Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.
Jhpiego, Dar es Salaam, Tanzania.
Pediatrics. 2017 May;139(5). doi: 10.1542/peds.2016-2132. Epub 2017 Apr 17.
This first-ever country-level study assesses the implementation of the Helping Babies Breathe (HBB) program in 15 of Tanzania's mainland regions by measuring coverage, adoption and retention of provider skills, acceptability among providers, and barriers and challenges to at-scale implementation.
Longitudinal facility-level follow-up visits assessed provider resuscitation knowledge and skills in using objective structured clinical examinations and readiness of facilities to resuscitate newborns, in terms of birth attendants trained and essential equipment available and functional. Focus group discussions were held with providers to determine the acceptability, challenges, and barriers to implementation of the HBB program.
Immediately after HBB training, 87.1% of providers passed the objective structured clinical examination. This number dropped to 79.4% at 4 to 6 weeks and 55.8% at 4 to 6 months ( < .001). Noting this fall-off in skills, the program implemented structured on-the-job training and supportive supervisory visits, which were associated with an improvement in skill retention. At long-term follow-up, >90% of facilities had bag-mask devices available to all beds in the labor and delivery ward, and 96% were functional. Overall, providers were highly satisfied with the HBB program but thought that the 1-day training used in Tanzania was too short, so they would welcome additional training and follow-up visits to reinforce skills.
The HBB program in Tanzania has gained acceptability and shown success in equipping providers with neonatal resuscitation knowledge, skills, and supplies. However, assessing the program's impact on neonatal mortality has proven challenging.
本研究首次评估了坦桑尼亚 15 个大陆地区实施 Helping Babies Breathe（HBB）项目的情况，通过衡量提供者技能的覆盖范围、采用率和保留率、提供者的可接受性，以及在大规模实施方面的障碍和挑战，来评估该项目。
通过使用客观结构化临床考试评估提供者复苏知识和使用技能，以及设施对新生儿复苏的准备情况，包括培训的接生员和可用的基本设备及功能，进行纵向机构层面的后续访问。与提供者举行焦点小组讨论，以确定 HBB 项目的可接受性、实施挑战和障碍。
HBB 培训后，立即有 87.1%的提供者通过了客观结构化临床考试。这一数字在 4 至 6 周时下降到 79.4%，在 4 至 6 个月时下降到 55.8%（<0.001）。鉴于技能的下降，该项目实施了结构化的在职培训和支持性监督访问，这与技能保留的提高有关。在长期随访中，>90%的设施在分娩和产房的所有床位都配备了袋面罩设备，且 96%的设备是功能正常的。总体而言，提供者对 HBB 项目非常满意，但认为坦桑尼亚使用的 1 天培训时间太短，因此他们欢迎额外的培训和随访访问，以加强技能。
坦桑尼亚的 HBB 项目已经获得了接受，并成功地为提供者提供了新生儿复苏的知识、技能和用品。然而，评估该项目对新生儿死亡率的影响一直具有挑战性。
