Improving newborn resuscitation in Uganda

Every year an estimated four million newborns die during their first month of life. Half of these deaths occur in the first 24 hours after birth, often as a result of asphyxia. Evidence demonstrates that immediate resuscitation of asphyxiated newborns can significantly reduce asphyxia-related newborn mortality. But challenges remain in ensuring the implementation of this evidence-based practice in low resource settings. In 2011, the USAID Health Care Improvement Project (HCI) applied modern quality improvement (QI) methods to build the capacity of facilities in two districts in Uganda to routinely detect and resuscitate asphyxiated newborns. A baseline assessment demonstrated that health providers at the primary care level lacked essential resuscitation skills and supplies and considered resuscitation to be a sophisticated procedure that could only be performed in a referral hospital. HCI engaged facilities in a collaborative QI initiative to bring resuscitation services to the primary care level. The intervention included developing provider resuscitation skills using locally developed models and coordinating with the national Helping Babies Breathe program to ensure sustained availability of essential resuscitation supplies. After 10 months of implementation, the proportion of providers who could successfully carry-out all resuscitation steps on a model increased from 16 to 62%. Consequently, among 936 deliveries conducted in 34 health facilities in the two districts in September 2011, all 95 asphyxiated newborns received resuscitation, 77% of them successfully, demonstrating rapid implementation of a neonatal resuscitation program in a resource-constrained setting.