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
Prof. (Dr.) Mohammod Shahidullah
Chairman, Dept. of Neonatology
Bangabandhu Sheikh Mujib Medical University (BSMMU)
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
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
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
Asphyxia : 21%
LBW/PT : 11%
South Asia Newborn Health Investigators Group (Unpublished)
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
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
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:
Build family capacity
Training of community based workers
First line eclampsia management
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
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)
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.
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
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.
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