title: Newborn mortality and fresh stillbirth rates in Tanzania after helping babies breathe training.
abstract: BACKGROUND
  Early neonatal mortality has remained high and unchanged for many years in Tanzania, a resource-limited country. Helping Babies Breathe (HBB), a novel educational program using basic interventions to enhance delivery room stabilization/resuscitation, has been developed to reduce the number of these deaths.
  
  
  METHODS
  Master trainers from the 3 major referral hospitals, 4 associated regional hospitals, and 1 district hospital were trained in the HBB program to serve as trainers for national dissemination. A before (n = 8124) and after (n = 78 500) design was used for implementation. The primary outcomes were a reduction in early neonatal deaths within 24 hours and rates of fresh stillbirths (FSB).
  
  
  RESULTS
  Implementation was associated with a significant reduction in neonatal deaths (relative risk [RR] with training 0.53; 95% confidence interval [CI] 0.43-0.65; P ≤ .0001) and rates of FSB (RR with training 0.76; 95% CI 0.64-0.90; P = .001). The use of stimulation increased from 47% to 88% (RR 1.87; 95% CI 1.82-1.90; P ≤ .0001) and suctioning from 15% to 22% (RR 1.40; 95% CI 1.33-1.46; P ≤ .0001) whereas face mask ventilation decreased from 8.2% to 5.2% (RR 0.65; 95% CI 0.60-0.72; P ≤ .0001).
  
  
  CONCLUSIONS
  HBB implementation was associated with a significant reduction in both early neonatal deaths within 24 hours and rates of FSB. HBB uses a basic intervention approach readily applicable at all deliveries. These findings should serve as a call to action for other resource-limited countries striving to meet Millennium Development Goal 4.
authors: Weill Cornell Medical College, 525 East 68th St, Suite N-506, New York, NY 10065, USA.
authors: Georgina
authors: G
authors: Msemo
authors: Augustine
authors: A
authors: Massawe
authors: Donan
authors: D
authors: Mmbando
authors: Neema
authors: N
authors: Rusibamayila
authors: Karim
authors: K
authors: Manji
authors: Hussein Lesio
authors: HL
authors: Kidanto
authors: Damas
authors: D
authors: Mwizamuholya
authors: Prisca
authors: P
authors: Ringia
authors: Hege Langli
authors: HL
authors: Ersdal
authors: Jeffrey
authors: J
authors: Perlman
mesh_terms: D001034:Apgar Score; D001238:Asphyxia Neonatorum / Q000401:mortality* / Q000451:nursing*; D002423:Cause of Death; D002983:Clinical Competence; D003479:Curriculum; D003906:Developing Countries; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000451:nursing; D007318:Inservice Training / Q000458:organization & administration*; D008297:Male; D008880:Midwifery / Q000193:education*; D063087:Noninvasive Ventilation; D015397:Program Evaluation; D012151:Resuscitation / Q000193:education* / Q000451:nursing*; D050497:Stillbirth / Q000453:epidemiology*; D016019:Survival Analysis; D015996:Survival Rate; D013636:Tanzania; D013663:Teaching / Q000458:organization & administration*