shahidullah_improving newborn resuscitation in bangladesh

8/2/2019 Shahidullah_Improving Newborn Resuscitation in Bangladesh

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Improving Newborn Resuscitation in Bangladesh

Professor (Dr.) Mohammod ShahidullahProject Director HBB National Scale-up Initiative &

Chairman, Neonatology Department and Pro-Vice ChancellorBangabandhu Sheikh Mujib Medical University (BSMMU)Shahbag, Dhaka, Bangladesh

Asia Regional Conference on

Intervention for Impact on Essential

Obstetric and Newborn Care


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Bangladesh Overview

Total Population150 Million

Under 5 year child mortality 53/1000 LB*

Infant Mortality 43/1000 LB*

Newborn Mortality 32/1000 LB*

Maternal Mortality Ratio (BMMS, 2010) 194/100,000 LB**

Total fertility rate ( BDHS 2011) 2.3*

Birth attended by Skilled Birth Attendant 32%*

Postnatal check of newborns by medically

trained attendants within 2 days29%*

Rate of exclusive breast feeding in


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Newborn, Infant and under-five Mortality in

Bangladesh

1-11 Months

Mortality Rate

11/1000LB

(21%)

1-5 Years

Mortality Rate

10/1000LB

(19%)

NMR

32/1000 LB

60%

Bangladesh Demographic Health Survey 2011

In 2008

estimated

113,190 newborndied in

Bangladesh.

2008: CHERG/WHO from

Black et al. Lancet 2010.


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Bangladesh neonatal cause of death changes

Source:2000: Lawn JE et al. Int J Epidemiol. 2006.

2005: Lawn JE, Cousens SN, for the CHERG Neonatal Group. Updated for 2005 with latest covariate data (Nov 2006).

2008: CHERG/WHO from Black et al. Lancet 2010.

Causes 2000 2005 2008

Infection36% 34% 31%

Preterm25% 28% 26%

Asphyxia

(intrapartum-related) 23% 22% 28%Congenital

4% 4% 5%Other

6% 6% 5%Tetanus

4% 4% 2%Diarrhoea

2% 2% 2%


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Proportion of newborn requires support

Source: Wall et al. Int J Gyn and Obstetr 2009; 107: s47-s64.


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Helping Babies Breathe

Helping Babies Breathe is an initiative of the American

Academy of Pediatrics and many partners, including the US Agency for International Development (USAID),

The Eunice Kennedy Shriver National Institute of Child Health and

Human Development (NICHD), and

Saving Newborn Lives/Save the Children. The curriculum was developed with input from the World

Health Organization (WHO).

All this is made possible by an unrestricted educational grant

from the Laerdal Foundation for Acute Medicine, andsupport from Latter-day Saint Charities.


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Helping Babies Breathe is a neonatal

resuscitation curriculum.

Every baby deserves assessment at birth and

simple newborn care

HBB can save lives and give a much better start

to many babies who struggle to breathe at birth.

The focus is to meet the needs of every baby

born.

Helping Babies Breathe


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Baselineevaluation

Survey

Observation

Training ImplementationEndline

evaluation

Survey

Observation

HBB Pilot Study in Bangladesh

BSMMU conducted HBB pilot study in 2010

USAID provided grant to BSMMU through MCHIP(Maternal Child Health Integrated Program)

Save the Children, through MCHIP providesmanagement and technical support

Study Design


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Millstone Dissemination of Pilot Study

September 2010

The Dissemination of the study findings

convinced the policy makers.

Honorable Minister, Ministry of Health and Family

Welfare provided instruction to prepare Scale-up plan

with in 6 months.


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National Scaling-up of HBB in Bangladesh

Development of National HBB Scale-up plan Series of nationalstakeholders consultationworkshops held on todevelop HBB Scale-upstrategy and plan

National HBB scale-upplan developed

HBB training curriculumadopted in line withNNHS and translated.

HBB implementationinitiated


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National Scale-up Plan

Capacity Building

Trained all SBAs of Bangladesh (public sector) Equipped all the facilities of public health sector and all cSBAs with NB

resuscitator and sucker

Quality Assurance

Supervision and monitoring of training

MIS system strengthening and

Evaluation of the HBB scale-up activities

Sustainability

Incorporate HBB curriculum in all relevant in-service and pre-servicecurriculum

Capacity building of the facilities for training & refreshers training.

Routine refreshers training for retention of skinless.


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HBB Training Plan

Training Participants Tentative date Batches

Training of

Master Trainers

Doctors specialists Jun 2011 Jul 2011

3

Training of

Trainers

Doctors fromMedical College Hospital,

District HospitalDistrict Health and FP

officials

Jun 2011 -Jun 2013

60-70

Training of SBA

of all public

health sectors

SBA of all categories Doctors, Nurses, Paramedics,FWVs and cSBAs

Aug 2011-Sep.2013

>1000


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13

Training and equipping

Mannequin (NeoNatalie-Laerdal)

Resuscitator & Suction device

For training andrefreshers training

Kept in all facilities from UHC

and above for refreshers training

For all facilities up-to FWC &

CSBAs for newborn resuscitation Arrangement taken to made them

readily available in all facilities.


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Training and equipping

Action plan

for training and willbe hanged in delivery sites of the

facilities

Flipchart- for training and

kept in facilities for

refreshers training

Learner Workbook-

Will be provided to all

trainee


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2 days TOT in BSMMU

Trainer will return

and provide training to

district and upazila SBAon HBB curriculum

Step-wise TOT and Training

6 district/CC

TOT- Doctors Medical College Hosp (if

any)- 6

District Hospital- 4

DDFP/ CS Office- 2/3

MO and MO-MCHFPfrom Upz- 2

Each StepTotal 11 steps

5-6 batches


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Step-wise Cascade Training

Participants

Medical College Hosp doctors and nurses

District Hospital- doctors and nurses MCWC- all doctors and FWV

UHC- 4-5 Medical Officer and 6 Nurses

FWVs

NGO Doctors and Paramedics (SBA) All CSBAs (FWA & fHA)

Training will start immediately after TOT


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Summary of HBB Training Planning

Period

District/City

Corpn

Training of Trainers Training on HBB Curriculum

Batch Trainers Batch DoctorsNurse/

Paramedics CSBA Total

Jun 11-Sep 11

13 11 210 168 507 1583 1028 2908Oct 11-Sep 12

33 30 598 513 1546 4929 3096 8863

Oct 12-

Sep 13 24 19 370 319 1126 2934 1764 5454

Total

70 60 1178 1000 3179 9446 5888 17225


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Status of HBB Training

Type Batches Participants

Core trainer 12

Master trainer 3 57

ToT 31 606

SSFP service providers 15 275

BRAC service providers 28 542

HBB training at upazila 332 5865

Total- 409 7357

Data as of 19 April 2012


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HBB Scale-up Status

Step 1 districts completedStep 2 districts completedStep 3 districts completedStep 4 districts completed exp KhulnaStep 5 districts TOT starts

Total

Target

Completed %

Districts

and old City

Corp.

70 26 37%

Batches 1100 394 36%

CSBA 5888 2404 41%

Nurse/

Paramedics

9446 3282 35%

Doctors 4357 1549 36%

Total 19691 7235 37%

Data as of 31 March 2012


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MOH&FW (DGFP, DGHS)

Overall implementation TAX/VAT of offshore procurement

MCHIP/Save the Children through USAID Fund Nationwide Implementation, supervision, monitoring and

Evaluation

BSMMU Adaptation of training materials Organize training in all level

Monitoring and supervision

UNICEF

Equipment for district implementing maternal and NB projects, supervision and monitoring

ICDDRB through Save the Children fromLaerdel Foundation Evaluation of HBB scale-up activities

Institutional Arrangement


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Partners of HBB National Scale-up in Bangladesh

Skilled Birth Attendants receiving training on HBB


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Skilled Birth Attendants receiving training on HBB

protocol


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Sabina Yasminwith her baby

who was

resuscitated with

bag & mask on

23rd

November at

Mohammadpur

UHC.

Dr Subol Chandra Borman , RMOresuscitating a newborn baby at

Jointapur UHC on 7th December.


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Thank You

shahidullah_improving newborn resuscitation in bangladesh

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