P0254 - Comparison of the Neonatal Resuscitation Education (Helping Babies Breathe) and Resource Needs Between Selected Health Care Facilities in Bangladesh, Pakistan, and Yemen

Background:
Birth asphyxia is defined by the World Health Organization as “the failure to initiate and sustain breathing at birth”, contributing to ∼ 30% of neonatal deaths worldwide. Helping Babies Breathe (HBB) is an evidence-based education program designed to teach basic neonatal resuscitation techniques in resource-limited settings. Bangladesh, Pakistan, and Yemen are identified as countries high on the United Nations Sustainable Development Goals (UN – SDG) needs index, where early neonatal mortality is high. This study aimed to determine gaps in neonatal resuscitation training and provision of care in selected health care facilities in three countries.

Methods:
We surveyed birth attendants of their neonatal resuscitation training and equipment needs in three regions of the world: the Rohingya refugee camp and host community in Cox’s Bazar, Bangladesh; government hospitals in Sayoun, and Ma’rib, Yemen; and charity Indus Hospital, Karachi, Pakistan, prior to implementation of a HBB training program. After informed consent, the survey was administered to participants, to evaluate the prevalence of previous neonatal resuscitation training and assess the gaps where HBB could have an impact.
Findings:
Between June and November 2019, 302 individuals completed the survey, amongst the three countries. Of respondents, 237/302 (78.5%) were female. 143/302 (47.4%) identified as midwives, 75/302 (24.8%) nurses, 50/302 (16.6%) doctors, and 34/302 (11.3%) other. The majority of trainees were nurses in Yemen (66.7%) and Pakistan (52.3%), whereas midwives were the majority discipline of the trainees in Bangladesh (78.5%).
Of respondents, Yemen had the most respondents with prior training in HBB: 25/39 (64.1%), compared to Bangladesh (58/177 (32.8%)) and Pakistan (10/86 (11.6%)). Chi-square test (1, N=302) = 35.4, p = 0.00001. Further, Yemen also had the most respondents who had prior training in any neonatal resuscitation: 37/39 (94.8%) versus Bangladesh (87/177 (49.2%)) or Pakistan (24/86 (27.9%)). Chi-square test (1,N=302) = 48.2, p = 0.00001.
Regarding equipment, 65/177 (36.7%) of respondents in Bangladesh reported they lacked materials specific to newborn care in their facility; 13/177 (7.3%) responded they did not have a bag/mask device. Of respondents in Yemen, 14/39 (35.9%) lacked some supplies needed for newborn care, and 9/39 (23.1%) lacked a bag/mask device. In contrast, only 3/86 (3.5%) respondents in Pakistan indicated they had equipment needs, and none required bag/mask devices. This difference in equipment needs was significant (Chi-square test (1, N=302) = 34.1, p = 0.00001.

Interpretation:
In selected health care facilities in Bangladesh, Pakistan, and Yemen, a significant proportion of birth attendants had either no training in neonatal resuscitation, and/or lacked supplies to provide neonatal resuscitation. This study highlights the neonatal resuscitation education gap which may be closed through Helping Babies Breathe; along with the provision of basic neonatal resuscitation supplies, there may be opportunity to narrow disparities in global neonatal mortality.