Frontline Health Workers Save Babies' Lives

The following piece was written for the Bill & Melinda Gates Foundation Blog.

Many women around the world give birth at home, which can be very dangerous – especially if they don’t have anyone to help them and can’t get to a medical center. Mothers in developing countries are frequently assisted at birth by traditional birth attendants (TBAs), women who are often not formally trained and therefore unaware of how to effectively deal with complications.

A newborn baby sleeps in its mother's lap inside the maternity ward of the Kafue District Hospital (Kafue, Zambia, 2007).

Forty-one percent of the 8.8 million children who die every year are newborns, in the first month of life. Many of the newborn deaths that occur at home are preventable. Recent data has shown that frontline workers, including traditional birth attendants, can save newborn lives when provided with additional training and supervision focused on treating a leading cause of newborn mortality: birth asphyxia (lack of oxygen at birth).

In a recent study in Zambia, researchers provided two weeks of training to traditional birth attendants working in a low population density area of Zambia where there were no doctors or hospitals; only one-third of mothers lived within an hour’s walk of a rural health facility. The attendants had already been trained on mouth-to-mouth resuscitation and basic maternal and newborn care. The additional training provided guidance on newborn resuscitation, including drying and warming the baby to prevent hypothermia (low body temperature), suctioning the mouth with a rubber bulb to remove mucus clearing the infant’s airway, assessing breathing and color, and, if necessary, helping the infant to breath using a pocket resuscitator.

The effects of this additional training were dramatic. Infants delivered by attendants that received the training survived twice as often. Deaths due to birth asphyxia in the first two days of life declined by 63 percent; this was largely accomplished through simple means – the pocket resuscitator was used in only 6 percent of cases. Families spontaneously paid the trained attendants more money for their services than the attendants who didn’t receive advanced training.

These results provide strong evidence that we can save newborn lives in a rural, high-risk, resource-poor setting with a relatively low-tech, adaptable approach based in the community. In communities where skilled assistance and a formal health system are lacking, basic training programs on newborn resuscitation, including hypothermia prevention, can be the critical difference between life and death.

Simple, adaptable efforts such as this can play a crucial role in achievement of Millennium Development Goal 4: reducing child deaths by two-thirds.