title: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Global Health, Massachusetts General Hospital, Boston, USA. krolson@partners.org
authors.forename: Kristian R
authors.initials: KR
authors.lastname: Olson
authors.forename: Aya
authors.initials: A
authors.lastname: Caldwell
authors.forename: Melva
authors.initials: M
authors.lastname: Sihombing
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Guarino
authors.forename: Brett D
authors.initials: BD
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D001238:Asphyxia Neonatorum / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007214:Indonesia; D007226:Infant Mortality; D007231:Infant, Newborn; D008880:Midwifery / Q000193:education*; D011175:Positive-Pressure Respiration / Q000379:methods; D011247:Pregnancy; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D019035:Rural Health Services / Q000592:standards; D015996:Survival Rate; D055815:Young Adult