{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T06:07:59Z","timestamp":1782108479964,"version":"3.54.5"},"reference-count":20,"publisher":"BMJ","issue":"3","funder":[{"name":"Save the children"},{"name":"National Hospital Abuja"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2018,8,11]]},"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:p>The neonatal period is a critical time for survival of the child. A disproportionate amount of neonatal deaths occur in low-resource countries and are attributable to perinatal events, especially birth asphyxia. This project aimed to reduce the incidence of birth asphyxia by 20% by June 2014 through training in neonatal resuscitation and improving the availability of resuscitation equipment in the delivery room in the National Hospital Abuja, Nigeria.<\/jats:p>\n               <jats:p>A prospective, longitudinal study using statistical process control analytical methods was done enrolling babies delivered at the National Hospital Abuja.<\/jats:p>\n               <jats:p>Low Apgar scores or birth asphyxia (defined a priori as any score &lt;7 at 1, 5 and\/or at 10 min) was assessed. To ensure reliability and validity of Apgar scoring, trainings on scoring were held for labour and delivery staff. Interventions included provision of additional equipment and trainings on neonatal resuscitation. Apgar scores were aggregated weekly over 25 months. Control charts with three SE confidence limits were used to monitor the proportion of scores \u22647.<\/jats:p>\n               <jats:p>The baseline incidence of low Apgar scores, as defined a priori, was 33%, 17% and 10% while postintervention the incidence was 18%, 17% and 6% at 1, 5 and 10 min, respectively\u2014a reduction of 45% and 40% in the 1-min and 10-min low Apgar scores.<\/jats:p>\n               <jats:p>Increased communication, additional resuscitation equipment and training of delivery personnel on neonatal resuscitation are associated with reductions in measures of birth asphyxia. These improvements have been sustained and efforts are ongoing to spread our interventions to other special care delivery units\/nursery in adjoining states. Our study demonstrates the feasibility and utility of using improvement science methods to assess and improve perinatal outcome in low-resource settings.<\/jats:p>","DOI":"10.1136\/bmjoq-2017-000231","type":"journal-article","created":{"date-parts":[[2018,9,4]],"date-time":"2018-09-04T10:36:59Z","timestamp":1536057419000},"page":"e000231","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Decreasing birth asphyxia: utility of statistical process control in a low-resource setting"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5422-614X","authenticated-orcid":false,"given":"Mariya","family":"Mukhtar-Yola","sequence":"first","affiliation":[{"name":"Neonatal Unit, Department of Paediatrics, National Hospital Abuja (NHA), Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lamidi Isah","family":"Audu","sequence":"additional","affiliation":[{"name":"Neonatal Unit, Department of Paediatrics, National Hospital Abuja (NHA), Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluyinka","family":"Olaniyan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, National Hospital Abuja, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry T","family":"Akinbi","sequence":"additional","affiliation":[{"name":"Perinatal Institute, Cincinnati Children\u2019s Hospital Medical Center, Cincinnatti, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adekunle","family":"Dawodu","sequence":"additional","affiliation":[{"name":"Global Health Center, CCHMC, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward F","family":"Donovan","sequence":"additional","affiliation":[{"name":"James Anderson Center for Health Systems Excellence, CCHMC, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,9,4]]},"reference":[{"key":"2025083112191829000_7.3.e000231.1","unstructured":"Save the children. Surviving the First Day, State of the Worlds Mothers. Geneva: World Health Organization, 2013."},{"key":"2025083112191829000_7.3.e000231.2","unstructured":"Every newborn an executive summary for the lancet\u2019s series. Lancet 2014."},{"key":"2025083112191829000_7.3.e000231.3","unstructured":"World Health Organization. Neonatal and perinatal mortality: country, regional and global estimates. http:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/43444\/9241563206_eng.pdf?sequence=1&isAllowed=y (accessed 11 Jul 2017)."},{"key":"2025083112191829000_7.3.e000231.4","unstructured":"World Health Organization. Every Newborn. An action plan to end preventable deaths. Geneva: WHO, 2014."},{"key":"2025083112191829000_7.3.e000231.5","unstructured":"Marilyn KH , Robert FH . Introduction To Statistical Process Control Techniques: Statit software, 2007."},{"key":"2025083112191829000_7.3.e000231.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60496-7"},{"key":"2025083112191829000_7.3.e000231.7","unstructured":"Federal Ministry of Health. Saving Newborn Lives in Nigeria: Newborn Health in the context of the Integrated Maternal, Newborn and Child Health Strategy. 2 edn. Abuja: Federal Ministry of Health, 2011:20\u20136."},{"key":"2025083112191829000_7.3.e000231.8","unstructured":"National population commission . NIGERIADEMOGRAPHIC AND HEALTH SURVEY, 2013."},{"key":"2025083112191829000_7.3.e000231.9","article-title":"Who has been caring for the baby?","volume":"14","author":"Gl","year":"2014","journal-title":"Lancet"},{"key":"2025083112191829000_7.3.e000231.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60792-3"},{"key":"2025083112191829000_7.3.e000231.11","first-page":"78","article-title":"Assessment of knowledge on neonatal resuscitation amongst health care providers in Kenya","volume":"11","author":"Murila","year":"2012","journal-title":"Pan Afr Med J"},{"key":"2025083112191829000_7.3.e000231.12","first-page":"23","article-title":"Neonatal resuscitation: knowledge and practice of nurses In Western Nigeriaigeria","volume":"2","author":"Ogunlesi","year":"2008","journal-title":"South African Journal of Child Health"},{"key":"2025083112191829000_7.3.e000231.13","doi-asserted-by":"crossref","first-page":"S73","DOI":"10.1080\/02724936.1998.11747984","article-title":"Neonatology in developing countries: problems, practices and prospects","volume":"18 Suppl","author":"Dawodu","year":"1998","journal-title":"Ann Trop Paediatr"},{"key":"2025083112191829000_7.3.e000231.14","doi-asserted-by":"publisher","DOI":"10.1542\/peds.107.4.648"},{"key":"2025083112191829000_7.3.e000231.15","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1038\/sj.jp.7210751","article-title":"Positive changes among very low birth weight infant apgar scores that are associated with the neonatal resuscitation program in illinois","volume":"22","author":"Patel","year":"2002","journal-title":"J Perinatol"},{"key":"2025083112191829000_7.3.e000231.16","first-page":"459","article-title":"The neonatal resuscitation training project in rural South Africa","volume":"5","author":"Couper","year":"2005","journal-title":"Rural Remote Health"},{"key":"2025083112191829000_7.3.e000231.17","unstructured":"RACHA. The neonatal resuscitation skills training program in cambodia its impact on the health care professionals\u2019 competency in newborn resuscitation. 2006 http:\/\/rc.racha.org.kh (accessed 14 Feb2017)."},{"key":"2025083112191829000_7.3.e000231.18","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.24.1.138"},{"key":"2025083112191829000_7.3.e000231.19","unstructured":"American Academy of Paediatrics. Helping Babies Breathe. Learner workbook. 2010."},{"key":"2025083112191829000_7.3.e000231.20","first-page":"605","article-title":"Apgar scores and asphyxia. results of a study and proposal for a clinical grading system","volume":"69","author":"Rothberg","year":"1986","journal-title":"S Afr Med J"}],"container-title":["BMJ Open Quality"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjoq-2017-000231","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T19:19:33Z","timestamp":1756667973000},"score":1,"resource":{"primary":{"URL":"https:\/\/qir.bmj.com\/lookup\/doi\/10.1136\/bmjoq-2017-000231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9]]},"references-count":20,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2018,9,4]]},"published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1136\/bmjoq-2017-000231"],"URL":"https:\/\/doi.org\/10.1136\/bmjoq-2017-000231","relation":{},"ISSN":["2399-6641"],"issn-type":[{"value":"2399-6641","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9]]}}}