Using quality improvement to decrease birth asphyxia rates after 'Helping Babies Breathe' training in Kenya

Acta Paediatr. 2017 Oct;106(10):1666-1673. doi: 10.1111/apa.13940. Epub 2017 Jul 14.


Aim: The Helping Babies Breathe (HBB) programme is known to decrease neonatal mortality in low-resource settings but gaps in care still exist. This study describes the use of quality improvement to sustain gains in birth asphyxia-related mortality after HBB.

Methods: Tenwek Hospital, a rural referral hospital in Kenya, identified high rates of birth asphyxia (BA). They developed a goal to decrease the suspected hypoxic-ischaemic encephalopathy (SHIE) rate by 50% within six months after HBB. Rapid cycles of change were used to test interventions including training, retention and engagement for staff/trainees and improved data collection. Run charts followed the rate over time, and chi-square analysis was used.

Results: Ninety-six providers received HBB from September to November 2014. Over 4000 delivery records were reviewed. Ten months of baseline data showed a median SHIE rate of 14.7/1000 live births (LB) with wide variability. Ten months post-HBB, the SHIE rate decreased by 53% to 7.1/1000 LB (p = 0.01). SHIE rates increased after initial decline; investigation determined that half the trained midwives had been transferred. Presenting data to administration resulted in staff retention. Rates have after remained above goal with narrowing control limits.

Conclusion: Focused quality improvement can sustain and advance gains in neonatal outcomes post-HBB training.

Keywords: Hospital practices; Neonatal resuscitation; Quality improvement; Simulation; Sub-Saharan Africa.

MeSH terms

  • Asphyxia Neonatorum / etiology
  • Asphyxia Neonatorum / prevention & control*
  • Education, Continuing / statistics & numerical data*
  • Humans
  • Hypoxia-Ischemia, Brain / complications
  • Hypoxia-Ischemia, Brain / prevention & control*
  • Infant, Newborn
  • Kenya
  • Quality Improvement
  • Respiration, Artificial