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This study aimed to examine the effects of the Helping Babies Breathe (HBB) training interventions program on the knowledge, psychomotor skills, and competency of health workers in managing birth asphyxia and reducing mortality of newborns experiencing asphyxia within 24 hours. This study used preand post-test design (quasi experimental study). Purposive sampling was employed, and a computer-generated number was used to select the participants. Health workers from Juba Teaching Hospital comprised the intervention group. They were evaluated before and after the training from February to June 2017. A post training skill and competency evaluation was performed using a NeoNatalie newborn simulator and was repeated after three months of implementation for intervention and control group. Seventy health workers were enrolled; 40 were in the intervention group and 30 in the control group. Early newborn mortality due to asphyxia within 24 hours in intervention and control measure at pre and post implementation showed a significant reduction within the intervention than the control. Knowledge, psychomotor and competency of health care workers improved immediately after training and early newborn mortality reduced by half at the end of three months. It is recommended that training of health workers on HBB should be scaled up in most of the health facilities in South Sudan. Introduction South Sudan has a high number newborn mortality. The neonatal mortality was estimated at 35 per 1,000 live births with infant mortality of 67 per 1,000 live births.1 In 2015, 4.5 million (75%) of all underfive deaths occurred within the first year of life. The risk of a child dying before completing the first year of age was highest in the African region (55 per 1000 live births) and over five times higher than that in the developed region (10 per 1000 live births). Although, there is reported decreased in the number of infant mortality birth worldwide, more newborn deaths are reported in low and poor developing countries where access to health care for the vulnerable (women and newborn) was difficult and sometimes nonexistent.2 According to the World Health Organization3 an estimated 136 million infants are born each year, and this figure is expected to rise globally to nearly 137 million births yearly by 2016. In the entire human life cycle, the riskiest period is the day of birth4 previous studies reported that 136 of the one million of newborn births each year will not survive their first day of life.5 Based on the global total of one million deaths each year, efforts must be aimed at reducing the high number of newborn deaths. The main causes of newborn deaths have remained unchanged for the last decade and are usually infection-related complications (26%), intrapartum complications (24%) including birth asphyxia, preterm delivery (34%) with breathing problems contributing to mortality and morbidity, and congenital abnormalities (9%).6 The real cause of newborn deaths is difficult and most challenging to determine for the health professionals. Nurses, midwives, clinical officers, medical officers, maternal health workers, and community health workers attending births must have the essential knowledge and skills to assess the neonates’ breathing status and effectively respond as needed. Majority of the health workers/staff often failed to recognize breathing difficulties early and, most of the times, could not assess and take immediate action to resuscitate non-breathing babies at the time of delivery. Priority has often been given to the mother’s needs. The neonates often remained unattended for several minutes with little attention. This problem could be partly attributed to not having a staff member present dedicated to the newborns. Despite the burden of newborn death being high in the low and poor countries, the coverage of skilled birth attendance is very scarce in these countries.7 Similarly, more than one million preterm neonates die from complications of preterm delivery, including respiratory distress syndrome, as majority of the preterm newborns require assistance to initiate breathing at birth.4 Having known that prematurity and intrapartum hypoxic are the main causes of early neonate mortality in majority of the neonates, global, regional, and local training of health workers in basic neonatal resuscitation will help improve the newborn survival and will save hundreds of thousands of newborn infants yearly.4 Despite the benefits of the health workers’ training on neonatal resuscitation in averting newborn deaths, the coverage of neonatal resuscitation remains very low in settings with a high burden of neonatal deaths. Currently, various neonatal resuscitation training courses are being promoted and implemented in many countries in order to build the capacity and competence of the health workers to become better qualified in managing sick newborns or children in the emergency setting. Healthcare in Low-resource Settings 2018; volume 6:7276 Correspondence: Christopher Vunni Draiko, College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand. E-mail: chrissvunni@gmail.com

healthcare in low-resource settings

Training interventions on Helping Babies Breathe among health workers in tertiary hospital of the Republic of South Sudan: A non-randomized quasi-experimental study