First Breath Stillbirths reduced through newborn care training
Karachi, Pakistan, March 1, 2010: One in 10 newborns in Pakistan are either stillborn – in many cases because the baby fails to start breathing – or die within seven days of birth. But newborn stillbirths in Pakistan and five other developing countries dropped by almost a third when rural health workers received newborn care training, including skills to resuscitate babies, according to a study published in the New England Journal of Medicine with research contributed by Aga Khan University’s Department of Community Health Sciences (CHS). The World Health Organization (WHO) estimates there are more than three million stillbirths worldwide each year with almost 70 per cent in sub-Saharan Africa and South Asia, including Pakistan, where the majority of births are handled by unskilled attendants. The study tested the efficacy of a three-day WHO Essential Newborn Care training regimen that covers basic newborn care techniques, the importance of early breastfeeding, how to keep infants warm and dry, and signs of serious health problems.
“Through the training we tried to bring important skills for newborn care to communities,” said Dr Imtiaz Jehan, Associate Professor, CHS, who headed the research in Pakistan. “These may be simple interventions, but they can help build capacity and make a huge impact.”
Under the study, one health professional each from Argentina, the Democratic Republic of Congo, Guatemala, India, Pakistan and Zambia travelled to the US to learn essential newborn care techniques. These six returned home to train others, ultimately reaching 3,600 nurses, midwives and birth attendants in rural communities, using a train-the-trainers model that proved very effective. The study, in Thatta District, involved over 650 birth attendants in 16 union councils covering doctors, lady health visitors, nurses, midwives and traditional birth attendants from over 85 private and government health facilities, working in health care facilities as well as at homes. Each attendant was provided the essential newborn care training as well as scales to accurately measure birth weight, hand-held pumps and masks to fill babies’ lungs with air, and clean-delivery kits to prevent infection. The greatest decrease in stillbirth rates was among deliveries attended by nurses, midwives, and traditional attendants, all of whom, the researchers believe, would likely not have received such training. Dr Jehan said, “It is clear that there are low-cost, effective solutions available, which are essential for countries like ours, where physicians are not always readily available.”
The study, the largest of its kind, was conducted at study sites that are part of the Global Network (GN) for Women’s and Children’s Health Research, a collaborative effort of the National Institute of Child Health and Human Development (NICHD), the National Institutes of Health and international, multidisciplinary teams of investigators. Their mission is to expand scientific knowledge, develop research infrastructures and improve health outcomes by building partnerships to conduct research on feasible, cost-effective, sustainable interventions for addressing the major causes of newborn, child and maternal deaths in the developing world. The Pakistan site of GN is a collaboration between AKU, through Senior Investigator, Dr Omrana Pasha, and Drexel University, USA, through Principal Investigator, Dr Robert L. Goldenberg. The NICHD, along with the Bill and Melinda Gates Foundation, funded the study.