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Management of Birth Asphyxia in Home Deliveries in Rural Gadchiroli: The Effect of Two Types of Birth Attendants and of Resuscitating with Mouth-to-Mouth, Tube-Mask or Bag–Mask

Journal of Perinatology volume 25, pages S82–S91 (2005)Cite this article

Abstract

OBJECTIVES:

To evaluate the effect of home-based neonatal care on birth asphyxia and to compare the effectiveness of two types of workers and three methods of resuscitation in home delivery.

STUDY DESIGN:

In a field trial of home-based neonatal care in rural Gadchiroli, India, birth asphyxia in home deliveries was managed differently during different phases. Trained traditional birth attendants (TBA) used mouth-to-mouth resuscitation in the baseline years (1993 to 1995). Additional village health workers (VHWs) only observed in 1995 to 1996. In the intervention years (1996 to 2003), they used tube-mask (1996 to 1999) and bag-mask (1999 to 2003). The incidence, case fatality (CF) and asphyxia-specific mortality rate (ASMR) during different phases were compared.

RESULTS:

During the intervention years, 5033 home deliveries occurred. VHWs were present during 84% home deliveries. The incidence of mild birth asphyxia decreased by 60%, from 14% in the observation year (1995 to 1996) to 6% in the intervention years (p<0.0001). The incidence of severe asphyxia did not change significantly, but the CF in neonates with severe asphyxia decreased by 47.5%, from 39 to 20% (p<0.07) and ASMR by 65%, from 11 to 4% (p<0.02). Mouth-to-mouth resuscitation reduced the ASMR by 12%, tube–mask further reduced the CF by 27% and the ASMR by 67%. The bag–mask showed an additional decrease in CF of 39% and in the fresh stillbirth rate of 33% in comparison to tube–mask (not significant). The cost of bag and mask was $13 per averted death. Oxytocic injection administered by unqualified doctors showed an odds ratio of three for the occurrence of severe asphyxia or fresh stillbirth.

CONCLUSIONS:

Home-based interventions delivered by a team of TBA and a semiskilled VHW reduced the asphyxia-related neonatal mortality by 65% compared to only TBA. The bag–mask appears to be superior to tube–mask or mouth-to-mouth resuscitation, with an estimated equipment cost of $13 per death averted.

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Authors and Affiliations

  1. SEARCH (Society for Education, Action and Research in Community Health), Gadchiroli, India

    Abhay T Bang MD, MPH, Rani A Bang MD, MPH, Sanjay B Baitule DHMS, Hanimi M Reddy PhD & Mahesh D Deshmukh MSc

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  1. Abhay T Bang MD, MPH
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  2. Rani A Bang MD, MPH
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  3. Sanjay B Baitule DHMS
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  4. Hanimi M Reddy PhD
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  5. Mahesh D Deshmukh MSc
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Corresponding author

Correspondence to Abhay T Bang MD, MPH.

Additional information

The Financial Support for this work came from The John D. and Catherine T. MacArthur Foundation, The Ford Foundation, Saving Newborn Lives, Save the Children, USA and The Bill & Melinda Gates Foundation.

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Bang, A., Bang, R., Baitule, S. et al. Management of Birth Asphyxia in Home Deliveries in Rural Gadchiroli: The Effect of Two Types of Birth Attendants and of Resuscitating with Mouth-to-Mouth, Tube-Mask or Bag–Mask. J Perinatol 25 (Suppl 1), S82–S91 (2005). https://doi.org/10.1038/sj.jp.7211275

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