J Pediatr Intensive Care 2017; 06(01): 028-038
DOI: 10.1055/s-0036-1584674
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Designing and Implementing the Helping Babies Breathe Program in Tanzania

Jeffrey M. Perlman
1   Division of Newborn Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, United States
Georgina Msemo
2   Newborn and Child Health Program Manager, Ministry of Health and Social Welfare, Samora Avenue, Dar es Salaam, Tanzania
Hege Ersdal
3   Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Armauer Hansens Norway and Haydom Lutheran Hospital, Manyara, Moshi, Tanzania
Prisca Ringia
4   Division of Obstetric Nursing, Weill Bugando Hospital, Mwanza, Tanzania
› Author Affiliations
Further Information

Publication History

14 June 2015

01 November 2015

Publication Date:
29 June 2016 (online)


The first day and especially the first hour are critical to newborn survival with the highest risk of intrapartum-related neonatal deaths, from 60 to 70%, occurring within 24 hours of birth. Birth asphyxia (BA) or failure to initiate or sustain spontaneous breathing at birth contributes to approximately 27 to 30% of neonatal deaths. In 2009, Helping Babies Breathe (HBB), an evidence-based educational program developed to teach neonatal resuscitation techniques in limited-resource setting, was introduced and piloted in Tanzania. HBB resulted in a significant 47% reduction in early neonatal mortality from 13.4 to 7.1 per 1,000 live-born deliveries (p < 0.0001) and a significant reduction (24%) in fresh stillbirths from 19.0 per 1,000 preimplementation to 14.4 per 1,000 births postimplementation (p = 0.001). The use of stimulation and suctioning increased, whereas the need for bag mask ventilation decreased significantly post-HBB. This success was attributed to several key strategies including elevating BA as a national priority in health care, identification of a primary person (a pediatrician) at the ministerial level who assumed ownership of the program, local site ownership by a midwife, a commitment to train all birth attendants in the current health workforce in HBB, a commitment to provide required resuscitation equipment at all levels, and periodic review of the data (biannually) at a centralized meeting, under the direction of the Ministry of Health, involving all stakeholders to instill a sense of accountability. A national rollout of provider training is almost complete with almost 15,000 already trained.

  • References

  • 1 Liu L, Johnson HL, Cousens S. , et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012; 379 (9832): 2151-2161
  • 2 Lawn JE, Lee ACC, Kinney M. , et al. Two million intrapartum-related stillbirths and neonatal deaths: where, why, and what can be done?. Int J Gynaecol Obstet 2009; 107 (Suppl. 01) S5-S18 , S19
  • 3 Black RE, Cousens S, Johnson HL. , et al; Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010; 375 (9730): 1969-1987
  • 4 Mwaniki MK, Atieno M, Lawn JE, Newton CR. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet 2012; 379 (9814): 445-452
  • 5 Situational Analyses of Newborn Health in Tanzania. March 2009. http://www.savethechildren.org/publications/technical-resources/saving-newborn-lives/country-documents/TanzaniaSitAn-red.pdf . Accessed May 26, 2015
  • 6 The National Roadmap Strategic Plan Tanzania 2008–2015. http://hdptz.esealtd.com/fileadmin/documents/KeySectorDocuments/MNCH/One_MNCH_plan.pdf . Accessed May 26, 2015
  • 7 Ersdal HL, Mduma E, Svensen E, Perlman J. Birth asphyxia: a major cause of early neonatal mortality in a Tanzanian rural hospital. Pediatrics 2012; 129 (05) e1238-e1243
  • 8 Goldaber KG, Gilstrap III LC, Leveno KJ, Dax JS, McIntire DD. Pathologic fetal acidemia. Obstet Gynecol 1991; 78 (06) 1103-1107
  • 9 Perlman JM, Risser R. Severe fetal acidemia: neonatal neurologic features and short-term outcome. Pediatr Neurol 1993; 9 (04) 277-282
  • 10 King TA, Jackson GL, Josey AS. , et al. The effect of profound umbilical artery acidemia in term neonates admitted to a newborn nursery. J Pediatr 1998; 132 (04) 624-629
  • 11 Perlman JM, Risser R. Cardiopulmonary resuscitation in the delivery room. Associated clinical events. Arch Pediatr Adolesc Med 1995; 149 (01) 20-25
  • 12 Ersdal HL, Mduma E, Svensen E, Perlman JM. Early initiation of basic resuscitation interventions including face mask ventilation may reduce birth asphyxia related mortality in low-income countries: a prospective descriptive observational study. Resuscitation 2012; 83 (07) 869-873
  • 13 Dawes GS. Birth Asphyxia, Resuscitation and Brain Damage. In: Foetal and Neonatal Physiology. Chicago, IL: Year Book Medical Publisher; 1968: 141-159
  • 14 American Academy of Pediatrics. Helping Babies Breathe(R). 2015. http://www.helpingbabiesbreathe.org . Accessed May 26, 2015
  • 15 Perlman JM, Davis PR, Wyllie J, Kattwinkel J. Therapeutic hypothermia following intrapartum hypoxia ischemia: an advisory statement from the Neonatal Task Force of the International Liaison Committee on Resuscitation. Resuscitation 2010; 81: 1459-1461
  • 16 Chamberlain DA, Hazinski MF. ; European Resuscitation Council; American Heart Association; Heart and Stroke Foundation of Canada; Australia and New Zealand Resuscitation Council; Resuscitation Council of Southern Africa; Consejo Latino-Americano de Resuscitación. Education in resuscitation. Resuscitation 2003; 59 (01) 11-43
  • 17 Søreide E, Morrison L, Hillman K. , et al; Utstein Formula for Survival Collaborators. The formula for survival in resuscitation. Resuscitation 2013; 84 (11) 1487-1493
  • 18 Msemo G, Massawe A, Mmbando D. , et al. Newborn mortality and fresh stillbirth rates in Tanzania after helping babies breathe training. Pediatrics 2013; 131 (02) e353-e360
  • 19 Spector JM, Daga S. Preventing those so-called stillbirths. Bull World Health Organ 2008; 86 (04) 315-316
  • 20 Zhu XY, Fang HQ, Zeng SP, Li YM, Lin HL, Shi SZ. The impact of the neonatal resuscitation program guidelines (NRPG) on the neonatal mortality in a hospital in Zhuhai, China. Singapore Med J 1997; 38 (11) 485-487
  • 21 Deorari AK, Paul VK, Singh M, Vidyasagar D. ; Medical Colleges Network. Impact of education and training on neonatal resuscitation practices in 14 teaching hospitals in India. Ann Trop Paediatr 2001; 21 (01) 29-33
  • 22 Kumar R. Effect of training on the resuscitation practices of traditional birth attendants. Trans R Soc Trop Med Hyg 1994; 88 (02) 159-160
  • 23 Ersdal HL, Vossius C, Bayo E. , et al. A one-day “Helping Babies Breathe” course improves simulated performance but not clinical management of neonates. Resuscitation 2013; 84 (10) 1422-1427
  • 24 Mduma E, Ersdal H, Svensen E, Kidanto H, Auestad B, Perlman J. Frequent brief on-site simulation training and reduction in 24-h neonatal mortality—an educational intervention study. Resuscitation 2015; 93: 1-7
  • 25 Perlman J, Velaphi S, Ersdal HL, Gadhia M. Antenatal corticosteroids for preterm births in resource-limited settings. Lancet 2015; 385 (9981): 1944 . Doi: 10.1016/S0140-6736(15)60953-9