Developing a culturally sensitive training program for recognition of hypoxic ischemic encephalopathy in rural India

Background: Birth asphyxia is a major cause of neonatal deaths in the developing world. The management of an asphyxiated infant includes effective resuscitation at birth and treatment of subsequent hypoxic ischemic encephalopathy (HIE). HIE is frequently under recognized in this setting and this contributes to early infant mortality and morbidity.

Methods: We present the evolution of a HIE recognition training program for rural India. The development of this program involved close community interaction, expert content analysis, and preparation and field-testing of a video education package.

Results: A 10-point assessment method was finalized (3 points for history, and 7 examination markers). An education workshop was developed which included prior assessment of knowledge, a video education package and a formal feedback form. The workshop was well received by the participants.

Conclusions: We believe that for the provision of supportive neonatal management or introduction of novel definitive therapies for HIE, the recognition program will be vital in low resource settings and needs to be integrated into the routine responsibilities of the local community health workers. This will ensure timely treatment and transfer of sick or high-risk infants to relevant health facilities and initiation of therapy.