Helping Babies Breathe annual
meeting
Prof Bogale Worku
Washington DC
July 17/ 2012
3
Ethiopia’s Progress to meet MDG 4.
Neonatal mortality rate
Mortality per 1000 live births
300
Under 5 mortality rate
MDG 4 Target
200
88
100
68
37
0
1960
1965
1970
1975
1980
2000 EDHS
48/1000
2005 EDHS
2010 EDHS
Target
38/1000
37/1000 , SBA <10%
?25/1000
1985
1990
1995
2000
2005
2010*
2015
According to 2008 National
EmONC assessment, 66 % of
HCs did not have a
resuscitation bag and mask.
Data sources: Updated from Opportunities for Africa’s Newborns with UN data from www.childmortality.org. * 2010 year contains 2008 data
National scale up strategy of HBB in
Ethiopia
• Govt ownership with extensive collaboration among all
maternal, newborn and child health partners
• HBB is integrated in existing and new trainings and
programs:
–
–
–
–
–
–
–
NBC training /Newborn corner ,
NICU nurse training ,
CEmONC / BEmONC,
PMTCT,
ICCM, New IMNCI
Pre-service training for midwifes
Others
National scale up strategy cont.
• Rollout strategy for Ethiopia
– Champions and high level advocacy
– Government coordination with all MNCH partners
– Master level TOT for trainers and supervisors of
existing MNCH training programs
– UNICEF making available resuscitation equipment
and for both training and service
– No specific budget needed as the program is
rolled out through integration though existing
programs
TOT Addis Ababa
TOT Addis Ababa
Evaluation - Newborn Corner
• The newborn corner is an initiative to address gaps in
preventing newborn morbidity and mortality by
ensuring standard newborn care immediately after
birth in health facilities.
• Piloting in 100 facilities by EPS in collaboration with
FMoH and UNICEF
 354 HW including MDs, HOs, midwifes and clinical
nurses
 3 days on ENC, HBB, KMC and sepsis management
 providing supplies and clinical mentoring post training.
The newborn corner
Trained personnel to care for the baby
A warm and clean surface
Essential newborn resuscitation equipments
Evaluation - Results
• Baseline and end line assessment in 60
facilities looking at knowledge, skills and
availability of basic resuscitation equipment
The newborn corner
Comparison % health workers skill on neonatal
resuscitation on base line and end line survey
Number of newborn with asphyxia
(one month in 60 health facilities )
Number of
deliveries
Still
birth(%)
Number of babies not
breathing at birth and
required resuscitation (%)
Survived
After
resuscitation
Case
fatality
from PNA
8080
453(5.6)
212 (2.6)
180 (84.9)
32 (17.77)
Results to date in Ethiopia
• Carders trained on HBB by 31 June 2012
Health workers 7 295
HEWs
20 050
Total
27 345
• Bag and mask distributed by 31 April 2012
Health centers
354
Hospitals
50
Total
404 out of 3000 HF (13,5%)
• Resuscitation equipment available 8 000, plus an
additional 10 000 to arrive shortly in Ethiopia. In
addition 2 000 NeoNatalie training dolls are available in
Ethiopia for HBB training.
Quality improvement process
• Neonatal registration book in place
• Supportive supervision and clinical mentoring
post-training
• Guidelines and protocols for newborn
resuscitation is being under development
• Quarterly / annual review meetings planned
Lessons learned
• Integration has been a successful way to quickly train
and orient a large number of health workers and
community health workers (HEWs) on HBB in Ethiopia.
• Having a strong governmental leadership with close
collaboration among partners is the only way to make
changes to newborn survival in a large country with
limited funding sources.
• Making training material and resuscitation equipment
available has helped the HBB rollout.
• Early data shows that the training on HBB among HWs
has improved their skills.
However…
• Still only around 10% of deliveries are
conducted in health facilities, and only 1% of
the HEW have the opportunity to conduct
deliveries.
• Data on newborns not yet systematically
collected as current HMIS does not fully
address NB issues
Acknowledgements
•
•
•
•
FMoH
UNICEF
WHO
ICAP – Ethiopia
Thank
you