Brigham Young University, Provo, UT, USA.
Children's Medical Mission, Kathmandu, Nepal.
Glob Health Sci Pract. 2023 Feb 28;11(1). doi: 10.9745/GHSP-D-22-00046.
Intrapartum events leading to asphyxia at birth are a leading cause of neonatal morbidity and mortality in Nepal. In response, the Nepal Ministry of Health and Population adopted the Helping Babies Breathe (HBB) training curriculum in 2015 as a tool to improve neonatal resuscitation and outcomes. Although the effectiveness of HBB training has been well documented, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN) designed an evidence-based intervention for scaling up newborn resuscitation training and skill retention. We report on its implementation and the changes in newborn outcomes during the program period.
The program empowered facility-based trainers in newborn resuscitation and skill retention at 12 facilities in Gandaki Province. Seven of 14 level I hospitals and 5 of 6 level II hospitals were selected. A single external mentor coached the facility-based trainers, provided general support, and monitored progress. Program evaluation tracked changes in newborn metrics over 21 Nepali months (March 2018-November 2019). All deliveries occurring in the health facilities during the program period were included in the evaluation. We assessed program effectiveness by analyzing time trends of neonatal mortality, morbidity, and stillbirths.
We gathered data on neonatal health outcomes of 33,417 deliveries, including 23,820 vaginal deliveries and 9,597 cesarean deliveries. During the program, 43 facility-based trainers taught resuscitation skills to 425 medical personnel and supported skill retention. Neonatal deaths within 24 hours of birth (incidence rate ratio [IRR]=0.993, =.044) and newborn morbidities (IRR=0.996, <.001) showed a significantly declining trend.
Our findings suggest that the SSN program had a substantial influence on critical neonatal outcomes. Future neonatal resuscitation capacity-building and skill retention efforts may benefit from incorporating elements of the program.
导致新生儿窒息的分娩期事件是尼泊尔新生儿发病率和死亡率的主要原因。为此，尼泊尔卫生和人口部于 2015 年采用了《帮助婴儿呼吸》（HBB）培训课程，作为改善新生儿复苏和结果的工具。尽管 HBB 培训的有效性已得到充分证明，但在保持技能方面仍存在挑战。Safa Sunaulo Nepal（SSN）设计了一项基于证据的干预措施，以扩大新生儿复苏培训和技能保留。我们报告其实施情况以及该方案期间新生儿结局的变化。
该方案在加德满都省的 12 个设施中为新生儿复苏和技能保留的机构培训师提供了支持。从 14 家一级医院中选择了 7 家，从 6 家二级医院中选择了 5 家。一名外部导师为机构培训师提供了新生儿复苏方面的辅导、提供一般支持并监测进展。方案评估跟踪了 21 个尼泊尔月（2018 年 3 月至 2019 年 11 月）期间新生儿指标的变化。该方案期间在卫生设施中发生的所有分娩均包括在评估中。我们通过分析新生儿死亡率、发病率和死产的时间趋势来评估方案的效果。
我们收集了 33417 例分娩的新生儿健康结局数据，包括 23820 例阴道分娩和 9597 例剖宫产。在该方案期间，43 名机构培训师向 425 名医务人员传授了复苏技能并支持技能保留。出生后 24 小时内新生儿死亡（发病率比[IRR]=0.993，<.044）和新生儿发病率（IRR=0.996，<.001）呈显著下降趋势。
我们的研究结果表明，SSN 方案对关键新生儿结局产生了重大影响。未来的新生儿复苏能力建设和技能保留工作可能受益于该方案的实施。
