Nancy Japhet (30yrs), a resident of Engoisengiu in Arusha Region is mother of two, but six months old Dativa, who is her second born didn’t make sound when she was born. It was a scary silence. However with the help of her nurse, she was, at least, able to breathe within a minute.
Divulging this in Dar es Salaam at the end-of a two-day programme meeting on scaling neo natal resuscitation in Tanzania held beginning June 28 this year Japhet said:
“When I had my first born he cried immediately after birth. I was so worried this time when I gave birth to Dativa as she couldn’t cry. The nurse didn’t give her to me immediately as they always to when a mother gives birth.. It was after a while that I heard my daughter crying. God is great, I was very happy, and relieved, but, the nurses were overjoyed,” she says.
Jaine Macha, who helps babies to breathe (HBB) at Mount Meru Hospital is the one who saved Dativa from the abnormal breathing complication.
Narrating how it all happened, at the meeting which involved regional medical officers, and administrative secretaries from 16 regions, health workers and beneficiaries of the project, she says that when the mother arrived at the hospital, her contractions were frequent and painful.
According to her, although the silence of the baby scared her mother, for the nurse the situation was not frightening at all.
The nurse drove her to action by quickly employing newborn resuscitation skills that were taught at Jhpiego on how to help babies who do not breathe after birth.
“I took penguin-shaped sucker and gently cleared the mucus from the baby’s nose; after well massaging the newborn’s back, I placed a special mask on the baby’s mouth and pumped in air ... and within a minute, the baby girl cried,” Macha says.
Macha says at the nursing school they were taught different ways on how to save lives, but HBB has brought in new, simple and very effective techniques.
Now they assess the baby as quickly and effectively as possible to minimise any irreversible damage.Today Dativa appears healthy and is growing stronger. Looking at her no one would even think that during the birth period, her life was in danger due to asphyxia.
Thanking the Children’s Investment Fund Foundation (CIFF) Scaling Neonatal Resuscitation in programme and the HBB initiative, care providers handling deliveries in the country’s health facilities say they now have the skills and equipment necessary to assist newborns to combat asphyxia within the first minute of birth.
Linda Makundi is a health worker in Coast Region with a two-year girl who is among the victims of asphyxia at birth.
Despite being a nurse, she got scared after learning that her baby failed to make sound immediately after birth, until the responsible nurses saved her daughter using the skills and equipment provided for the purpose.
“I have been serving babies’ lives, but never thought that one day the situation would turn back to me. I almost cried after I saw the nurses struggling to rescue my baby from asphyxia. They quickly teamed up, worked and gave a similar aid to my baby as the one I used to give others,” she says.
The health state of newborns in Tanzania shows that the leading causes of death among children below five years of age, including 40 per cent newborn deaths, are contributed by intrapartum (12 percent), preterm complications (12 percent), sepsis/meningitis (8 percent), pneumonia (3 percent), congenital abnormalities (5 percent) and other conditions (2 percent).
Other causes are injury (6 per cent), HIV/Aids (6 per cent), diarrhoea (8 per cent), malaria (10 per cent), pneumonia (15 per cent), other disorders (16 per cent).
HBB Project Manager Dr Erica Thomas says birth attendants in 3,564 delivery rooms use the mini lab which is equipped with neonatalie model, ambu-bag with mask, penguin-shaped sucker, action plan wall poster, small action plan, clinical reminder, learner workbook and clinical mentorship guide, for on job training and for refresher updates in HBB skills.
She says the programme has reached 3, 564 health facilities in Tanzania Mainland, out of 7,533 health facilities, of which 260 are hospitals, 741 health centres and 6,256 dispensaries.
HBB Equipment distributed to health facilities (delivery rooms), she says are 7,644 ambu bags with size 0 and 1 mask; 10,222 penguin-shaped suckers and 3,894 neonatalie models.
“We supported 272,673 newborns that needed resuscitation services ... an approximate 178-fold increase from 1,533 newborns reported when the programme started in May 2013,” she says.
According to her, they have covered 16 regions, 109 districts in the country, surpassing the set target by 7 percent. “Our contribution is 13, 207 health providers equipped with HBB skills to assist newborns in surviving asphyxia within the first minute of birth,” she says.
With the support of CIFF, Jhpiego, an affiliate of Johns Hopkins University, we have worked with the Ministry of Health, Community Development, Gender, Elderly and Children to roll out HBB.There is evidence based on hand on the approaches used to impart neonatal resuscitation techniques in resource-limited areas.
Despite this evolving trend, Director, maternal and child survival programme (MCSP) and Jhpiego vice president Koki Agrawal says Tanzania‘s progress in newborn survival has been slow despite the tremendous success in the reduction of under-five and infant mortality rates.
For instance, in 1999 the neonatal mortality rate was 40 deaths per 1,000 live births in 1999 whereas in 2015 it was 25 neonatal deaths per 1,000 live births.
“Though we can say there has been some reduction in neonatal mortality, this is not something to celebrate about after a span of fourteen years. I believe, we can change this grim picture by committing ourselves differently, voicing and acting to save the lives of the dying newborns. This must change,” she advises.
Even though, she says through this programme, “we have achieved a lot. We’ve empowered health providers, health facilities, regional and district officials to save the lives of babies who fail to establish spontaneous breathe at birth (those having birth asphyxia) through skills strengthening and provision of lifesaving equipment.
Besides, she says, the programme has also supported participatory planning, maternal, newborn health data reviews and discussions to inform planning.
The health facilities, regions and districts are now well prepared to save babies born failing to breathe at birth (birth asphyxia). As a matter of fact, HBB experience in some countries has become an example of how to take an effective intervention to scale.
“Let this programme’s ending, marks the beginning of our own sustainability initiatives, creates a need for commitment to sustain at national, regional and local government levels.
Let the end demonstrate how best we can capitalise on existing scarce resources to sustain and propel gains beyond the programme life. We can do this by ensuring every birth attendant has the necessary skills and mastery required for the allocated job, and tasks in maternal and newborn care within the health facility,” she suggests.
She says: “A better strategy to enrich staff rotation system is desirable as in service offsite trainings are resource intensive endeavors, alternative options like structured on the job skills retention and succession planning would serve to retain skills at the point of care.
“We believe locally designed initiatives; with management supported will position our regions and districts on the top among the best performers in maternal and newborn health survival. These services are among the most demanded. Today regional administrations can choose a legacy of zero tolerance to the innumerable still born and early newborn deaths,” she says.
Agrawal says the National HBB programme in collaboration with Jhpiego Tanzania’s Newborn Resuscitation Programme has attained the widest coverage reaching over 16,000 providers in 16 mainland regions. These are Coast, Lindi, Dar es Salaam, Morogoro, Iringa, Njombe, Mbeya, Ruvuma, Manyara, Arusha, Kilimanjaro, Tanga, Kigoma, Singida, Kagera and Mara by working hand in hand with regional and district health officials for the large scale roll out.
“We are optimistic that our continued joint partnership and efforts will contribute to surpassing the NMR target of 16 per 1,000 live births by 2020,” she says.
She adds that the programme’s ending, calls for a fresh start of regions’ own initiatives of implementing national and regional strategies differently and innovatively.
“We owe Tanzanian families, women and children our commitment and leadership through the managerial mandate we have to give newborns a right start, by allocating the scarce resources better. With a good oversight we will avoid complications of failed newborn resuscitation, that is; cerebral palsy, other neurological disabilities and deaths,” she says.
Health, Community Development, Gender, Elderly and Children minister Ummy Mwalimu’s speech delivered on her behalf by the Chief Medical Officer, Prof Muhammad Bakari Kambi said since the country has just started to implement the UN Sustainable Development Goals, still there is a big number of newborns and children under age of five dying.
“A total of 39,500 infants and 98,000 children under the age of five die every year due to three reasons. They include birth asphyxia, preterm complications and infections by bacteria,” she said.
She said low speed in checking newborn deaths is unacceptable; the average of children deaths is slowly decreasing, adding that eliminating children deaths is important.
The minister said the project has succeeded through the national programme of (HBB), which aim at serving newborns from birth asphyxia.
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