Understanding Neonatal Mortality in Papua New Guinea: A Descriptive Analysis of Regional Birthing Practices and Implementation of Neonatal Resuscitation

BACKGROUND: Papua New Guinea (PNG) did not fully meet all 8 Millennium Development Goals outlined by the United Nations--including goal number 4 to reduce child mortality. While the under-5 mortality ratio decreased between 2004-2015, the neonatal mortality ratio remained unchanged. Previous interventions aimed at reducing neonatal mortality have been effective in other low-resource settings; however, little data exists regarding the standard of obstetric and neonatal care in PNG, particularly at a regional level. OBJECTIVE: To evaluate and compare existing birthing practices both in the regional hospital and among one rural people group within PNG prior to identifying and providing an appropriate intervention with a primary goal of reducing neonatal mortality. METHODS: This study was completed in 2 phases. In the first phase (2015), birthing practices among two distinct populations in PNG were described after 35 vaginal deliveries were directly observed at the provincial hospital and 31 oral interviews were completed on a nearby island with mothers who had previous rural deliveries. After identifying neonatal resuscitation training as a need among village midwives, Helping Babies Breathe (HBB) training was implemented during the second phase of the project (2018). RESULTS: Despite traveling an average distance of 22.3 km to reach the hospital, women who delivered at the hospital were more likely to have received prenatal care (91%) compared to only 58% of women who delivered on the island (located 12.5 km away). Prior to the HBB training, hand hygiene was utilized before all hospital deliveries and only before 1 rural delivery. Infants born on the island were rarely dried and stimulated immediately (13%), while this practice was part of routine care at the hospital (94%). Clean supplies were used to cut the umbilical cord for just over half the island deliveries (52%) compared to all of the hospital births. On the island, 61% of deliveries were attended by a village midwife and 22.6% of neonates died (compared to 8.6% at the hospital). 17 women from the island underwent HBB training in 2018. Compared to a pre-course assessment, there was a 100% increase in the number of participants who correctly washed their hands. Additionally, 82% immediately dried and stimulated the baby and 65% correctly provided ventilation (increase from 0 and 6%, respectively). CONCLUSION: There is a large discrepancy of routine newborn care within the hospital and rural populations in the New Ireland Province, including higher rates of neonatal mortality among babies born on the island. Standardized neonatal resuscitation training can be effectively delivered to village midwives in this region despite no previous training and high illiteracy rates. Further studies are needed to determine the long-term retention among trained providers and the regional effect on neonatal mortality.