msemo: hbb program in tanzania

7/28/2019 Msemo: HBB Program in Tanzania

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Helping Babies Breathe Program

in Tanzania

Georgina Msemo (MD, Mmed Paed)

Global Newborn Health ConferenceSouth Africa, 16th April 2013


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Background Country Context

Population size 44.9 million (census 2012)

Under five: 7.74 mill

Infant: 1.65 mill

Women of child bearing age 10.4 mill

Live births:1.8mill

Tanzania is divided administratively into:

30 regions (25 Mainland; 5 Zanzibar)

142 LGAs ( Local government authorities)


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Maternal, Newborn and Child Health

Country commitments /targets

MDG 5- reduce maternal mortality rate to

193/100,000 live births by 2015

MDG 4- reduce U5 mortality to 54/ 1000 live

births

MKUKUTA and Election Manifesto reducematernal mortality rate to 264/100,000 live

births and U5MR to 79/1000 by 2010


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Background- Country situation

Situation in 2004/5

DHS 2004/5 showed no improvement in

reduction of maternal and neonatal

mortality

24% Reduction in under-five mortality and

31% reduction in infant mortality (1999-2004)


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National DHS 2004/5 showed child survival gains

162

141136 147

112

91 9287

99

68

3237.9

40.432

145

54.3

0

20

40

60

80

100

120

140

160

180

1990 1992 1996 1999 2004 2009 2015

Mortality(nq0)

Under-five

Infant

Neonatal

MDG Target

An improvement of 24% in under 5 mortality represents

39,200 fewer child deaths per year in Tanzania

-24%

-31%

Source: URT Measure DHS


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Country effort to attain MDG 4

1. Continue with child health interventions atscale:

IMCI (used research for advocacy to scale up)

- Case management Quality of Care at Hospital level

Immunization (through campaign and outreach, nowGAVI HSS opportunity to scale up )

Vitamin A supplementation

Malaria interventions Long Lasting Insecticide Treated Nets (LLINs), Access to Malaria

Treatment

Management of Diarrhoea (ORS/Zinc)


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Country effort to attain MDG 4

2. Strengthen Newborn care by dealing with

major killers of neonates mainly:

Infections-28%

Premature complications-27%

Birth asphyxia- 26%


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Efforts to strengthen newborn

care

Newborn health desk office established in theMinistry of Health-Newborn programming

Adaptation/Review IMCI guidelines at all

levels to include the newborn in the first weekof life-Neonatal Infections

Establishment of Kangaroo mother care

services- Low birth weight babies Newborn Resuscitation program-Reducing

birth asphyxia related mortality


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Birth Asphyxia on "Tanzania's

HBB program."


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HBB-Background

49% of women and their babies do not receive

skilled care during birth (DHS 2010)

The first day at birth especially the first hour is

critical for a newborn survival

Proper monitoring of labour, appropriate

newborns resuscitation are interventions to

reduce newborn deaths


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HBB-Background

Limited resuscitation skills and knowledgeamong service providers.

The number of skilled providers present at

delivery was 15 years


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HBB-Background

High level Political commitment:

His Excellency President Jakaya Kikwete

Statement made in Sept 2007 during 62nd session

UN General Assembly- countries are the MDGtimeline while targets set are not there yet

In 2008 during the Launch of MNCH Roadmap2008-2015 and Deliver now Campaign for

women and children and He wanted to have scaled interventions that are

proved to work rather than pilots


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Components of HBB

The program has:

An intervention component (training)

A research component The Primary Goal- to reduce Birth Asphyxia

related mortality by 50%

A Secondary Goal- to reduce stillbirth deathsby 25%.


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Intervention component

Educational material developed by the AAP

(later translated into Swahili), Neonatalie

model and resuscitation equipment were used

Cascade model approach to train health

providers throughout the country


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Cascade training approach

10,000+

1332

145

40 MasterTrainers

Zonal/Regional

DistrictTrainers

Service

providers

Serviceproviders

Service

providers

Service

Provider

Districttrainers

DistrictTrainers

Zonal/Regional

Zonal/Regional

Zonal/Regional


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Continuing cascade training andrefresher training

Trained providers and trainers:

Continue to provide on job training to other

service providers

Refresher training in the facilities where they

are working.


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National data acquisition and reporting

Each facility reports all births and theiroutcome using existing reporting format.

Weekly notification reporting of all newborn

death. Data compile at health facility on monthly

basis.

Districts /Region compile both a quarterly

report and annual report. Central level receive bi-annually reports from

regions using existing reporting system.


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Master trainers 40 trained in September/October 2009

(WHO support)

Zonal trainers 126 trained in October-December 2009

(WHO support) District trainers 592 trained in December 2009-

December 2012 (UNICEF support)

Service providers 1987 trained up to December support

from some CCHPs (UN JP2 and Laerdal Foundationsupport)

Status of training to date


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Research components

Research sites were 8 ( Eastern Zone -3 and

collaborating institutions; Northern zone -3;

Lake zone -2)

A data collection form with core elements and

desired elements was used


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Program monitoring

Data committee reviews and assesses the

status of implementation

Steering committee ensures the running of

the program


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Variable Pre HBB Post HBB

Number/Total Number (rate/1000)

Risk Reduction

(95% CI)

Neonatal Deaths 24h 107/7969 (13.4) 552/77369 (7.1) 0.53( 0.43-0.65)*

Stillbirths 155/8124(19.0) 1131/78500 (14.4) 0.76(0.64-0.90) **

Perinatal Deaths 262/8124(32.2) 1683/ 78500(21.6) 0.67(0.59-0.76)*

* p < 0.0001, ** p=0.001.

Summary of Neonatal Deaths, Stillbirth Ratesand Perinatal Deaths


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Results Conclusion

HBB implementation is associated with:

HBB implementation was associated with a significant reduction inboth early neonatal deaths within 24 hours and rates of FSB

HBB uses a basic intervention approach readily applicable at all

deliveries.

These findings should serve as a call to action for other resource-limited countries striving to meet Millennium Development Goal

Published in the February 2013 edition Journal of the American Academy ofPediatrics


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Challenges for the current HBB

program

Inadequate supportive supervision to the

sites

Inadequate funds to roll-out cascade

trainings

Inadequate skilled providers

Ensuring availability and maintenance of

equipment


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Scale up plan

Used research findings to acquire CIFF

support- three year program (2012-2015)

Scale up neonatal resuscitation training to

remaining service providers

Improve facility readiness by providing

resuscitation equipment and training

materials

Establish mentorship program for MNCH


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Sustainability Plan

HBB program fully owned by the Ministry

Steps have been taken to ensure newborn resuscitationtraining takes hold in all areas of the medical system.

The HBB curriculum is being introduced into the pre-service midwifery curriculumMidwifery instructors from more than half of the nursing schoolshave already been trained in HBB to be able to train the nextgeneration of service providers.

Districts have already begun to budget for HBB trainingand supervision in their annual budgets

National clinical mentoring system to be developed.


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Acknowledgements

Global Task Force on Resuscitation

Tore Laerdal and the Laerdal Foundation

American Academy of Paediatrics

UN Agency UNICEF and WHO

Children Investment Foundation Fund

SNL/SC- Newborn health programming initiatives

Jeff Pearlman- Weil cornel University


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Asanteni Sana

msemo: hbb program in tanzania

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