Management of Birth Asphyxia in Home Deliveries in Rural Gadchiroli: The Effect of Two Types of Birth Attendants and of Resuscitating with Mouth-to-Mouth, Tube-Mask or Bag–Mask

Abstract

OBJECTIVES:To evaluate the effect of home-based neonatal care on birth asphyxia and to compare the effectiveness of two types of workers and three methods of resuscitation in home delivery. STUDY DESIGN:In a field trial of home-based neonatal care in rural Gadchiroli, India, birth asphyxia in home deliveries was managed differently during different phases. Trained traditional birth attendants (TBA) used mouthto-mouth resuscitation in the baseline years (1993 to 1995). Additional village health workers (VHWs) only observed in 1995 to 1996. In the intervention years (1996 to 2003), they used tube-mask (1996 to 1999) and bag-mask (1999 to 2003). The incidence, case fatality (CF) and asphyxia-specific mortality rate (ASMR) during different phases were compared. RESULTS:During the intervention years, 5033 home deliveries occurred. VHWs were present during 84% home deliveries. The incidence of mild birth asphyxia decreased by 60%, from 14% in the observation year (1995 to 1996) to 6% in the intervention years (p<0.0001). The incidence of severe asphyxia did not change significantly, but the CF in neonates with severe asphyxia decreased by 47.5%, from 39 to 20% (p<0.07) and ASMR by 65%, from 11 to 4% (p<0.02). Mouth-to-mouth resuscitation reduced the ASMR by 12%, tube-mask further reduced the CF by 27% and the ASMR by 67%. The bag-mask showed an additional decrease in CF of 39% and in the fresh stillbirth rate of 33% in comparison to tube-mask (not significant). The cost of bag and mask was $13 per averted death. Oxytocic injection administered by unqualified doctors showed an odds ratio of three for the occurrence of severe asphyxia or fresh stillbirth. CONCLUSIONS:Home-based interventions delivered by a team of TBA and a semiskilled VHW reduced the asphyxia-related neonatal mortality by 65% compared to only TBA. The bag-mask appears to be superior to tube-mask or mouth-to-mouth resuscitation, with an estimated equipment cost of $13 per death averted.

Rates, timing and causes of neonatal deaths in rural India: implications for neonatal health programmes

“…Neonatal deaths in India AH Baqui et al 6,23,27 The definition used in this study was found to have more than 70% sensitivity and specificity in Bangladesh. 22,25 The proportion of deaths assigned to some causes, particularly sepsis/pneumonia or prematurity, are highly dependent upon their placement within the hierarchy.…”

“…Symptoms of respiratory illness are thought to be difficult to elicit from verbal autopsy interviews 20,25,26 and the definition of sepsis or pneumonia used here could include both viral and bacterial infections of various etiologies. Likewise, the definition used for preterm birth ("baby very small or smaller than 6,23,27 The definition used in this study was found to have more than 70% sensitivity and specificity in Bangladesh. 22,25 The proportion of deaths assigned to some causes, particularly sepsis/pneumonia or prematurity, are highly dependent upon their placement within the hierarchy.…”

Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review

“…The remaining 13 references, which pertained to 5 trials, were included in the review. [18][19][20][21][22][23][24][25][26][27][28][29][30] Trial characteristics Table 2 summarizes the characteristics of included trials, all of which were conducted in southern Asian countries with high baseline neonatal mortality rates (> 45 deaths per 1000 live births). Sylhet 18 and Shivgarh 20 trials were cluster-randomized and provided cluster-adjusted mortality data.…”

Risk factors for adverse outcome in asphyxiated new born in Eastern Nepal

“…6 The national neonatology forum of india has defined birth asphyxia as gasping and ineffective breathing or lack of breathing at 1 minute after birth. 7 Neonatal deaths account for 40% of all deaths among children under five among which 80% neonatal deaths are due to prematurity and low-birth-weight, infections, asphyxia and birth trauma. 8 So, by decreasing birth asphyxia related death we can significantly decrease under five mortality.…”