1. Course: Helping Babies Breathe (HBB) is a new evidence-based neonatal resuscitation education curriculum specifically designed for low resource countries Goal: Describe efficacy of teaching HBB in the real-world setting of Maseru, Lesotho Background: First hour & day are critical times in newborn survival, 60-70% of neonatal deaths occur within 24 hrs 1,2 Common causes of neonatal death 3 : Birth asphyxia Infection Prematurity ~27-30% of neonatal deaths are from birth asphyxia or failure to initiate and sustain breaths at birth 4 Lesotho: Population ~2 million 5 Infant mortality 91/1000 live births (2010) 6 Course: Helping Babies Breathe (HBB) is a new evidence-based neonatal resuscitation education curriculum specifically designed for low resource countries Goal: Describe efficacy of teaching HBB in the real-world setting of Maseru, Lesotho Background: First hour & day are critical times in newborn survival, 60-70% of neonatal deaths occur within 24 hrs 1,2 Common causes of neonatal death 3 : Birth asphyxia Infection Prematurity ~27-30% of neonatal deaths are from birth asphyxia or failure to initiate and sustain breaths at birth 4 Lesotho: Population ~2 million 5 Infant mortality 91/1000 live births (2010) 6 Knowledge, Skills, and Use of Neonatal Resuscitation in Lesotho, Before and After Participation in a Helping Babies Breathe Train-the-Trainer Program Jennifer Werdenberg MD *~, Rebecca Hoban MD MPH +, Acacia Cognata MD MSPH *, Asad Moten BS #, Norma Perez DO **, Lineo Thahane *~ MD, Edith Mohapi, MD *~, Elizabeth Montgomery MD MPH *~^ *Baylor College of Medicine Dept. of Pediatrics, ~Baylor International Pediatric AIDS Initiative (BIPAI); +Tufts U. Dept. of Pediatrics, Section of Neonatology; # Harvard-MIT School of Bioengineering; **UT-H Dept. of Pediatrics, Section of Infectious Diseases; ^Baylor College of Medicine, Dept. of Pediatrics, Section of Retrovirology & Global Health Methods: Evaluation of improved knowledge via: Pre- and post-testing of knowledge via 16-question multiple-choice questionnaire (MCQ) Pre- and post-test bag-mask ventilation (BMV) skills assessed using 7-item validated checklist Post-training objective structured clinical exams (OSCE) utilizing case-based neonatal scenarios OSCE #1: scenario required learner to perform stimulation & suctioning on mannequin OSCE #2: scenario required full resuscitation of mannequin with BMV & heart rate checks Post-course qualitative survey Evaluation of knowledge retention and dissemination of course by trainers via: 3-8 and 9-12 month follow-up post-test (remaining data will be collected 9-12 months after course) 9-12 month survey (remaining data will be collected 9-12 months after course) Methods: Evaluation of improved knowledge via: Pre- and post-testing of knowledge via 16-question multiple-choice questionnaire (MCQ) Pre- and post-test bag-mask ventilation (BMV) skills assessed using 7-item validated checklist Post-training objective structured clinical exams (OSCE) utilizing case-based neonatal scenarios OSCE #1: scenario required learner to perform stimulation & suctioning on mannequin OSCE #2: scenario required full resuscitation of mannequin with BMV & heart rate checks Post-course qualitative survey Evaluation of knowledge retention and dissemination of course by trainers via: 3-8 and 9-12 month follow-up post-test (remaining data will be collected 9-12 months after course) 9-12 month survey (remaining data will be collected 9-12 months after course) Learner characteristics (n = 17) 15/17 (88%) of learners are nurse midwives 13/17 (76%) work in community-level clinic or health center 4/17 (24%) work at a district, regional, or national hospital 17/17 (100%) report previous use of BMV, although not all report previous training 5/17 (29%) had been trained on a simulator before this course Learner characteristics (n = 17) 15/17 (88%) of learners are nurse midwives 13/17 (76%) work in community-level clinic or health center 4/17 (24%) work at a district, regional, or national hospital 17/17 (100%) report previous use of BMV, although not all report previous training 5/17 (29%) had been trained on a simulator before this course Quantitative Results: Comparison of post-test knowledge MCQ taken immediately after the course and 3-8 mo after the course revealed no significant change in score, p >0.01. Qualitative results: Learners report confidence that they could save lives at birth and teach these skills to others Learners report plans to train others within 6 months Conclusions: Newborn resuscitation knowledge significantly improved and was retained 3 months after course Bag-mask ventilation skills significantly improved after HBB course Post-training OSCE scores indicate learner competency to perform basic neonatal resuscitation [1] Lawn, JE, Lee ACC, Kinney M, et al. Two million intrapartum-related stillbirths and neonatal deaths: where, why and what can be done? Int J Gynaecol Obstet. 2009; 07(suppl 1)S5-S18, S19 [2] Kruger C, Niemi M, Espeland H et al. The effects of standardised protocols of obstetric and neonatal care on perinatal and early neonatal mortality at a rural hospital in Tanzania. Int Health 2012;4(1):55-62 [3] Black RE, Cousens S, Johnson HL, et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730)1969-1987 [4] Mwaniki MK, Atieno M, Lawn JE, Newton CR. Long term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet. 2012;379 (9814)445-452 [5] Department of economic and social affairs population division (2009) world population prospects table A1 2008 revision. UN Retrieved 3/12/2009 [6] Lesotho MOH annual joint review report 2011 Quantitative Results: Comparison of post-test knowledge MCQ taken immediately after the course and 3-8 mo after the course revealed no significant change in score, p >0.01. Qualitative results: Learners report confidence that they could save lives at birth and teach these skills to others Learners report plans to train others within 6 months Conclusions: Newborn resuscitation knowledge significantly improved and was retained 3 months after course Bag-mask ventilation skills significantly improved after HBB course Post-training OSCE scores indicate learner competency to perform basic neonatal resuscitation [1] Lawn, JE, Lee ACC, Kinney M, et al. Two million intrapartum-related stillbirths and neonatal deaths: where, why and what can be done? Int J Gynaecol Obstet. 2009; 07(suppl 1)S5-S18, S19 [2] Kruger C, Niemi M, Espeland H et al. The effects of standardised protocols of obstetric and neonatal care on perinatal and early neonatal mortality at a rural hospital in Tanzania. Int Health 2012;4(1):55-62 [3] Black RE, Cousens S, Johnson HL, et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730)1969-1987 [4] Mwaniki MK, Atieno M, Lawn JE, Newton CR. Long term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet. 2012;379 (9814)445-452 [5] Department of economic and social affairs population division (2009) world population prospects table A1 2008 revision. UN Retrieved 3/12/2009 [6] Lesotho MOH annual joint review report 2011

2. [1] Lawn, JE, Lee ACC, Kinney M, et al. Two million intrapartum-related stillbirths and neonatal deaths: where, why and what can be done? Int J Gynaecol Obstet. 2009; 07(suppl 1)S5-S18, S19 [2] Kruger C, Niemi M, Espeland H et all. The effects of standardised protocols of obstetric and neonatal care on perinatal and early neonatal mortality at a rural hospital in Tanzania. Int Health 2012;4(1):55-62 [3] Black RE, Cousens S, Johnson HL, et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730)1969-1987 [4] Mwaniki MK, Atieno M, Lawn JE, Newton CR. Long term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet. 2012;379 (9814)445-452 [5] Department of economic and social affairs population division (2009) world population prospects table A1 2008 revision. UN Retrieved 3/12/2009 [6]Lesotho MOH annual joint review report 2011