Abstract
The Helping Babies Breathe program gave major reductions in perinatal mortality in Tanzania from 2009 to 2012. We aimed to study whether this effect was sustained, and whether resuscitation skills changed with continued frequent training. We analysed prospective data covering all births (n = 19,571) at Haydom Lutheran Hospital in Tanzania from July 2013 -June 2018. Resuscitation training was continued during this period. All deliveries were monitored by an observer recording the timing of events and resuscitation interventions. Heart rate was recorded by dry-electrode ECG and bag-mask-ventilation by sensors attached to the resuscitator device. We analyzed changes over time in outcomes, use of resuscitation interventions and performance of resuscitation using binary regression models with the log-link function to obtain adjusted relative risks. With introduction of user fees for deliveries since 2014, the number of deliveries decreased by 30% from start to the end of the five-year period. An increase in low heart rate at birth and need for bag-mask-ventilation indicate a gradual selection of more vulnerable newborns delivered in the hospital over time. Despite this selection, newborn deaths <24 hours did not change significantly and was maintained at an average of 8.8/1000 live births. The annual reductions in relative risk for perinatal death adjusted for vulnerability factors was 0.84 (95%CI 0.76-0.94). During the five-year period, longer duration of bag-mask ventilation sequences without interruption was observed. Delivered tidal volumes were increased and mask leak was decreased during ventilation. The time to initiation or total duration of ventilation did not change significantly. The reduction in 24-hour newborn mortality after introduction of Helping Babies Breathe was maintained, and a further decrease over the five-year period was evident when analyses were adjusted for vulnerability of the newborns. Perinatal survival and performance of ventilation were significantly improved.
Highlights
The reduction of neonatal deaths over the last decade has been modest, despite declining mortality of infants between 1 month and five years of age [1]
With introduction of user fees for deliveries since 2014, the number of deliveries decreased by 30% from start to the end of the five-year period
The reduction in 24-hour newborn mortality after introduction of Helping Babies Breathe was maintained, and a further decrease over the five-year period was evident when analyses were adjusted for vulnerability of the newborns
Summary
The reduction of neonatal deaths over the last decade has been modest, despite declining mortality of infants between 1 month and five years of age [1]. The estimated global neonatal mortality ( 28 days) fell from 31/1000 in 2000 to 18/1000 in 2017 [2]. The annual rate reduction in neonatal mortality was 3.1% compared to 4.7% after the neonatal period. The relative contribution of neonatal deaths in the global under-5-mortality has increased from 39% to 45% [1]. The majority of these neonatal deaths are preventable. Safer births are achievable by improvements in a continuum from pregnancy, obstetric to neonatal care, each accounting for 1/3 of preventable deaths [3]
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