Asia Regional Conference on

Intervention for Impact on Essential Obstetric and Newborn Care

Improving Newborn Resuscitation in Bangladesh

Professor (Dr.) Mohammod Shahidullah
Project Director HBB National Scale-up Initiative & Chairman, Neonatology Department and Pro-Vice Chancellor Bangabandhu Sheikh Mujib Medical University (BSMMU) Shahbag, Dhaka, Bangladesh

Bangladesh Overview
Total Population
Under 5 year child mortality Infant Mortality 150 Million 53/1000 LB* 43/1000 LB*

Newborn Mortality Maternal Mortality Ratio (BMMS, 2010) Total fertility rate ( BDHS 2011)
Birth attended by Skilled Birth Attendant

32/1000 LB* 194/100,000 LB** 2.3*

32%*

Postnatal check of newborns by medically trained attendants within 2 days Rate of exclusive breast feeding in <6 month old children

29%*
64%*
* BDHS 2011 ** BMMS 2010

Newborn, Infant and under-five Mortality in Bangladesh

1-5 Years Mortality Rate 10/1000LB (19%) NMR 32/1000 LB 60% 1-11 Months Mortality Rate 11/1000LB (21%)

In 2008 estimated 113,190 newborn died in Bangladesh.

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

Bangladesh Demographic Health Survey 2011

Bangladesh neonatal cause of death changes

Causes
Infection Preterm Asphyxia (intrapartum-related) Congenital Other Tetanus

2000
36% 25% 23% 4% 6% 4%

2005
34% 28% 22% 4% 6% 4%

2008
31% 26% 28% 5% 5% 2%

Diarrhoea

2%

2%

2%

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.

Proportion of newborn requires support

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

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, and support from Latter-day Saint Charities.

Helping Babies Breathe 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.

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 provides

management and technical support

Study Design
Survey Baseline evaluation Observation Survey Endline evaluation Observation

Training

Implementation

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.

National Scaling-up of HBB in Bangladesh

Development of Series of nationalNational HBB Scale-up plan stakeholders consultation workshops held on to develop HBB Scale-up strategy and plan National HBB scale-up plan developed HBB training curriculum adopted in line with NNHS and translated. HBB implementation initiated

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-service curriculum Capacity building of the facilities for training & refreshers training. Routine refreshers training for retention of skinless.

HBB Training Plan

Training Participants Tentative date Batches

Training of Master Trainers

Training of Trainers

Doctors specialists
Doctors from Medical College Hospital, District Hospital District Health and FP officials SBA of all categories Doctors, Nurses, Paramedics, FWVs and cSBAs

Jun 2011 Jul 2011

Jun 2011 Jun 2013

3
60-70

Training of SBA of all public health sectors

Aug 2011Sep.2013

>1000

Training and equipping

Mannequin (NeoNatalie-Laerdal) For training and refreshers training Kept in all facilities from UHC and above for refreshers training

Resuscitator & Suction device For all facilities up-to FWC & CSBAs for newborn resuscitation Arrangement taken to made them readily available in all facilities.
13

Training and equipping

Action plan for training and will be hanged in delivery sites of the facilities

Flipchart- for training and kept in facilities for refreshers training Learner WorkbookWill be provided to all trainee

Step-wise TOT and Training

Total 11 steps

Each Step

6 district/CC
TOT- Doctors Medical College Hosp (if 2 days TOT in BSMMU any)- 6 Trainer will return 5-6 batches District Hospital- 4 and provide training to district and upazila SBA DDFP/ CS Office- 2/3 on HBB curriculum MO and MO-MCHFP from Upz- 2

Step-wise Cascade Training

Training will start immediately after TOT
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)

Summary of HBB Training Planning

District/ City Corpn Training of Trainers
Batch Trainers Batch

Training on HBB Curriculum

Doctors

Period Jun 11Sep 11 Oct 11Sep 12 Oct 12Sep 13

Nurse/ Paramedics

CSBA

Total

13

11

210

168

507

1583

1028

2908

33

30

598

513

1546

4929

3096

8863

24

19

370

319

1126

2934

1764

5454

Total

70

60

1178

1000

3179

9446

5888 17225

Status of HBB Training

Type
Core trainer Master trainer ToT 3 31

Batches

Participants
12 57 606

SSFP service providers

BRAC service providers HBB training at upazila

15
28 332

275
542 5865

Total-

409

7357
Data as of 19 April 2012

HBB Scale-up Status

Total Completed Target
Districts and old City Corp. Batches CSBA 70 26

%
37%

1100 5888

394 2404

36% 41%

Nurse/ Paramedics
Step 1 districts completed Step 2 districts completed Step 3 districts completed Step 4 districts completed exp Khulna Step 5 districts TOT starts

9446
4357 19691

3282
1549 7235

35%
36% 37%

Doctors Total

Data as of 31 March 2012

Institutional Arrangement
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 from Laerdel Foundation

Evaluation of HBB scale-up activities

Partners of HBB National Scale-up in Bangladesh

Skilled Birth Attendants receiving training on HBB protocol

Sabina Yasmin with her baby who was resuscitated with bag & mask on 23rd Dr Subol Chandra Borman , RMO November at resuscitating a newborn baby at Mohammadpur Jointapur UHC on 7th December. UHC.

Thank You