Impact of Neonatal Resuscitation Capacity Building of Birth Attendants on Stillbirth Rate at Public Health Facilities in Uttar Pradesh, India

ABSTRACT

Objective: To document the impact of neonatal resuscitationcapacity building of birth attendants at district and sub-districtlevel on fresh stillbirth within the public health system in India.Design: An implementation research using pre-post studydesign.Setting: 3 high-infant and neonatal mortality districts (Gonda,Aligarh and Raebareli) of Uttar Pradesh, India.Participants: Pregnant women who delivered at the healthfacilities and their newborns.Interventions: An intervention package with (i) training onessential newborn care resuscitation; (ii) skill laboratoriesestablishment for peer-interactive learning; (iii) betterdocumentation; and (iv) supportive supervision was implementedat all health facilities in the districts.Main outcome measures: Impact on fresh stillbirth rates andresuscitation practices were documented at 42 health facilities(Gonda-17, Aligarh-8 and Raebareli-17) over 12-18 months.Results: Out of the 3.3% (4431/133627) newborns requiringresuscitation, 58.5% (n=2599) were completely revived, 19%(n=842) had some features of hypoxic insult after birth and 1.4%(n=62) were stillbirths. There was 15.6% reduction in still birth ratein the three districts with the intervention package.Conclusion: The reduction in still birth rate and improvement innewborn resuscitation efforts in the three districts indicatedfeasibility of implementation and scalability of the interventionpackage. However sustenance of the impact over longer periodneeds documentation