Newborn Resuscitation Scale Up and Retention Program Associated with Improved Neonatal Outcomes in Western Nepal

Background: The adoption of the Helping Babies Breath (HBB) tool has improved the outcomes of neonatal resuscitation following intrapartum events. Perinatal asphyxia however remains a leading cause of neonatal morbidity and mortality in Nepal. HBB training has proven effective, but a major challenge is maintaining resuscitation skills over time. Safa Sanaulo Nepal (SSN) designed an evidence-based strategy for scaling up training and sustaining long-term retention. This paper describes the implementation of SSN’s model, and changes in newborn outcomes that occurred during the program. Methods and findings: The skills retention strategy relied on facility-based trainers to scale up and maintain resuscitation skills in 18 facilities in the area of Nepalgunj, Nepal. A single external mentor coached and assisted the facility-based trainers, provided general support, and monitored progress. Prospective outcome monitoring tracked changes in health metrics for a period of 24 months (March 2018 to March 2020). During this time, 46 facility-based trainers taught resuscitation skills to 1,785 midwives, nurses, and physicians, and supported skill retention with limited data gathered on neonatal health outcomes of 49,809 vaginal deliveries and 12,823 Caesarean sections. To analyze changes over the time SSN’s program was implemented, a comparison of beginning (first three months of assessment) and follow-up (last three months) rates of neonatal mortality, morbidity, and stillbirths was conducted. The total number of births assessed in this comparison was 15,947. Results indicate mortality dropped 60% (p = 0.01), morbidity dropped 77% (p = 0.01), and intrapartum stillbirths dropped 73% (p = 0.001) from beginning to follow-up. Conclusions: SSN’s model provides a valuable example of how an evidence-based program focusing on facility-based trainers, who are mentored and supported to scale-up and sustain resuscitation skills over time, may have a substantial influence on critical neonatal outcomes. This program demonstrated that capacity building required minimal external support and expense, with a single mentor mentoring, supporting, and monitoring 18 facilities. Future programs working to reduce neonatal mortality, morbidity, and intrapartum stillbirths may incorporate program elements to further improve neonatal outcomes.