{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T19:58:19Z","timestamp":1767211099871,"version":"3.46.0"},"reference-count":36,"publisher":"BMJ","issue":"9","funder":[{"name":"Saving Lives at Birth Grand Challenges"},{"name":"Laerdal Foundation, Stavanger Norway"},{"name":"Global Health and Vaccination Research (GLOBVAC) program at the Research Council of Norway","award":["project number 228203"],"award-info":[{"award-number":["project number 228203"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,9,5]]},"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Globally, perinatal mortality remains high, especially in sub-Saharan countries, mainly because of inadequate obstetric and newborn care. Helping Babies Breathe (HBB) resuscitation training as part of a continuous quality improvement (CQI) programme may improve outcomes. The aim of this study was to describe observed changes in perinatal survival during a 6-year period, while adjusting for relevant perinatal risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Delivery rooms and operating theatre in a rural referral hospital in northern-central Tanzania providing comprehensive obstetric and basic newborn care 24\u2009hours a day. The hospital serves approximately 2 million people comprising low social-economic status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All newborns (n=31\u2009122) born in the hospital from February 2010 through January 2017; 4893 were born in the 1-year baseline period (February 2010 through January 2011), 26\u2009229 in the following CQI period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>The HBB CQI project, including frequent HBB training, was implemented from February 2011. This is a quality assessment analysis of prospectively collected observational data including patient, process and outcome measures of every delivery. Logistic regression modelling was used to construct risk-adjusted variable life adjusted display (VLAD) and cumulative sum (CUSUM) plots to monitor changes in perinatal survival (primary outcome).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the 6-year CQI period, the unadjusted number of extra lives saved according to the VLAD plot was 150 despite more women admitted with pregnancy and labour complications and more caesarean deliveries. After adjusting for these risk factors, the risk-adjusted VLAD plot indicated that an estimated 250 extra lives were saved. The risk-adjusted CUSUM plot confirmed a persistent and steady increase in perinatal survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The risk-adjusted statistical process control methods indicate significant improvement in perinatal survival after initiation of the HBB CQI project with continuous focus on newborn resuscitation training during the period, despite a concomitant increase in high-risk deliveries. Risk-adjusted VLAD and CUSUM are useful methods to quantify, illustrate and demonstrate persistent changes in outcome over time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-030572","type":"journal-article","created":{"date-parts":[[2019,9,27]],"date-time":"2019-09-27T14:09:11Z","timestamp":1569593351000},"page":"e030572","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Frequent refresher training on newborn resuscitation and potential impact on perinatal outcome over time in a rural Tanzanian hospital: an observational study"],"prefix":"10.1136","volume":"9","author":[{"given":"Estomih","family":"Mduma","sequence":"first","affiliation":[{"name":"Haydom Lutheran Hospital, Haydom, Tanzania"},{"name":"Department of Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan Terje","family":"Kval\u00f8y","sequence":"additional","affiliation":[{"name":"Research, Stavanger University Hospital, Stavanger, Norway"},{"name":"Department of Mathematics and Physics, University of Stavanger Department of Mathematics and Natural Science, Stavanger, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eldar","family":"Soreide","sequence":"additional","affiliation":[{"name":"Critical Care and Anaesthesiology Research Group, Department of Clinical Medicine, Stavanger University Hospital, Stavanger, Norway"},{"name":"Faculty of Medicine, University of Bergen, Bergen, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erling","family":"Svensen","sequence":"additional","affiliation":[{"name":"Haukeland Universitetssjukehus, Bergen, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paschal","family":"Mdoe","sequence":"additional","affiliation":[{"name":"Haydom Lutheran Hospital, Haydom, Tanzania"},{"name":"Faculty of Social Science, University of Stavanger, Stavanger, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Perlman","sequence":"additional","affiliation":[{"name":"Pediatrics, Weill Cornell Medical College, New York Presbyterian Hospital, New York City, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Natural Science, University of Stavanger, Stavanger, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hussein Lessio","family":"Kidanto","sequence":"additional","affiliation":[{"name":"School of Medicine, Aga Khan University, Dar es Salaam, Tanzania"},{"name":"Helse Stavanger HF, Stavanger, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hege Langli","family":"Ersdal","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway"},{"name":"Faculty of Health Sciences, University of Stavanger, Stavanger, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,9,27]]},"reference":[{"key":"2025120600431332000_9.9.e030572.1","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/S0140-6736(14)60497-9","article-title":"Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990\u20132013: a systematic analysis for the global burden of disease study 2013","volume":"384","author":"Wang","year":"2014","journal-title":"The Lancet"},{"key":"2025120600431332000_9.9.e030572.2","unstructured":"WHO . 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