Scaling up interventions to manage birth asphyxia in bangladesh
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Scaling Up Interventions to Manage Birth Asphyxia in Bangladesh. Prof. (Dr.) Mohammod Shahidullah Chairman, Dept. of Neonatology and Pro-Vice Chancellor, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh. Where do newborn babies die?.

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Scaling Up Interventions to Manage Birth Asphyxia in Bangladesh

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Scaling Up Interventions to Manage Birth Asphyxia in Bangladesh

Prof. (Dr.) Mohammod Shahidullah

Chairman, Dept. of Neonatology


Pro-Vice Chancellor,

Bangabandhu Sheikh Mujib Medical University (BSMMU)

Dhaka, Bangladesh

Where do newborn babies die?

1.5 million (38%of all newborn deaths) occur in 4 countries of South Asia

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

66% in Africa and South Asia

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

Global situation

3% of all newborns in developing countries suffer from birth asphyxia, of which 23% die within neonatal period & an equal number develop neurological sequelae (WHO).

More than two-thirds of all newborn deaths (2.7 million out of 4 million each year) occur in just 10 countries.

Many of these countries have very large populations (such as India and China) others have very high percentage of newborns dying (such as Afghanistan, Congo and Tanzania) countries

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

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

Source: BDHS 1993 - 2007

Neonatal deaths- 57% of all <5 deaths

One neonate dies every 3-4 minutes

Neonatal death per year is 120,000

Bangladesh situation: Neonatal mortality

Bangladesh situation: Causes of neonatal deaths

Infection: 50%

Asphyxia : 21%

LBW/PT : 11%


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




South Asia Newborn Health Investigators Group (Unpublished)

Bangladesh situation

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

85% of these deaths are due to perinatal asphyxia, low birth weight (LBW) and neonatal sepsis

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

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 facility level implementation of interventions

Ensure policy and resource commitment

Now in the process of developing the action plan

Bangladesh National Neonatal Health Strategies and Guidelines (NNHS)

Key strategies –

Increase capacity for identification

Strengthening awareness on risk factors and preventive measures

Increase coverage and quality of ANC and identification of high risk cases

Increase capacity for early management

Improve post resuscitation referral and management

Addressing birth asphyxia in NNHS

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 NNHS

Key actions –

For facility levels

Enhance capacity for initial and prompt management

Enhance capacity for management for antenatal and obstetric complications

Enhance capacity for post complication management

Addressing birth asphyxia in NNHS

HBB Initiative: A feasibility study in building skill in birth asphyxia management

Addressing birth asphyxia in NNHS

A training module (for resuscitation) has been developed by AAP (American Academy of Pediatrics)

Application was called to test the module: Proposal submitted 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 Save the Children USA through MCHIP(MaMoni)

HBB: Background

The goal of this HBB initiative is to improve the knowledge and skill of the skilled birth attendant (doctors, nurses, FWVs, FWAs, paramedics) to identify and manage the newborn having birth asphyxia.

It ultimately will help to reduce neonatal mortality due to birth asphyxia.

HBB: Goal

To achieve the above goal the following objectives are identified:

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

To train skilled birth attendant (FWV, FWA, Female health assistant) working at community level on Essential Newborn Care (ENC) and newborn resuscitation

HBB: Objectives

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

To increase the capacity for bag and mask and mouth to mouth resuscitation measures for the SBA involved in neonatal care

To improve post-resuscitation referral and care.

HBB: Objectives

HBB: Interventions

Adaptation, test and introduction of standard HBB curriculum on Essential newborn care and neonatal resuscitation

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

HBB: Scaling up through NNHS

In NNHS there is provision for operation research on Birth Asphyxia management, sepsis management, management of Pre-term and LBW both in facilities and community.

Considering the above point this HBB study finding can be used for scaling up of Birth asphyxia management as per provision of NNHS.

The HBB Technical Advisory Group (TAG) will act as an interface and advocate for scale up at a national level

Thank You

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