Predictors of 24-h outcome in newborns in need of positive pressure ventilation at birth.

BACKGROUND: Birth asphyxia, defined as 5-minute Apgar score <7 in apneic newborns, is a major cause of newborn mortality. Heart rate (HR) response to ventilation is considered an important indicator of effective resuscitation. OBJECTIVES: To describe the relationship between initial HR in apneic newborns, HR responses to ventilation and 24-h survival or death. METHODS: In a Tanzanian hospital, data on all newborns ≥34 weeks gestational age resuscitated between June 2013-January 2017 were recorded using self-inflating bags containing sensors measuring ventilation parameters and expired CO2, dry-electrode electrocardiography sensors, and trained observers. RESULTS: 757 newborns of gestational age 38 ±â€¯2 weeks and birthweight 3131 ±â€¯594 g were included; 706 survived and 51 died. Fetal HR abnormalities (abnormal, undetectable or not assessed) increased the risk of death almost 2-fold (RR = 1.77; CI: 1.07, 2.96, p = 0.027). For every beat/min increase in first detected HR after birth the risk of death was reduced by 2% (RR = 0.98; CI: 0.97, 0.99, p < 0.001). A decrease in HR to <100 beats/minute when ventilation was paused increased the risk of death almost 2-fold (RR = 1.76; CI: 0.96, 3.20, p = 0.066). An initial rapid increase in HR to >100 beats/min in response to treatment reduced the risk of dying by 75% (RR = 0.25; CI: 0.14, 0.44, p < 0.001). A 1% increase in expired CO2 was associated with 28% reduced risk of death (RR = 0.72; CI: 0.62,0.85, p < 0.001). CONCLUSIONS: The risk of death in apneic newborns can be predicted by the fetal HR (absent or abnormal), initial newborn HR (bradycardia), and the HR response to ventilation. These findings stress the importance of reliable fetal HR monitoring during labor and providing effective ventilation following birth to enhance survival.

Factors affecting effective ventilation during newborn resuscitation: a qualitative study among midwives in rural Tanzania.

BACKGROUND: Intrapartum-related hypoxia accounts for 30% of neonatal deaths in Tanzania. This has led to the introduction and scaling-up of the Helping Babies Breathe (HBB) programme, which is a simulation-based learning programme in newborn resuscitation skills. Studies have documented ineffective ventilation of non-breathing newborns and the inability to follow the HBB algorithm among providers. OBJECTIVE: This study aimed at exploring barriers and facilitators to effective bag mask ventilation, an essential component of the HBB algorithm, during actual newborn resuscitation in rural Tanzania. METHODS: Eight midwives, each with more than one year's working experience in the labour ward, were interviewed individually at Haydom Lutheran Hospital, Tanzania. The audio recordings were transcribed and translated into English and analysed using qualitative content analysis. RESULTS: Midwives reported the ability to monitor labour properly, preparing resuscitation equipment before delivery, teamwork and frequent ventilation training as the most effective factors in improving actual ventilation practices and promoting the survival of newborns. They thought that their anxiety and fear due to stress of ventilating a non-breathing baby often led to poor resuscitation performance. Additionally, they experienced difficulties assessing the baby's condition and providing appropriate clinical responses to initial interventions at birth; hence, further necessary actions and timely initiation of ventilation were delayed. CONCLUSIONS: Efforts should be focused on improving labour monitoring, birth preparedness and accurate assessment immediately after birth, to decrease intrapartum-related hypoxia. Midwives should be well prepared to treat a non-breathing baby through high-quality and frequent simulation training with an emphasis on teamwork training.

Cancer of the cervix: knowledge and attitudes of female patients admitted at Muhimbili National Hospital, Dar es Salaam.

OBJECTIVES: To determine the level of knowledge of basic symptoms of cancer of the cervix among Tanzanian females and to determine causes of late presentation with advanced disease among cancer patients. DESIGN: Hospital based cross-sectional study. SETTING: Muhimbili National Hospital, Dar es Salaam, Tanzania. SUBJECTS: Eighty nine cervical cancer patients and 178 controls were interviewed between August 1999 and January 2000. Data was analyzed using Epi-Info version 6.04. RESULTS: At Muhimbili National Hospital most patients are admitted in very advanced stages of the disease (Stage IIb and IV). We determined, using a structured questionnaire, knowledge of basic symptoms of cancer of the cervix, attitude and reasons for late presentation among female patients admitted at Muhimbili National Hospital gynaecological ward. The mean age of cases was 48.8(SD11.1) years and the mean parity was 6.7 years were comparable to that of control, which were 45 years(SD10.8) and mean parity of 6.6 respectively. Mean age in years at marriage was lower for cases 17.5(SD 2.9) than controls 18.8(SD3.5). Majority of cases (50.6%) and controls (23.6%) were illiterate, and 21.3% of cases and 33.7% of controls had incomplete primary education. Majority of both cases (47.23%) and controls (56.7%) had no routine gynaecological examination and they did not find it necessary. More than 90% of the cases were in advanced stages of the disease (stage IIb-IV). CONCLUSION: Both cases and controls had low knowledge of basic symptoms of cancer of the cervix and as a result most of those who happen to have problems reported late with advanced disease.