Mayer Maria M, Xhinti Nomvuyo, Mashao Lolly, Mlisana Zolile, Bobotyana Luzuko, Lowman Casey, Patterson Janna, Perlman Jeffrey M, Velaphi Sithembiso
Department of Paediatrics, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa.
Division of Education and Training, Helping Babies Breathe Programme, Resuscitation Council of Southern Africa, Johannesburg, South Africa.
Front Pediatr. 2022 May 18;10:872694. doi: 10.3389/fped.2022.872694. eCollection 2022.
Training in the Helping Babies Breathe (HBB) Program has been associated with a reduction in early neonatal mortality rate (ENMR), the neonatal mortality rate (NMR), and fresh stillbirth rate (FSBR) in low- and middle-income countries (LMICs). This program was implemented in five different healthcare facilities in the Oliver Reginald Tambo (ORT) District, South Africa from September 2015 to December 2020.
To determine and compare the FSBR, ENMR, and NMR between 2015 before initiation of the program (baseline) and subsequent years up to 2020 following the implementation of facility-based training of HBB in five hospitals in ORT District.
Records of perinatal statistics from January 2015 to December 2020 were reviewed to calculate FSBR, ENMR, and NMR. Data were collected from the five healthcare facilities which included two district hospitals (Hospital A&B), two regional hospitals (Hospital C&D), and one tertiary hospital (Hospital E). Comparisons were made between pre- (2015) and post- (2016-2020) HBB implementation periods. Differences in changes over time were also assessed using linear regression analysis.
There were 19,275 births in 2015, increasing to 22,192 in 2020 with the majority (55.3%) of births occurring in regional hospitals. There were significant reductions in ENMR (OR-0.78, 95% CI 0.70-0.87) and NMR (OR-0.81, 95% CI 0.73-0.90), but not in FSBR, in the five hospitals combined when comparing the two time periods. Significant reduction was also noted in trends over time in ENMR ( = 0.45, = 0.001) and NMR ( = 0.23, = 0.026), but not in FSBR ( = 0.0, = 0.984) with all hospitals combined. In looking at individual hospitals, Hospital A ( = 0.61, < 0.001) and Hospital E ( = 0.19, = 0.048) showed a significant reduction in ENMR over time, but there were no significant changes in all mortality rates for Hospitals B, C, and D, and for the district or regional hospitals combined.
There was an overall reduction of 22% and 19% in ENMR and NMR, respectively, from pre- to post-HBB implementation periods, although there were variations from year to year over the 5-year period and, across hospitals. These differences suggest that there were other factors that affected the perinatal/neonatal outcomes in the hospital sites in addition to the implementation of training in HBB.
在低收入和中等收入国家（LMICs），参与“帮助婴儿呼吸”（HBB）项目的培训与降低早期新生儿死亡率（ENMR）、新生儿死亡率（NMR）和新鲜死产率（FSBR）相关。该项目于2015年9月至2020年12月在南非奥利弗·雷金纳德·坦博（ORT）区的五个不同医疗机构实施。
确定并比较2015年项目启动前（基线）与2020年ORT区五家医院实施基于机构的HBB培训后的后续年份之间的FSBR、ENMR和NMR。
回顾2015年1月至2020年12月的围产期统计记录，以计算FSBR、ENMR和NMR。数据收集自五个医疗机构，包括两家区级医院（A医院和B医院）、两家地区医院（C医院和D医院）和一家三级医院（E医院）。对HBB实施前（2015年）和实施后（2016 - 2020年）的时期进行比较。还使用线性回归分析评估随时间变化的差异。
2015年有19275例分娩，2020年增至22192例，其中大多数（55.3%）分娩发生在地区医院。在比较两个时间段时，五家医院合并后的ENMR（OR - 0.78，95%CI 0.70 - 0.87）和NMR（OR - 0.81，95%CI 0.73 - 0.90）显著降低，但FSBR未降低。所有医院合并后，ENMR（β = 0.45，P = 0.001）和NMR（β = 0.23，P = 0.026）随时间的趋势也显著降低，但FSBR（β = 0.0，P = 0.984）未降低。在查看各医院时，A医院（β = 0.61，P < 0.001）和E医院（β = 0.19，P = 0.048）随时间ENMR显著降低，但B、C、D医院以及区级或地区医院合并后的所有死亡率均无显著变化。
从HBB实施前到实施后，ENMR和NMR总体分别降低了22%和19%，尽管在这5年期间各年以及各医院之间存在差异。这些差异表明，除了实施HBB培训外，还有其他因素影响医院场所的围产期/新生儿结局。
