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

被引：85
作者：
Bang A.T. [1 ]
Bang R.A. [1 ]
Baitule S.B. [1 ]
Reddy H.M. [1 ]
Deshmusk M.D. [1 ]
机构：
[1] SEARCH
来源：
Journal of Perinatology | 2005年 / 25卷 / Suppl 1期
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D O I：
10.1038/sj.jp.7211275
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学科分类号：
摘要：
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 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 occured. 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 rduced the ASMR by 12% tube-mask further reduced th 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. © 2005 Nature Publishing Group All rights reserved.
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页码：S82 / S91
页数：9
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