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 mouth-to-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 US dollars 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 US dollars 13 per death averted.
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 mouth-to-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 US dollars 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 US dollars 13 per death averted.
Authors: Waldemar A Carlo; Linda L Wright; Elwyn Chomba; Elizabeth M McClure; Maria E Carlo; Carla M Bann; Monica Collins; Hillary Harris Journal: J Pediatr Date: 2008-12-05 Impact factor: 4.406
Authors: Gary L Darmstadt; Anne C C Lee; Simon Cousens; Lynn Sibley; Zulfiqar A Bhutta; France Donnay; Dave Osrin; Abhay Bang; Vishwajeet Kumar; Steven N Wall; Abdullah Baqui; Joy E Lawn Journal: Int J Gynaecol Obstet Date: 2009-10 Impact factor: 3.561
Authors: Gary L Darmstadt; Shams El Arifeen; Yoonjoung Choi; Sanwarul Bari; Syed M Rahman; Ishtiaq Mannan; Peter J Winch; A S M Nawshad Uddin Ahmed; Habibur Rahman Seraji; Nazma Begum; Robert E Black; Mathuram Santosham; Abdullah H Baqui Journal: Health Policy Plan Date: 2009-11-16 Impact factor: 3.344
Authors: Anne C C Lee; Luke C Mullany; James M Tielsch; Joanne Katz; Subarna K Khatry; Steven C LeClerq; Ramesh K Adhikari; Shardaram R Shrestha; Gary L Darmstadt Journal: Pediatrics Date: 2008-05 Impact factor: 7.124
Authors: Anne C C Lee; Luke C Mullany; James M Tielsch; Joanne Katz; Subarna K Khatry; Steven C LeClerq; Ramesh K Adhikari; Shardaram R Shrestha; Gary L Darmstadt Journal: Pediatrics Date: 2008-05 Impact factor: 7.124
Authors: Gary L Darmstadt; Yoonjoung Choi; Shams E Arifeen; Sanwarul Bari; Syed M Rahman; Ishtiaq Mannan; Habibur Rahman Seraji; Peter J Winch; Samir K Saha; A S M Nawshad Uddin Ahmed; Saifuddin Ahmed; Nazma Begum; Anne C C Lee; Robert E Black; Mathuram Santosham; Derrick Crook; Abdullah H Baqui Journal: PLoS One Date: 2010-03-24 Impact factor: 3.240
Authors: Charles Opondo; Stephen Ntoburi; John Wagai; Jackline Wafula; Aggrey Wasunna; Fred Were; Annah Wamae; Santau Migiro; Grace Irimu; Mike English Journal: Trop Med Int Health Date: 2009-08-19 Impact factor: 2.622
Authors: Abdullah H Baqui; Saifuddin Ahmed; Shams El Arifeen; Gary L Darmstadt; Amanda M Rosecrans; Ishtiaq Mannan; Syed M Rahman; Nazma Begum; Arif B A Mahmud; Habibur R Seraji; Emma K Williams; Peter J Winch; Mathuram Santosham; Robert E Black Journal: BMJ Date: 2009-08-14