Willingness to administer mouth-to-mouth ventilation in a first response program in rural Bangladesh.

BACKGROUND: Timely mouth-to-mouth ventilation is critical to resuscitate drowning victims. While drowning is frequent, there are no lay persons trained in cardio-pulmonary resuscitation (CPR) in rural Bangladesh. As part of a feasibility study to create a first response system in a conservative Islamic village environment, a pilot was undertaken to examine willingness to provide mouth-to-mouth ventilation for drowning resuscitation. METHODS: A questionnaire was administered to 721 participants at the beginning of a village-based CPR training course. Trainees were asked regarding willingness to administer mouth-to-mouth ventilation on a variety of hypothetical victims. Responses were tabulated according to the age, sex and relationship of the trainee to the postulated victim. RESULTS: Willingness to deliver mouth-to-mouth ventilation was influenced by sex of a potential recipient and relationship to the trainee. Adolescent participants were significantly more willing to perform mouth-to-mouth ventilation on someone of the same sex. Willingness increased for both sexes when the postulated victim was an immediate family member. Willingness was lower with extended family members and lowest with strangers. Adult trainees were more likely to perform mouth-to-mouth ventilation than adolescent trainees in any scenario. CONCLUSION: Adults express more willingness to resuscitate a broader range of drowning victims than adolescents. However in rural Bangladesh, adolescents are more likely to be in close proximity to a drowning in progress. Further efforts are needed to increase willingness of adolescents to provide resuscitation to drowning victims. However, despite potential cultural limitations, trained responders appear to be willing to give mouth-to-mouth ventilation to various recipients. Final determination will require evidence on response outcomes which is being collected.

Feasibility of a first responder programme in rural Bangladesh.

OBJECTIVES: To develop and implement a first responder training programme, assess the feasibility of training lay persons with low literacy in rural Bangladesh and determine the acceptability of the programme in the community. METHODS: A first responder training programme including cardiopulmonary resuscitation (CPR) was developed covering 20 villages in a rural sub-district in north-central Bangladesh. 2398 participants received training and 2120 graduated over a 14-month period. Responders were a mix of adolescents, community volunteers and community elders. The programme was evaluated through post-training assessment of knowledge and skills of participants and performance evaluation of trainers. A focus group discussion was used to assess the response of community leaders to usefulness and community acceptance of the programme. RESULTS: Materials developed for training include a low-literacy training manual, posters and a training video. Almost 90 per cent (88.4) of participants qualified in post training assessment. Adolescents and community volunteers had higher pass rates than community elders. In all, CPR skills showed a significant decline over 9 months of assessment, while first aid knowledge appeared stable over the same period. Community leaders considered the programme useful for the community and expressed their support for the programme. CONCLUSION: Developing a first responder training programme that includes CPR in a rural Bangladesh community is feasible if participants have secondary school attainment. Adolescents and young adults are suitable candidates. Evaluation is ongoing to see whether the programme graduates were able to reduce morbidity and mortality through effective first response efforts.