{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T12:16:45Z","timestamp":1781871405881,"version":"3.54.5"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,7,14]],"date-time":"2017-07-14T00:00:00Z","timestamp":1499990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007172","name":"Cincinnati Children's Hospital Medical Center","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007172","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002724","name":"Child Health Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002724","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>The Helping Babies Breathe (<jats:styled-content style=\"fixed-case\">HBB<\/jats:styled-content>) programme is known to decrease neonatal mortality in low\u2010resource settings but gaps in care still exist. This study describes the use of quality improvement to sustain gains in birth asphyxia\u2010related mortality after <jats:styled-content style=\"fixed-case\">HBB<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Tenwek Hospital, a rural referral hospital in Kenya, identified high rates of birth asphyxia (<jats:styled-content style=\"fixed-case\">BA<\/jats:styled-content>). They developed a goal to decrease the suspected hypoxic\u2010ischaemic encephalopathy (<jats:styled-content style=\"fixed-case\">SHIE<\/jats:styled-content>) rate by 50% within six months after <jats:styled-content style=\"fixed-case\">HBB<\/jats:styled-content>. 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\u2010square analysis was used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ninety\u2010six providers received <jats:styled-content style=\"fixed-case\">HBB<\/jats:styled-content> from September to November 2014. Over 4000 delivery records were reviewed. Ten months of baseline data showed a median <jats:styled-content style=\"fixed-case\">SHIE<\/jats:styled-content> rate of 14.7\/1000 live births (<jats:styled-content style=\"fixed-case\">LB<\/jats:styled-content>) with wide variability. Ten months post\u2010<jats:styled-content style=\"fixed-case\">HBB<\/jats:styled-content>, the <jats:styled-content style=\"fixed-case\">SHIE<\/jats:styled-content> rate decreased by 53% to 7.1\/1000 <jats:styled-content style=\"fixed-case\">LB<\/jats:styled-content> (p = 0.01). <jats:styled-content style=\"fixed-case\">SHIE<\/jats:styled-content> 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Focused quality improvement can sustain and advance gains in neonatal outcomes post\u2010<jats:styled-content style=\"fixed-case\">HBB<\/jats:styled-content> training.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apa.13940","type":"journal-article","created":{"date-parts":[[2017,6,5]],"date-time":"2017-06-05T05:53:01Z","timestamp":1496641981000},"page":"1666-1673","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Using quality improvement to decrease birth asphyxia rates after \u2018Helping Babies Breathe\u2019 training in Kenya"],"prefix":"10.1111","volume":"106","author":[{"given":"Amy R.L.","family":"Rule","sequence":"first","affiliation":[{"name":"Perinatal Institute Cincinnati Children's Hospital Medical Center Cincinnati OH USA"},{"name":"Tenwek Hospital and Tenwek School of Nursing Bomet Kenya"},{"name":"Global Child Health Center Cincinnati Children's Hospital Medical Center Cincinnati OH USA"},{"name":"Division of Hospital Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Maina","sequence":"additional","affiliation":[{"name":"Tenwek Hospital and Tenwek School of Nursing Bomet Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cheruiyot","sequence":"additional","affiliation":[{"name":"Tenwek Hospital and Tenwek School of Nursing Bomet Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"Mueri","sequence":"additional","affiliation":[{"name":"Tenwek Hospital and Tenwek School of Nursing Bomet Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Simmons","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH USA"},{"name":"James Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical Center Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beena D.","family":"Kamath\u2010Rayne","sequence":"additional","affiliation":[{"name":"Perinatal Institute Cincinnati Children's Hospital Medical Center Cincinnati OH USA"},{"name":"Global Child Health Center Cincinnati Children's Hospital Medical Center Cincinnati OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,7,14]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60496-7"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000389"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60750-9"},{"key":"e_1_2_12_5_1","unstructured":"Kenya Association for Maternal & Neonatal Health.Commonwealth Health Online. 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