Impact of Helping Babies Breathe (HBB), a basic neonatal resuscitation educational program for birth attendants in low-resource setting: a systematic review

Abstract

A B S T R A C T Background: Reducing neonatal deaths and mortality due to birth asphyxia from preventable causes have been a continuing challenge in low-resource settings where the burden is high. The development of effective low cost interventions and their delivery are needed to bring down the number of deaths from birth asphyxia. Helping Babies Breathe (HBB), which is a neonatal resuscitation educational curriculum using "train the trainer" model aimed for birth attendants working in low-resource settings, are now being promoted as a strategy to improve the quality of care of the non-breathing newborn. However, its impact has not been fully evaluated. Objectives: To assess the impact of HBB training of birth attendance working in low-resource settings on neonatal mortality and the learners’ educational outcomes. Results: Six observational before-after studies were included. A total of 102 083 newborn infants and 1027 birth attendants from various professions (both skilled and semi-skilled) fulfilled the inclusion criteria. Two studies evaluated the impact of HBB training versus standard care on neonatal mortality, and one of them assessed both neonatal outcome and educational outcomes. Four studies evaluated exclusively the impact of HBB on educational outcomes. All studies were conducted in low-resource settings. Evidence from these two observational studies show that facility-based HBB neonatal resuscitation may avert a substantial number of early (within 24 hours of birth) intrapartum related ("birth asphyxia") deaths and fresh stillbirths. There is also promising evidence that birth attendants trained in the HBB curriculum significantly improve their knowledge and preparedness for neonatal emergencies in low-resource settings compared to those with no additional training, but there seems to be insufficient evidence to prove that these newly acquired skills in neonatal resuscitation are transferred into clinical practice.

Authors Conclusions: The HBB in-service training appears to have the potential to reduce neonatal mortality in low resource settings. There is also some evidence of educational benefit for those who receive the training. Further studies are needed for evaluating the implementation strategies of HBB in-service training of birth attendants that ensure retention of their knowledge/skills and improve clinical performance both in a hospital and community context.