Community-based newborn resuscitation among frontline providers in a low-resource country

Abstract

Objective: To evaluate a birth asphyxia management program among community midwives in a low-resource rural setting.

Methods: Concise training with provision of positive-pressure ventilation devices was implemented in Indonesia in 2005. The effectiveness of the intervention among community-based midwives between October 2007 and September 2008 was evaluated. The intervention cohort was compared with a neighboring control cohort.

Results: Overall, 242 intervention and 106 control midwives were surveyed. In total, 3116 births were attended, 84.0% of deliveries occurred at home, and 97.4% of midwives had not previously owned a resuscitation device. When positive-pressure ventilation was administered, newborn survival on day 1 was equivalent in the 2 cohorts (88.4% versus 84.4%; P=0.66). However, significantly more newborns in the intervention group underwent ventilation (risk ratio 2.3; 95% confidence interval, 1.4-8.0). The intervention group had significantly greater scores on both knowledge (t[144.35]=10.52; P<0.001) and confidence (t[134.17]=11.66; P<0.001).

Conclusion: Focused community-based resuscitation training and device delivery resulted in a significantly increased proportion of newborns receiving life-saving positive-pressure breaths, in addition to improved provider knowledge and confidence. Furthermore, the program demonstrated the establishment of an effective training infrastructure within a disrupted health system.