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Scaling Up Interventions to Scaling Up Interventions to Manage Birth Asphyxia in Manage Birth Asphyxia in

Bangladesh Bangladesh

Prof. (Dr.) Mohammod ShahidullahChairman, Dept. of Neonatology

andPro-Vice Chancellor,

Bangabandhu Sheikh Mujib Medical University (BSMMU)

Dhaka, Bangladesh

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Where do newborn babies die?Where do newborn babies die?

99% of newborn deaths are in low/middle income countries 66% in Africa and South Asia

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

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

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• 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

Global situation Global situation

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

50

3125

133

116

9488

65

5252

6566

31

87 82

37414248

52

0

20

40

60

80

100

120

140

160

180

1993 1997 2001 2004 2007 2010 MDG Target

U-5

MR

per

100

0 LB

U-5 mortality IMR Newborn mortality

Significant Reduction in U-5 and Infant

Mortality, NMR Stagnant since Mid-90s

Source: BDHS 1993 - 2007

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Bangladesh situation: Bangladesh situation: Neonatal mortalityNeonatal mortality

• Neonatal deaths- 57% of all <5 deaths

• One neonate dies every 3-4 minutes

• Neonatal death per year is 120,000

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Bangladesh situation: Bangladesh situation: Causes of neonatal deathsCauses of neonatal deaths

Unspecified4%

Possible Serious Infections

34%

Birth Asphyxia21%

LBW/PMB11%

Birth Injury4%

Others2%

Undetermined3%

ARI10%

Diarrhoea1%ARI+Diarr

1%N. Tetanus

4%

Cong. Abnorm5%

BDHS:2004

Infection: 50%

Asphyxia : 21%

LBW/PT : 11%

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

South Asia Newborn Health Investigators Group (Unpublished)

0

100

200

300

400

500

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

Age at death (day)

Nu

mb

er o

f d

eath

s

0

20

40

60

80

100

Cu

mu

lati

ve f

req

uen

cy (

%)

AsphyxiaInfection

LBW

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Bangladesh situation 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.

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Bangladesh National Neonatal Health Bangladesh National Neonatal Health Strategies and Guidelines (NNHS)Strategies and Guidelines (NNHS)

• 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

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Addressing birth asphyxia in NNHSAddressing birth asphyxia in 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

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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 NNHSAddressing birth asphyxia in NNHS

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Addressing birth asphyxia in NNHSAddressing 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

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HBB Initiative: HBB Initiative: A feasibility study in building skill in A feasibility study in building skill in

birth asphyxia managementbirth asphyxia management

Addressing birth asphyxia in NNHSAddressing birth asphyxia in NNHS

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HBB: BackgroundHBB: Background

• 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)

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HBB: GoalHBB: Goal

• 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.

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• 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: ObjectivesHBB: Objectives

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• 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: ObjectivesHBB: Objectives

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HBB: InterventionsHBB: 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

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• 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

HBB: Scaling up through NNHS HBB: Scaling up through NNHS

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Thank YouThank You