title: Stillbirth and newborn mortality in India after helping babies breathe training.
abstract: OBJECTIVE
  This study evaluated the effectiveness of Helping Babies Breathe (HBB) newborn care and resuscitation training for birth attendants in reducing stillbirth (SB), and predischarge and neonatal mortality (NMR). India contributes to a large proportion of the worlds annual 3.1 million neonatal deaths and 2.6 million SBs.
  
  
  METHODS
  This prospective study included 4187 births at >28 weeks' gestation before and 5411 births after HBB training in Karnataka. A total of 599 birth attendants from rural primary health centers and district and urban hospitals received HBB training developed by the American Academy of Pediatrics, using a train-the-trainer cascade. Pre-post written trainee knowledge, posttraining provider performance and skills, SB, predischarge mortality, and NMR before and after HBB training were assessed by using χ(2) and t-tests for categorical and continuous variables, respectively. Backward stepwise logistic regression analysis adjusted for potential confounding.
  
  
  RESULTS
  Provider knowledge and performance systematically improved with HBB training. HBB training reduced resuscitation but increased assisted bag and mask ventilation incidence. SB declined from 3.0% to 2.3% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.98) and fresh SB from 1.7% to 0.9% (OR 0.54, 95% CI 0.37-0.78) after HBB training. Predischarge mortality was 0.1% in both periods. NMR was 1.8% before and 1.9% after HBB training (OR 1.09, 95% CI 0.80-1.47, P = .59) but unknown status at 28 days was 2% greater after HBB training (P = .007).
  
  
  CONCLUSIONS
  HBB training reduced SB without increasing NMR, indicating that resuscitated infants survived the neonatal period. Monitoring and community-based assessment are recommended.
authors: Department of Physiology, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India 590010. sgoudar@jnmc.edu
authors: Shivaprasad S
authors: SS
authors: Goudar
authors: Manjunath S
authors: MS
authors: Somannavar
authors: Robert
authors: R
authors: Clark
authors: Jocelyn M
authors: JM
authors: Lockyer
authors: Amit P
authors: AP
authors: Revankar
authors: Herta M
authors: HM
authors: Fidler
authors: Nancy L
authors: NL
authors: Sloan
authors: Susan
authors: S
authors: Niermeyer
authors: William J
authors: WJ
authors: Keenan
authors: Nalini
authors: N
authors: Singhal
mesh_terms: D001238:Asphyxia Neonatorum / Q000401:mortality* / Q000451:nursing*; D002983:Clinical Competence; D003479:Curriculum; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D007231:Infant, Newborn; D007318:Inservice Training / Q000458:organization & administration*; D008297:Male; D008880:Midwifery / Q000193:education*; D063087:Noninvasive Ventilation / Q000401:mortality / Q000451:nursing*; D011247:Pregnancy; D011446:Prospective Studies; D012151:Resuscitation / Q000193:education* / Q000401:mortality / Q000451:nursing*; D050497:Stillbirth / Q000453:epidemiology*; D015996:Survival Rate; D013663:Teaching / Q000458:organization & administration*