This application provides evidence that the Principal and Senior Foreign Investigators have an established record of major accomplishments in the Global Network including the design, implementation, and publication of single site and common protocol studies and clinical trials. For the next 5 year cycle, a rigorously-designed multicenter cluster randomized controlled clinical trial of the innovative use of a low cost and simple heart rate detector to guide neonatal resuscitation in primary care settings in low-income countries using the standard American Academy of Pediatrics Helping Babies Breathe protocol is proposed to determine its effectiveness in reducing early (7-day) neonatal mortality. The heart rate detector will assist birth attendants to determine the heart rate. Five to 10 percent of newborn infants appear lifeless at birth without breathing or crying, and determination of the heart rate and other signs of life is difficult for the birth attendants. For infants born alive, a increasing heart rate is the best indicator of an effective resuscitation. Assessment of heart rate changes is difficult to periderm with the usual clinical assessments in the field, and thus many infants die soon after birth. Neonatal resuscitation skills can be guided by heart rate detection even if a feeble heart rate is detected. If effective, electronic heart rate detection may be a breakthrough for deliveries by low- and middle-skilled birth attendants. The proposed team of investigators has collaborated for over 10 years and will continue to work with the NICHD and other sites of the Global Network to design, implement, analyze, and report innovative randomized trials and observational studies that are likely to reduce mortality and morbidities of mothers and infants. The qualifications and unequivocal commitment of the investigators the Zambian staff, as well as the full endorsement of the Government of Zambia, University Teaching Hospital (Zambia), University of Zambia, and the University of Alabama at Birmingham will ensure superior performance if this site is granted participation in the Network. The long-term objective is to improve local health care systems with education, training, implementation, and sustainability of programs to decrease neonatal mortality with the goal of long-term reduction in mortality and morbidity of infants.

Public Health Relevance

This project addresses the continued high rate of early (7-day) neonatal mortality despite resuscitation training in low income countries and the critical barrier f difficulty in the detection of the heart rate during the first minutes after birth by low- and midde-skilled birth attendants. The heart rate detector can be used during resuscitation to indicate that resuscitation measures are improving heart rate.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Cooperative Clinical Research--Cooperative Agreements (U10)
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Special Emphasis Panel (ZHD1-DSR-M (54))
Program Officer
Koso-Thomas, Marion
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University of Alabama Birmingham
Schools of Medicine
United States
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McClure, E M; Garces, A; Saleem, S et al. (2018) Global Network for Women's and Children's Health Research: probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system. BJOG 125:131-138
Harrison, Margo S; Pasha, Omrana; Saleem, Sarah et al. (2017) A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low- and middle-income countries. Acta Obstet Gynecol Scand 96:410-420
Chomba, Elwyn; Carlo, Wally A; Goudar, Shivaprasad S et al. (2017) Effects of Essential Newborn Care Training on Fresh Stillbirths and Early Neonatal Deaths by Maternal Education. Neonatology 111:61-67
Bang, Akash; Patel, Archana; Bellad, Roopa et al. (2016) Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time? BMC Pregnancy Childbirth 16:364
Bellad, Roopa M; Bang, Akash; Carlo, Waldemar A et al. (2016) A pre-post study of a multi-country scale up of resuscitation training of facility birth attendants: does Helping Babies Breathe training save lives? BMC Pregnancy Childbirth 16:222
Berrueta, Mabel; Hemingway-Foday, Jennifer; Thorsten, Vanessa R et al. (2016) Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries. Reprod Health 13:66
Hibberd, Patricia L; Hansen, Nellie I; Wang, Marie E et al. (2016) Trends in the incidence of possible severe bacterial infection and case fatality rates in rural communities in Sub-Saharan Africa, South Asia and Latin America, 2010-2013: a multicenter prospective cohort study. Reprod Health 13:65
Meyers, J M; Bann, C M; Stoll, B J et al. (2016) Neurodevelopmental outcomes in postnatal growth-restricted preterm infants with postnatal head-sparing. J Perinatol 36:1116-1121
Klein, Karen; McClure, Elizabeth M; Colaci, Daniela et al. (2016) The Antenatal Corticosteroids Trial (ACT): a secondary analysis to explore site differences in a multi-country trial. Reprod Health 13:64
Althabe, Fernando; Thorsten, Vanessa; Klein, Karen et al. (2016) The Antenatal Corticosteroids Trial (ACT)'s explanations for neonatal mortality - a secondary analysis. Reprod Health 13:62

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