Evaluation of the Helping Babies Breathe programme in Migori County, Kenya.

INTRODUCTION

Kenya's 2021 neonatal mortality rate was 18.42 per 1000 live births, far exceeding the Sustainable Development Goal of 12 per 1000 live births. Helping Babies Breathe (HBB) was developed to equip birth attendants with necessary skills for neonatal resuscitation in low-resource settings. This study aims to evaluate the implementation and impact of HBB training in Migori County, Kenya.

METHODS

This single-group pretest-posttest study was conducted at 26 healthcare centres in Migori County, Kenya. Preimplementation neonatal health data were collected between January 2022 and June 2023. HBB training was conducted in June 2023, and postimplementation neonatal health data were collected from then until January 2024. To evaluate providers' retention of knowledge and skills, validated Knowledge Checks and Objective Structured Clinical Examination (OSCEs) were conducted immediately following training, at 4 months and at 9 months following training.

RESULTS

The proportion of neonates not breathing and not receiving bag and mask ventilation within 1 min of birth decreased significantly following HBB training (12.73% pretraining vs 6.90% post-training, p=0.01). However, in-facility neonatal mortality did not decrease significantly when a trained HBB provider was present (86.73% survival without a provider vs 87.92% with, p=0.64). Providers' knowledge and hands-on skills deteriorated significantly within 9 months following initial training despite quarterly follow-up trainings (Knowledge Check score average 97.24% immediately post-training vs 92.67% at 9 months, p=0.01; OSCE B average 92.48% immediately post-training vs 87.10% at 9 months, p=0.04).

CONCLUSIONS

HBB training significantly improved providers' knowledge of HBB initially, but quarterly follow-up trainings were insufficient to sustain knowledge and resuscitation skills. No significant reduction in in-facility neonatal mortality was observed following implementation of HBB, although the study was not powered to detect this change. There was an increase in the appropriate use of bag and mask ventilation. As HBB training is expanded across Kenya, more frequent refresher trainings and provider engagement strategies are recommended to sustain providers' knowledge and skills.