Spring 2013 Grant Winner
Bangladesh has made a significant effort to reduce its burden of child mortality. However, neonatal mortality persists and requires targeted interventions if it is to improve. The Sylhet region endures the highest neonatal mortality rate. Timing ofneonatal death is heavily skewed to the perinatal time period, with intra-partum related birth asphyxia a leading cause of death and stillbirth. Research indicates that inadequate resuscitation of babies that do not breathe may lead to misclassificationof the newborn as stillborn. This overlap between stillbirth and birth asphyxia has been poorly investigated at the community level, where home births are common. I propose iterative data collection to explore the community definition of stillbirth and babies with breathing problems. Attention will be focused on resuscitation practices among family members and health providers attending home births. This study could provide: 1) clear criteria for neonatal resuscitation in the community setting; 2)evidence for the need to provide adequate resuscitation training for families, and health care providers; and 3) future validation of verbal autopsies for stillbirths. A primary objective of the project is to review the curriculum of the USAID Helping Babies Breathe Initiative to see if their recommendations align with my findings. A secondary objective is to explore the ethical concern of excluding stillbirth counts from estimates of the global burden of neonatal mortality. The design of this study facilitates an exchange of knowledge between families, birth attendants, and community health care providers, who together comprise the cohort of individuals directly involved in neonatal care in rural Bangladesh.