Abstract
BackgroundPrevention of adverse perinatal outcome using the Helping Babies Breathe (HBB) neonatal resuscitation algorithm can reduce perinatal mortality in low income settings. Mercy Ships is a non-governmental organisation providing free healthcare education in sub-Saharan Africa and in an attempt to reach more rural areas of Madagascar with our neonatal resuscitation training we designed a novel approach in collaboration with US Peace Corps Volunteers (PCV). PCVs work in rural areas and contribute to locally determined public health initiatives.MethodWe used a model of knowledge translation and implementation to train non-medical PCVs in HBB who would then train rural healthcare workers. Bulb suction and a self-inflating bag were donated to each health centre. We evaluated knowledge translation and behaviour change at 4 months using the Kirkpatrick model of evaluation.ResultsTen PCVs received training and then trained 42 healthcare workers in 10 rural health centres serving a combined population of over 1 million. Both PCVs and rural healthcare workers showed significant increases in knowledge and skills (p < 0.001). The commonest behaviour changes persisting at 4 months were adequate preparation before delivery; use of rubbing and drying as a means of stimulation instead of foot tapping or back slapping; and use of the self-inflating bag to give respirations. Anecdotal evidence of changes in neonatal outcome were reported in several health care centres.ConclusionOur study demonstrates that non-medically trained PCVs can be used to successfully train rural healthcare workers in newborn resuscitation using the HBB algorithm and this results in improvements in personal and organizational practice at 4 months, including anecdotal evidence of improved patient outcome. Our novel method of training, including the provision of essential equipment, may be another tool in the armamentarium of those seeking to disseminate good practice to the most rural areas.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-016-0207-3) contains supplementary material, which is available to authorized users.
Highlights
Prevention of adverse perinatal outcome using the Helping Babies Breathe (HBB) neonatal resuscitation algorithm can reduce perinatal mortality in low income settings
While primary prevention is likely to have the biggest impact on outcome, secondary prevention using the Helping Babies Breathe (HBB) neonatal resuscitation algorithm [10], and other simple resuscitation techniques can effectively reduce perinatal mortality [11,12,13,14] even in resource limited settings
Strategies for prevention of adverse perinatal outcome can be divided into 3 phases (i) primary prevention of insult with adequate fetal monitoring, correct use of the partogram, and timely obstetric intervention; (ii) secondary prevention after the insult by immediate basic resuscitation of the non-breathing baby; (iii) tertiary prevention of complications in the baby by adequate postnatal treatment [9]
Summary
Prevention of adverse perinatal outcome using the Helping Babies Breathe (HBB) neonatal resuscitation algorithm can reduce perinatal mortality in low income settings. Mercy Ships is a non-governmental organisation providing free healthcare education in sub-Saharan Africa and in an attempt to reach more rural areas of Madagascar with our neonatal resuscitation training we designed a novel approach in collaboration with US Peace Corps Volunteers (PCV). Strategies for prevention of adverse perinatal outcome can be divided in to 3 phases: (i) primary prevention of insult; (ii) secondary prevention after the insult; (iii). While primary prevention is likely to have the biggest impact on outcome, secondary prevention using the Helping Babies Breathe (HBB) neonatal resuscitation algorithm [10], and other simple resuscitation techniques can effectively reduce perinatal mortality [11,12,13,14] even in resource limited settings. HBB uses a low-tech, neonatal simulator (NeoNatalie, Laerdal Medical) to train birth attendants (of various skill levels), and is included in the WHO Essential Newborn Care Course [15]
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