title: The impact of an intervention package promoting effective neonatal resuscitation training in rural China.
abstract: OBJECTIVE
  To evaluate an intervention package promoting effective neonatal resuscitation training at county level hospitals across China.
  
  
  METHODS
  The intervention package was implemented across 4 counties and included expert seminars, training workshops, establishment of hospital-based resuscitation teams, and supervision of training by national and provincial instructors. Upon completing the activities, a survey was conducted in all county hospitals in the 4 intervention counties and 4 randomly selected control counties. Data on healthcare providers' knowledge and self-confidence, and incidence of deaths from birth asphyxia from 2009 to 2011 in all hospitals were collected and compared between the two groups.
  
  
  RESULTS
  Eleven intervention and eleven control hospitals participated in the evaluation, with 97 and 87 health providers, respectively, completing the questionnaire survey. Over 90% of intervention hospitals had implemented neonatal resuscitation related practice protocols, while in control hospitals the proportion was less than 55%. The average knowledge scores of health providers in the intervention and control counties taking a written exam were 9.2±1.2 and 8.4±1.5, respectively (P<0.001) out of maximum possible score of 10, and the average self-confidence scores were 57.3±2.5 and 54.1±8.2, respectively (P<0.001). Incidence of birth asphyxia (defined as 1-min Apgar score≤7) decreased from 8.8% to 6.0% (P<0.001) in the intervention counties, and asphyxia-related deaths in the delivery room decreased from 27.6 to 5.0 per 100,000 (P=0.076). There was no difference over time in asphyxia rates for the control counties.
  
  
  CONCLUSIONS
  The intervention has not only improved skills of health providers, decreased the mortality and morbidity of birth asphyxia, but also resulted in effective implementation of guidelines and protocols within hospitals.
authors.affiliation: National Center for Women's and Children's Health China CDC, Beijing, PR China. Electronic address: xutao6622@163.com.
authors.forename: Tao
authors.initials: T
authors.lastname: Xu
authors.affiliation: National Center for Women's and Children's Health China CDC, Beijing, PR China.
authors.forename: Huishan
authors.initials: H
authors.lastname: Wang
authors.affiliation: National Center for Women's and Children's Health China CDC, Beijing, PR China.
authors.forename: Limin
authors.initials: L
authors.lastname: Gong
authors.affiliation: Peking University Third Hospital, PR China.
authors.forename: Hongmao
authors.initials: H
authors.lastname: Ye
authors.affiliation: Tinghua University First Hospital, PR China.
authors.forename: Renjie
authors.initials: R
authors.lastname: Yu
authors.affiliation: Peking Union Medical College Hospital, PR China.
authors.forename: Danhua
authors.initials: D
authors.lastname: Wang
authors.affiliation: Beijing Maternity Hospital affiliated with Capital Medical University, PR China.
authors.forename: Lixin
authors.initials: L
authors.lastname: Wang
authors.affiliation: Peking University First Hospital, PR China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Feng
authors.affiliation: Division of Neonatal and Developmental Medicine, Stanford University, USA.
authors.forename: Henry Chong
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Division of Neonatology, St. Christopher's Hospital for Children, USA.
authors.forename: Jane Ellen
authors.initials: JE
authors.lastname: McGowan
authors.affiliation: National Center for Women's and Children's Health China CDC, Beijing, PR China. Electronic address: zt@chinawch.org.cn.
authors.forename: Tong
authors.initials: T
authors.lastname: Zhang
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education*; D002681:China; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018743:Perinatal Care / Q000592:standards*; D011785:Quality Assurance, Health Care; D012424:Rural Population; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Asphyxia neonatorum; China; In-service training; Intervention; Neonatal mortality; Resuscitation