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Global Health: Science and Practice

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ORIGINAL ARTICLE
Open Access

Helping Babies Breathe, Second Edition: A Model for Strengthening Educational Programs to Increase Global Newborn Survival

Beena D. Kamath-Rayne, Anu Thukral, Michael K. Visick, Eileen Schoen, Erick Amick, Ashok Deorari, Carrie Jo Cain, William J. Keenan, Nalini Singhal, George A. Little and Susan Niermeyer
Global Health: Science and Practice October 2018, 6(3):538-551; https://doi.org/10.9745/GHSP-D-18-00147
Beena D. Kamath-Rayne
aDepartment of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA, and Perinatal Institute and Global Child Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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  • For correspondence: Beena.Kamath-Rayne@cchmc.org
Anu Thukral
bDepartment of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
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Michael K. Visick
cLatter-day Saint Charities, Salt Lake City, UT, USA.
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Eileen Schoen
dDivision of Life Support, American Academy of Pediatrics, Itasca, IL, USA.
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Erick Amick
dDivision of Life Support, American Academy of Pediatrics, Itasca, IL, USA.
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Ashok Deorari
bDepartment of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
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Carrie Jo Cain
eWorld Hope International, Alexandria, VA, USA and Freetown, Sierra Leone.
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William J. Keenan
fDivision of Neonatology, Saint Louis University, St. Louis, MO, USA.
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Nalini Singhal
gDivision of Neonatology, University of Calgary, Alberta, Canada.
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George A. Little
hDivision of Neonatology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
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Susan Niermeyer
iSection of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA.
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  • FIGURE 1
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    FIGURE 1

    The Utstein Formula of Survival

    Adapted with permission from Søreide et al.27

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    Pilot testing of Helping Babies Breathe 1st Edition in Dar es Salaam, Tanzania. © 2010 Eileen Schoen/American Academy of Pediatrics.

  • FIGURE 2
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    FIGURE 2

    Helping Babies Breathe Second Edition Action Plan

    Abbreviations: ECEB, Essential Care for Every Baby; HMS, Helping Mothers Survive.

    Source: Niermeyer S, Kamath-Rayne B, Keenan W, Little G, Singhal N, Visick M, eds. (2016).7 Reprinted with permission from the American Academy of Pediatrics.

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    Field testing of Helping Babies Breathe 2nd Edition with MNCH aides in Kabala, Sierra Leone. © 2016 Erick Amick/American Academy of Pediatrics.

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    TABLE.

    Key Training Themes in Qualitative Analysis From Helping Babies Breathe Second Edition Field Testing in India

    ThemesSubthemesSelected Comments
    Most Effective Themes
    FacilitatorsProvoke discussion
    Feedback
    One-on-one interaction
    “The facilitator could give feedback, genuine feedback.”
    Workshop structureEmphasis on doing rather than lecturing
    Small group size
    Time for practice, observation, and learning from each other's mistakes
    Enough equipment for everyone to practice with
    Networking with others outside of their area to discuss their practice similarities and differences
    “I think it uses everybody's time more effectively. I think working in small groups … that was the beauty of the program.”
    Quality improvementReflection of each individual's practice and how to improve
    Worked well with rest of workshop structure
    “[B]ecause we train so many people, and we impart knowledge and skills, and it is individual improvement which is looked at. That session for the first time, looked at the individual and what he/she will do to bring change to their unit.”
    ContentClear and concise presentation of information
    Action plan was a helpful summary
    Flip chart serving as a written guide for facilitating
    “Planning of the flip chart and implementation guide has been incorporated. That was the one thing which everyone wanted. While you are organizing and conducting a workshop, what you need to do, and what our facilitators should do, is now written.”
    Least Effective Themes
    ContentSuggestive or ambiguous language such as “may” or “could”
    Time to read and review material prior to the course
    Complexity of content for peripheral clinics
    “If it is meant mostly for peripheral settings, where resources are scarce, and I think the messages have to be direct and loud, that message is not obvious. Because you can say from this what is most important? It doesn't strike.”
    FormatPresentation of material (color coding, font size, binding of flip chart)
    IntegrationHow to ensure implementation at facility after training
    Skills would not be maintained unless practiced and refresher courses available
    Administrative support of the program at their facility
    Buy-in from local leaders
    “Otherwise we go through the same cycle of doing the workshop, but having no impact.”
    “There has to be some time, some kind of timeline, that every day or alternate day, or once a week they have a practice session of this duration. And the unit in charge should be made responsible for this action.”
    Unrealistic expectationsDifficult to implement with low resources
    Supply chain
    Facility where workshop held versus reality in periphery
    Overemphasis of skin-to-skin care
    Concerns about resources and space
    Lack of experience with quality improvement
    “[How to do skin-to-skin care] is all very vague, and therefore it may not be taken up well. So more clarity on that and the pictures need to be done.”
    “Quality is considered a very special thing. It is something that is a luxury for people who have a lot of resources. This is their mindset. Because in a source limited situation, quality cannot be done. This is the mindset. So how to change that mindset?”

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Global Health: Science and Practice: 6 (3)
Global Health: Science and Practice
Vol. 6, No. 3
October 03, 2018
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Helping Babies Breathe, Second Edition: A Model for Strengthening Educational Programs to Increase Global Newborn Survival
Beena D. Kamath-Rayne, Anu Thukral, Michael K. Visick, Eileen Schoen, Erick Amick, Ashok Deorari, Carrie Jo Cain, William J. Keenan, Nalini Singhal, George A. Little, Susan Niermeyer
Global Health: Science and Practice Oct 2018, 6 (3) 538-551; DOI: 10.9745/GHSP-D-18-00147

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Helping Babies Breathe, Second Edition: A Model for Strengthening Educational Programs to Increase Global Newborn Survival
Beena D. Kamath-Rayne, Anu Thukral, Michael K. Visick, Eileen Schoen, Erick Amick, Ashok Deorari, Carrie Jo Cain, William J. Keenan, Nalini Singhal, George A. Little, Susan Niermeyer
Global Health: Science and Practice Oct 2018, 6 (3) 538-551; DOI: 10.9745/GHSP-D-18-00147
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