A groundbreaking study published in The New England Journal of Medicine reveals that simulation-based training and quality improvement programs can significantly reduce perinatal mortality in low-resource settings. The study involved over 125,000 individual training sessions and 1,300 group simulations, impacting more than 280,000 mothers and newborns. This large-scale intervention led to an 18% reduction in perinatal deaths, offering a scalable model for global maternal and neonatal care.
Every day, thousands of newborns take their first breath but in many parts of the world, that breath is never guaranteed. Birth-related complications remain one of the leading causes of infant mortality, particularly in low-resource settings. However, a groundbreaking study published in the New England Journal of Medicine (NEJM) suggests a powerful solution: simulation-based training and quality improvement programs that equip healthcare providers with life-saving skills before emergencies unfold.
A Game-Changer in Perinatal Care
The Safer Births Bundle of Care, a structured program designed to enhance perinatal care, was recently tested in a three-year stepped-wedge cluster-randomized study across 30 high-burden healthcare facilities in Tanzania. This large-scale initiative combined hands-on simulation training, real-time clinical data utilization, and the deployment of innovative neonatal care tools. The goal? To improve perinatal outcomes and provide a sustainable, scalable model for healthcare systems worldwide.
The success of the Safer Births Bundle of Care program was rooted in robust collaborations among various organizations. Local Hospital, Ministry of Health, Local Government and Regional Authority, professional bodies such as the Midwifery Association and the Pediatric Association and UNICEF in Tanzania, played pivotal roles in the program’s implementation. International support from the SAFER Simulation Center at Stavanger University Hospital and Laerdal Global Health in Norway further strengthened these efforts.
Numbers and Key Findings: Reducing Newborn Deaths
The intervention was massive: over 125,000 individual training sessions and about 1300 group simulations led by a facilitator were recorded. The study involved 281,165 mothers and 277,734 newborns across five regions in Tanzania. Researchers observed a striking 18% reduction in perinatal mortality following the program’s implementation. The estimated incidence of perinatal death dropped from 15.3 to 12.5 deaths per 1,000 births. Notably, while the incidence of intrapartum stillbirths remained largely unchanged (8.6 deaths per 1,000 births at baseline vs. 8.7 per 1,000 post-intervention), the number of neonatal deaths within the first 24 hours plummeted from 6.4 to 3.9 per 1,000 births, highlighting the critical role of timely and effective newborn resuscitation.
Why This Study Matters
The publication of this research in NEJM, recognized as the world’s leading medical journal, underscores the growing recognition of simulation-based training as an essential component of modern healthcare. By demonstrating that structured interventions can dramatically improve newborn survival, this study sets a precedent for how maternal and neonatal health programs should be designed and implemented.
A key element of the Safer Births Bundle of Care is its reliance on simulation-based learning. Training programs like Helping Babies Breathe and innovative tools such as the NeoNatalie Live simulator allowed healthcare workers to practice resuscitation techniques repeatedly, ensuring they were fully prepared when real-life emergencies arose. This hands-on approach proved crucial in reducing neonatal deaths within the first 24 hours, a period when newborns are most vulnerable. And the simulation can be effectively implemented even when time and resources are limited, as already described in another article.
Beyond the Numbers: Empowering Healthcare Providers
A qualitative study published in 2023 involving interviews with healthcare providers and managers at two thirds of the involved facilities revealed that the implementation of the Safer Births Bundle of Care had profound effects beyond measurable outcomes. Midwives reported increased confidence in recognizing emergencies, such as non-breathing newborns and excessive postpartum bleeding, and in initiating effective actions while awaiting a doctor’s arrival. Additionally, providers noted a reduction in the “blame and shame” culture, leading to improved self-confidence and a safer working environment.
Global Implications
The success of the Safer Births Bundle of Care has garnered global attention, highlighting its potential to transform maternal and newborn health. The program’s remarkable results, reducing maternal deaths by up to 50% and neonatal deaths by up to 45% in areas of implementation, demonstrate its effectiveness and scalability. In 2020, the program received funding from the Global Financing Facility (a part of the World Bank) to scale up to 30 hospitals across five regions in Tanzania, covering approximately 500,000 births per year. Based on these promising results, the Safer Births Bundle of Care was awarded an additional $8.5 million to further extend its reach in Tanzania.
This comprehensive approach, combining simulation-based training with continuous quality improvement strategies, provides a sustainable framework for reducing birth-related mortality, offering a model for other low-resource settings aiming to improve maternal and neonatal health outcomes.
Conclusion
This landmark study reaffirms that investing in structured, evidence-based training programs can lead to real, measurable improvements in perinatal survival. The combination of frequent hands-on training, clinical data integration, and innovative technology is not just an academic exercise, it’s a tangible, life-saving intervention. As global health initiatives strive to reduce birth-related mortality, the Safer Births Bundle of Care provides a model for how we can turn knowledge into action, one breath at a time.
For those eager to explore the study in greater detail, the full text is available at NEJM.
READ ALSO
