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Scaling Up Interventions toManage Birth Asphyxia inBangladeshScaling Up Interventions toManage Birth Asphyxia inBangladesh

Prof. (Dr.) Mohammod Shahidullah

Chairman, Dept. of Neonatology

and

Pro-Vice Chancellor,

Bangabandhu Sheikh Mujib Medical University(BSMMU)

Dhaka, Bangladesh

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Where do newborn babies die?Where do newborn babies die?

99% of newborn deaths are in low/middle income countries

66% in Africa and South Asia

1.5 million (38% ofall newborndeaths) occur in4 countries ofSouth Asia

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4 million newborn deaths – Why?almost all are due to preventable conditions4 million newborn deaths – Why?almost all are due to preventable conditions

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•3% of all newborns in developing countriessuffer from birth asphyxia, of which 23% diewithin neonatal period & an equal numberdevelop neurological sequelae (WHO).

•More than two-thirds of all newborn deaths (2.7million out of 4 million each year) occur in just10 countries.

•Many of these countries have very largepopulations (such as India and China) othershave very high percentage of newborns dying(such as Afghanistan, Congo and Tanzania)countries

Global situationGlobal situation

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Bangaldesh situation:Trends-Child, Infant, Neonatal mortality ratesBangaldesh situation:Trends-Child, Infant, Neonatal mortality rates

Significant Reduction in U-5 and InfantMortality, NMR Stagnant since Mid-90s

Source: BDHS 1993 - 2007

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Bangladesh situation:Neonatal mortalityBangladesh situation:Neonatal mortality

•Neonatal deaths- 57% of all <5 deaths

•One neonate dies every 3-4 minutes

•Neonatal death per year is 120,000

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Bangladesh situation:Causes of neonatal deathsBangladesh situation:Causes of neonatal deaths

BDHS:2004

Infection: 50%

Asphyxia : 21%

LBW/PT : 11%

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Most newborn mortality occurs in first 7days of life – up to 50% in first 24 hoursMost newborn mortality occurs in first 7days of life – up to 50% in first 24 hours

South Asia Newborn Health Investigators Group (Unpublished)

Asphyxia

Infection

LBW

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Bangladesh situationBangladesh situation

•3.8 million babies born/yr in Bangladesh ofwhich 120000 die in the first 28 days of life.

•85% of these deaths are due to perinatalasphyxia, low birth weight (LBW) and neonatalsepsis

•Hospital based study in Bangladesh -- 30 to50% of total Neonatal admission and over 50%of deaths are related to birth asphyxia.

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Bangladesh National Neonatal HealthStrategies and Guidelines (NNHS)Bangladesh National Neonatal HealthStrategies and Guidelines (NNHS)

•Formulated in a participatory manner

•Endorsed by the MOH&FW in May 2009

•Focused on –

–Coverage and capacity

–Management of infection, asphyxia and LBW

–Stronger systems to facilitate community and facilitylevel implementation of interventions

–Ensure policy and resource commitment

•Now in the process of developing the action plan

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Addressing birth asphyxia in NNHSAddressing birth asphyxia in NNHS

•Key strategies –

–Increase capacity for identification

–Strengthening awareness on risk factors andpreventive measures

–Increase coverage and quality of ANC andidentification of high risk cases

–Increase capacity for early management

–Improve post resuscitation referral andmanagement

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Key actions –

•For all levels:

–Increased coverage of skilled birth attendance

–Establish referral linkage

–Improve GO-NGO partnership

–Develop comprehensive BCC plan

•For community level:

–Raise awareness

–Build family capacity

–Training of community based workers

–First line eclampsia management

Addressing birth asphyxia in NNHSAddressing birth asphyxia in NNHS

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Addressing birth asphyxia in NNHSAddressing birth asphyxia in NNHS

Key actions –

•For facility levels

–Enhance capacity for initial and promptmanagement

–Enhance capacity for management forantenatal and obstetric complications

–Enhance capacity for post complicationmanagement

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HBB Initiative: A feasibility study in building skill inbirth asphyxia managementHBB Initiative: A feasibility study in building skill inbirth asphyxia management

Addressing birth asphyxia in NNHSAddressing birth asphyxia in NNHS

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HBB: BackgroundHBB: Background

•A training module (for resuscitation) has been developedby AAP (American Academy of Pediatrics)

•Application was called to test the module: Proposalsubmitted from BSMMU

•Initially two countries ware selected- India and Kenya

•AAP proposed to arrange grant from other source;USAID supported through field funding

•Local management support will be given through Savethe Children USA through MCHIP(MaMoni)

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HBB: GoalHBB: Goal

•The goal of this HBB initiative is to improve theknowledge and skill of the skilled birth attendant(doctors, nurses, FWVs, FWAs, paramedics) toidentify and manage the newborn having birthasphyxia.

•It ultimately will help to reduce neonatal mortalitydue to birth asphyxia.

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•To achieve the above goal the following objectives areidentified:

•To train the service providers (doctors, nurses, FWVs,FWAs, Paramedics) of selected Government and non-government hospitals on essential newborn care andnewborn resuscitation

•To train skilled birth attendant (FWV, FWA, Femalehealth assistant) working at community level onEssential Newborn Care (ENC) and newbornresuscitation

HBB: ObjectivesHBB: Objectives

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•To increase the capacity of skilled birth attendants(SBA) for identification of new-born having birthasphyxia

•To increase the capacity for bag and mask andmouth to mouth resuscitation measures for the SBAinvolved in neonatal care

•To improve post-resuscitation referral and care.

HBB: ObjectivesHBB: Objectives

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HBB: InterventionsHBB: Interventions

•Adaptation, test and introduction of standard HBBcurriculum on Essential newborn care and neonatalresuscitation

•Setting up of a system of training , supervision,monitoring and referral for different level health system

•To train master trainers and trainers on HBB curriculum(Two master trainers trained in India)

•To train service providers (doctors, nurses, FWVs,FWAs, Paramedics) on essential new-born care (ENC)and newborn resuscitation in target areas

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• In NNHS there is provision for operationresearch on Birth Asphyxia management,sepsis management, management of Pre-termand LBW both in facilities and community.

• Considering the above point this HBB studyfinding can be used for scaling up of Birthasphyxia management as per provision ofNNHS.

•The HBB Technical Advisory Group (TAG) willact as an interface and advocate for scale up ata national level

HBB: Scaling up through NNHSHBB: Scaling up through NNHS

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Thank YouThank You