Abstract
BackgroundHigh-quality resuscitation among non-crying babies immediately after birth can reduce intrapartum-related deaths and morbidity. Helping Babies Breathe program aims to improve performance on neonatal resuscitation care in resource-limited settings. Quality improvement (QI) interventions can sustain simulated neonatal resuscitation knowledge and skills and clinical performance. This study aimed to evaluate the effect of a scaled-up QI intervention package on the performance of health workers on basic neonatal resuscitation care among non-crying infants in public hospitals in Nepal.MethodsA prospective observational cohort design was applied in four public hospitals of Nepal. Performances of health workers on basic neonatal care were analysed before and after the introduction of the QI interventions.ResultsOut of the total 32,524 births observed during the study period, 3031 newborn infants were not crying at birth. A lower proportion of non-crying infants were given additional stimulation during the intervention compared to control (aOR 0.18; 95% CI 0.13–0.26). The proportion of clearing the airway increased among non-crying infants after the introduction of QI interventions (aOR 1.23; 95% CI 1.03–1.46). The proportion of non-crying infants who were initiated on BMV was higher during the intervention period (aOR 1.28, 95% CI 1.04–1.57) compared to control. The cumulative median time to initiate ventilation during the intervention was 39.46 s less compared to the baseline.ConclusionQI intervention package improved health workers’ performance on the initiation of BMV, and clearing the airway. The average time to first ventilation decreased after the implementation of the package. The QI package can be scaled-up in other public hospitals in Nepal and other similar settings.
Highlights
High-quality resuscitation among non-crying babies immediately after birth can reduce intrapartumrelated deaths and morbidity
This study aimed to evaluate the effect of this scaled-up Quality improvement (QI) package on the performance of health workers on basic neonatal resuscitation care in those hospitals
A lower proportion of non-crying infants were stimulated during the intervention (83.8%) than that in control period (96.7%)
Summary
High-quality resuscitation among non-crying babies immediately after birth can reduce intrapartumrelated deaths and morbidity. Helping Babies Breathe program aims to improve performance on neonatal resuscitation care in resource-limited settings. This study aimed to evaluate the effect of a scaled-up QI intervention package on the performance of health workers on basic neonatal resuscitation care among non-crying infants in public hospitals in Nepal. The Helping Babies Breathe (HBB) program was initiated to improve health workers’ performance on basic resuscitation care in resource-limited settings [6]. Studies show that the HBB program improves the timely initiation of bag and mask ventilation (BMV) and reduce early neonatal mortality and stillbirths [7,8,9] Despite these efforts, low-andmiddle income countries are still struggling to improve the performance of health workers and to reduce intrapartum-related deaths at scale [10,11,12]. Quality improvement (QI) interventions including frequent skill drills, continuous mentoring, and frequent training sessions have the potential to sustain and transfer simulated neonatal resuscitation knowledge and skills into clinical performance [12, 14, 16, 17]
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