title: A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: does Helping Babies Breathe training save lives?
abstract: Whether facility-based implementation of Helping Babies Breathe (HBB) reduces neonatal mortality at a population level in low and middle income countries (LMIC) has not been studied. Therefore, we evaluated HBB implementation in this context where our study team has ongoing prospective outcome data on all pregnancies regardless of place of delivery.
  
  
  
  We compared outcomes of birth cohorts in three sites in India and Kenya pre-post implementation of a facility-based intervention, using a prospective, population-based registry in 52 geographic clusters. Our hypothesis was that HBB implementation would result in a 20 % decrease in the perinatal mortality rate (PMR) among births ≥1500 g.
  
  
  
  We enrolled 70,704 births during two 12-month study periods. Births within each site did not differ pre-post intervention, except for an increased proportion of <2500 g newborns and deliveries by caesarean section in the post period. There were no significant differences in PMR among all registry births; however, a post-hoc analysis stratified by birthweight documented improvement in <2500 g mortality in Belgaum in both registry and in HBB-trained facility births. No improvement in <2500 g mortality measures was noted in Nagpur or Kenya and there was no improvement in normal birth weight survival.
  
  
  
  Rapid scale up of HBB training of facility birth attendants in three diverse sites in India and Kenya was not associated with consistent improvements in mortality among all neonates ≥1500 g; however, differential improvements in <2500 g survival in Belgaum suggest the need for careful implementation of HBB training with attention to the target population, data collection, and ongoing quality monitoring activities.
  
  
  
  The study was registered at ClinicalTrials.gov: NCT01681017 .
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Roopa M
authors.initials: RM
authors.lastname: Bellad
authors.affiliation: Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India.
authors.forename: Akash
authors.initials: A
authors.lastname: Bang
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: Sreelatha
authors.initials: S
authors.lastname: Meleth
authors.affiliation: RTI International, Durham, NC, USA.
authors.forename: Norman
authors.initials: N
authors.lastname: Goco
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.affiliation: Department of Obstetrics and Gynecology, Christiana Care Health Services, Newark, DE, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
authors.affiliation: Lata Medical Research Foundation, Nagpur, India.|Indira Gandhi Government Medical College, Nagpur, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.affiliation: School of Medicine, Indiana University, Indianapolis, IN, USA.
authors.forename: Sherri
authors.initials: S
authors.lastname: Bucher
authors.affiliation: Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Gisore
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA. lindawright.md@gmail.com.|, 5800 Nicholson Lane, #1206, Rockville, MD, 20852, USA. lindawright.md@gmail.com.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000401:mortality* / Q000628:therapy; D036861:Delivery, Obstetric / Q000193:education / Q000639:trends; D005260:Female; D006268:Health Facilities / Q000639:trends; D006801:Humans; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008880:Midwifery / Q000193:education*; D054238:Perinatal Mortality / Q000639:trends*; D011247:Pregnancy; D015397:Program Evaluation; D012151:Resuscitation / Q000193:education*