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Practice and Persevere: Neonatal Survival Workshops Aim to Reduce Infant Mortality in Ghana

With only five years left until the 2015 deadline to achieve the Millennium Development Goals (MDGs), United Nations Secretary-General Ban Ki-Moon has called on world leaders to attend a summit in New York on 20-22 September 2010 to accelerate progress towards the MDGs, aimed at slashing poverty, hunger, disease, maternal and child deaths and other ills. MDG 4 aims for a two-thirds reduction in the mortality of children under-five. According to UNICEF, Africa represents over 50% of the nearly nine million under-five deaths worldwide. The greatest risk of childhood death occurs during the neonatal phase, which extends from birth through the first month of life. Birth asphyxia, the inability to breathe, is a primary cause of neonatal death, which constitutes a huge proportion of all under-5 fatalities. Achieving this MDG will require both reaching out to the many expectant and new mothers who too often have little contact with public services and training those frontline caregivers who may not realize their own power to save newborns’ lives.

The Millennium Cities Initiative (MCI) is working hard to put interventions in place that can help reduce neonatal mortality in selected urban centers in sub-Saharan Africa. Most recently, MCI is partnering with the American Academy of Pediatrics (AAP) and Johnson & Johnson to conduct a neonatal survival and newborn care program. Over the past two weeks, training programs for midwives and nurses were held in Accra and Kumasi, Ghana. These workshops mark the first phase of a three-part series intended to train a broad network of health professionals in both cities, who are now beginning to reach out to mothers, as part of a six-month public health outreach and education program.

Neonatal survival workshop participants practice the AAP's Helping Babies Breathe techniques.

Sixty enthusiastic caregivers spent five days together – 30 participants at Suntreso Hospital in Kumasi and 30 participants at Ussher Polyclinic in Accra – sometimes working nights, only to return to class the next day, eager to learn and to practice some more. Participants mastered the AAP Helping Babies BreatheSM (HBB) protocols through extensive hands-on demonstrations with a state-of–the-art, touch-sensitive mannequin, bag and mask for ventilation. They also seized on the importance of the Golden Minute,SM the first minute following birth, during which a baby should be breathing well or else needs to be ventilated.

Dr. Fred Adomako-Boateng, one of MCI’s four lead trainers (pictured at left), taught the midwives and nurses the HBB protocols and top symptoms of newborn illness and infection during the week in Kumasi. He told the caregivers, ”If you are able to prevent infections, we know that infant mortality will go down, Suntreso (Hospital) will be lifted high, and people will ask you to work to introduce them to HBB concepts.”

Dr. Fred Adomako-Boateng teaches nurses and midwives neonatal survival protocols.

The notion that ‘practice makes perfect’ was reinforced, as was the need to share this learning with other caregivers. In the words of one midwife, “Don’t keep what we’ve learned to ourselves. We must disseminate it and explain it to our colleagues.” This idea was seconded by Regional Deputy Director of Nursing Services Ms. Comfort Asare, “I hope the protocols distributed aren’t kept under lock and key. They should be a daily reference tool to use within the first 48 hours, when babies are dying.” Next, these enthusiastic and empowered caregivers will be teaching new mothers the most important points that they themselves have mastered, including key symptoms of illness, danger signs to look out for and when to notify a medical practitioner.

MCI Project Manager for Ghana Abenaa Akuamoa-Boateng explained that only a few years ago, 111 out of every 1,000 infants born were dying. The team at Suntreso Hospital in Kumasi appreciates now that the bulk of these deaths were happening during this all-important initial period. “Twenty-three percent of babies die from asphyxia,” Abenaa noted, going on to say, “This can be solved.” She described how, when AAP learned what was happening, the organization’s leaders became determined to provide a curriculum accessible to lower level and lay people that can ensure a continuum of care from pregnancy to newborn survival.

The feedback thus far on the MCI trainings has been excellent, especially in their applicability to the participants’ own work. Akuamoa-Boateng reported back to the midwives and nurses, “You told us this workshop was very, very practical and something you needed to play your role and contribute to MDG 4 – saving the lives of the newborn. Every day is an opportunity to turn things around to the advantage of mothers and their babies.”

During the closing ceremony each participant was given a certificate of completion and was personally congratulated by Ms. Comfort Asare on behalf of the Regional Director of Health Services. She urged the trainees to practice and persevere: “If you do not share the knowledge that you have, and if you do not practice the skills you now have – your loss of knowledge will be to the detriment of the babies.”

This series of trainings, which are expected to have a long-term, life-saving impact for mothers and infants across Ghana’s two largest metropolitan areas, with their combined total population of roughly six million, constitutes MCI’s most ambitious intervention to date in the critical areas of neonatal survival and newborn care. In the final words of a midwife who spoke to the group, “We have learned a lot and now, by the grace of God, we hope that our babies will breathe.”

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