Dhaka, Bangladesh, April 8, 2015

Helping Babies Survive

What Causes Neonatal Death?

PresenterPresentation NotesDaily risk of death during first month of life based on analysis of 47 DHS datasets (1995-2003) with 10,048 neonatal deaths. Lawn et al

We can Reduce the Main Causes of Neonatal Death

Preterm birth 1. Preterm labor management* 2. Care including Kangaroo mother care (Essential care for small and every baby) 3. Feeding (Essential care for small baby)

Birth complications (and intrapartum stillbirths) 1. Prevention with obstetric care* 2. Essential Newborn Care, (Essential Care for Every baby) 3. Resuscitation* ( Helping Babies Breathe)

Neonatal infections 1. Prevention, (essential care for small and every baby), breastfeeding,

Chlorhexidine* 2. Case management of neonatal sepsis *

* Prioritized by the UN Commission on Life Saving Commodities for Women and Children

EDUCATIONAL DESIGN

SIMPLE HANDS ON CO-OPERATIVE LEARNING

EDUCATIONAL DESIGN PURPOSEFUL DEVELOPMENT OF EDUCATIONAL MODELS

Bag and Mask Ventilation Expression breast milk

Nasogastric tube feeding

EDUCATIONAL DESIGN

ONGOING PROFESSIONAL DEVELOPMENT: Suggestions for practice Ability to practice with partners as modeled in the course Low cost simulators for practice IMPLEMENTATION OF CHANGE: How to start What to monitor Possible options for change

Helping Babies Breathe

PresenterPresentation NotesRather than focusing on the content of these educational programs, I would like instead to examine critically some of the features that make the programs different and increase their effectiveness. At the heart of each program is an Action Plan basically a roadmap for action. This represents a simple series of steps, but a highly refined series of evaluation/decision/action cycles. The graphic format and limited number of steps mean that the Action Plan can be carried around in your head. You and I, whether or not we are speaking the same language will have the same framework in our heads- and prompted by the the cues given by the baby crying, breathing, heart rate- we will both move along the same pathway of resuscitative actions. The graphic Action Plan also emphasizes normal, supportive care (green); steps that mean caution (yellow), and the zone where there is danger (red). In particular The Golden Minute emphasizes that within one minute after birth, a baby should be crying or breathing spontaneously or should have ventilation provided with bag and mask. What has been the impact of this Golden Minute? It has been a powerful device to change behavior and change expectations. A baby who does not breathe or cry is no longer laid aside and classified as a stillbirth, but is immediately provided help to breathe.

Helping Babies Breathe Materials Action Plan

Facilitator Flip Chart Learner Workbook Neonatal Simulator

Bag and Mask Suction Device

PresenterPresentation NotesThe full educational package includes the Action Plan, a Faciliator Flip Chart which amplifies every step of the Action Plan for the learner and serves as an instructor manual for the facilitator, and the Learner Workbook, which serves as a guide for exercises, group discussion , and refresher practice after the course. As part of the educational program, a set of training and clinical devices were purpose-built at a very affordable price a low-tech, high fidelity neonatal simulator, a simplified ventilation bag and mask, and a re-usable bulb suction that can be fully disinfected. Education and clinical equipment are delivered simultaneously so learning can be immediately put into practice.

Change in Skills but not Practice: Observations at Haydom Hospital, Tanzania

Sept 2009 Nov 2010

Scenario (video analysis)

N= 39 N=27

Routine care (% pass) 41 74*

Bag-mask (% pass) 18 74^

Delivery room (observation)

N=2745 N=3116

Stimulation (%) 17.7 14.1*

BMV (%) 8.4 7.5

Time to BMV (sec) 76+54 89+76*

* p

Msemo G et al. Pediatrics 2013; 131:e353

Impact of Low-Dose, High-Frequency Practice: Haydom Hospital, Tanzania

Sept 2009 Nov 2010 Feb 2010- Jan 2011

Feb 2011- Jan 2012

Clinical interventions

Fresh stillbirth (per 1000 live births)

16.0 14.4*

Death < 24 hours (per 1000 live births)

11.1 7.2*

Delivery room (obs) N=2745 N=3116 N=4876 N=4734

Stimulation (%) 17.7 14.1* 14.4 16.0 *

BMV (%) 8.4 7.5 7.2 5.7 +

Time to BMV (%) 76+54 89+76* 89+72 97+74

* p < 0.05 + p =0.03 Ersdal HL et al. Resuscitation 2013; 84:1422

April 2010 HBB training February 2011 LDHF practice

PresenterPresentation NotesLow-dose, high-frequency practice resulted in improved use of stimulation and a decrease in the need for bag and mask ventilation (a good result!).

Essential Care for Every Baby Action Plan

PresenterPresentation NotesCommon color blocks

Essential Care for Every Baby materials

PresenterPresentation NotesAddition of a new element Parent Guide

Essential Care for Every Baby Parent Guide

Essential Care for Every Baby Provider Guide Review and Quality Improvement

PresenterPresentation NotesIncorporation of distinct quality improvement element in Provider Guide

Field Testing

MCQ Pre 19.4/26 Post 25.2/26 Confidence Pre 3.2/5 Post 4.6/5

Nasogastric Tube Feeding

Expression of Breast Milk

THANK YOU!

Help babies breath if they do not cry at birth.

Provide essential care to all

babies. Keep small

babies well and help them grow

Slide Number 1Helping Babies Survive What Causes Neonatal Death?Slide Number 4EDUCATIONAL DESIGN EDUCATIONAL DESIGNEDUCATIONAL DESIGNSlide Number 8Helping Babies Breathe MaterialsChange in Skills but not Practice: Observations at Haydom Hospital, TanzaniaSlide Number 11Impact of Low-Dose, High-Frequency Practice:Haydom Hospital, TanzaniaSlide Number 13Essential Care for Every BabyAction PlanEssential Care for Every BabymaterialsEssential Care for Every BabyParent GuideEssential Care for Every BabyProvider Guide Review and Quality ImprovementSlide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23Slide Number 24Slide Number 25Slide Number 26Slide Number 27