measure the impact of training after a one year period on both perinatal asphyxia and neonatal mortality.

METHODOLOGY
Pre-training assessment of neonatal services in Ikorodu LGA was carried out. Over an 18-month period, 48 doctors and nurses were trained as facilitators. They in turn stepped down in 20 trainings to HCWs providing newborn care services in the 23 public Primary Health Care facilities, 3 General Hospitals as well as 14 Private Hospitals in Ikorodu LGA. Training was done using the HBB curriculum. There was a pre and post test knowledge assessment during the training session and also one year after. Assessment of knowledge acquisition was also done during the trainings and one year later.
DISCUSSION
A total of 831 HCWs were trained which is 69.2% of the target population. There was a significant knowledge acquisition in the immediate post training period (p <0.001) as assessment scores increased from 81.9% to 95.2%. Following the impact assessment one year later, there was a reduction in asphyxia related admissions and mortality at the two biggest hospitals evaluated. There was also a significant improvement in newborn outcomes (p=0.04 and 0.012). As seen in similar studies, there was a significant loss in bag and mask skills with a reduction in scores from 89.4% to 84.9% (p<0.001).
This interventional project was well subscribed to by both public and private hospitals, leading to improved linkages and better collaboration thus encouraging early and prompt referrals when needed.

Conclusion:
HBB training led to a significant improvement in newborn outcomes and should be made mandatory for all HCWs involved in newborn care. It has proven to be a significant tool in reducing asphyxia related newborn morbidity and mortality in hospitals.