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Objective To document the impact of neonatal resuscitation capacity building of birth attendants at district and sub-district level on fresh stillbirth within the public health system in India. Design An implementation research using pre-post study design. Setting 3 high-infant and neonatal mortality districts (Gonda, Aligarh and Raebareli) of Uttar Pradesh, India. Participants Pregnant women who delivered at the health facilities and their newborns. Interventions An intervention package with (i) training on essential newborn care resuscitation; (ii) skill laboratories establishment for peer-interactive learning; (iii) better documentation; and (iv) supportive supervision was implemented at all health facilities in the districts. Main outcome measures Impact on fresh stillbirth rates and resuscitation practices were documented at 42 health facilities (Gonda-17, Aligarh-8 and Raebareli-17) over 12-18 months. Results Out of the 3.3% (4431/133627) newborns requiring resuscitation, 58.5% (n=2599) were completely revived, 19% (n=842) had some features of hypoxic insult after birth and 1.4% (n=62) were stillbirths. There was 15.6% reduction in still birth rate in the three districts with the intervention package. Conclusions The reduction in still birth rate and improvement in newborn resuscitation efforts in the three districts indicated feasibility of implementation and scalability of the intervention package. However sustenance of the impact over longer period needs documentation.

Background: In India, 18%–20% of newborn deaths are attributed to perinatal asphyxia. Effective resuscitation at birth can prevent neonatal mortality and improve the chances of intact survival. The information about sustainability and retention of gained resuscitation knowledge and skill in India is limited. Objective: The objective of this study is to evaluate the retention of newborn care and resuscitation knowledge and skill of birth attendants at public health facilities after 1 year of clinical practice at the health facilities within Public Health System in India. Methods: In three districts of Uttar Pradesh, knowledge and skill status of 168 birth attendants (54 doctors and 114 nurses) were documented at pre- and posttraining and after 1 year. Results: There was a marked improvement in knowledge scores (doctors: 42%–85% and nurses: 35%–86%) and skill scores (doctors: 15%–89% and nurses: 15%–90%) after training. There was significant retention of knowledge (doctors 58% and nurses 52%) and skill (doctors 82% and nurses 79%) after 1 year, although there was knowledge–skill gap observed after 1 year. Conclusion: The improvement and retention of skill and knowledge among the birth attendants were encouraging. The differential retention of skill and knowledge may be due to the training methodology and opportunity for skill refresher through the skill laboratories.

Background: Retention of neonatal resuscitation skill among birth attendants have been a challenge in developing countries. The objective of the study was to document the performance of skill labs and its impact on the skill and knowledge of the birth attendants in India.Methods: In three districts of Uttar Pradesh, impact assessment of twelve skill labs was done adopting mixed quantitative and qualitative methodology.Results: Twelve skill labs supported skill building of 606 birth attendants over one year. Six of the units performed well and four moderately and too units poorly. The health functionaries at all levels were positive about their experience about the skill labs. Majority of them hoped sustenance of these units. There was marked retention of resuscitation skill after one year.Conclusions: The skill labs appear to be useful modality for promoting retention of the resuscitation skills of birth attendants.