J Pediatr Intensive Care 2017; 06(01): 028-038
DOI: 10.1055/s-0036-1584674
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Designing and Implementing the Helping Babies Breathe Program in Tanzania

Jeffrey M. Perlman
1  Division of Newborn Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, United States
Georgina Msemo
2  Newborn and Child Health Program Manager, Ministry of Health and Social Welfare, Samora Avenue, Dar es Salaam, Tanzania
Hege Ersdal
3  Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Armauer Hansens Norway and Haydom Lutheran Hospital, Manyara, Moshi, Tanzania
Prisca Ringia
4  Division of Obstetric Nursing, Weill Bugando Hospital, Mwanza, Tanzania
› Author Affiliations
Further Information

Publication History

14 June 2015

01 November 2015

Publication Date:
29 June 2016 (eFirst)


The first day and especially the first hour are critical to newborn survival with the highest risk of intrapartum-related neonatal deaths, from 60 to 70%, occurring within 24 hours of birth. Birth asphyxia (BA) or failure to initiate or sustain spontaneous breathing at birth contributes to approximately 27 to 30% of neonatal deaths. In 2009, Helping Babies Breathe (HBB), an evidence-based educational program developed to teach neonatal resuscitation techniques in limited-resource setting, was introduced and piloted in Tanzania. HBB resulted in a significant 47% reduction in early neonatal mortality from 13.4 to 7.1 per 1,000 live-born deliveries (p < 0.0001) and a significant reduction (24%) in fresh stillbirths from 19.0 per 1,000 preimplementation to 14.4 per 1,000 births postimplementation (p = 0.001). The use of stimulation and suctioning increased, whereas the need for bag mask ventilation decreased significantly post-HBB. This success was attributed to several key strategies including elevating BA as a national priority in health care, identification of a primary person (a pediatrician) at the ministerial level who assumed ownership of the program, local site ownership by a midwife, a commitment to train all birth attendants in the current health workforce in HBB, a commitment to provide required resuscitation equipment at all levels, and periodic review of the data (biannually) at a centralized meeting, under the direction of the Ministry of Health, involving all stakeholders to instill a sense of accountability. A national rollout of provider training is almost complete with almost 15,000 already trained.