Over 80% of deliveries in Sudan occur in rural areas, attended by village midwives (VMWs).

To determine the impact of Helping Babies Breathe training and regular peer–peer skills practice (HBBT^+RPPSP) on VMW resuscitation practices and outcomes.

In a prospective community-based intervention study, 71/82 VMWs, reporting to six East Nile rural medical centres, with previous experience in community health research, consented to HBBT^+RPPSP. Outcomes included changes in the resuscitation practices, fresh stillbirths (FSB) and early neonatal deaths <1 week (ENND).

There were 1350 and 3040 deliveries before and after HBBT^+RPPSP, respectively, with no significant differences between the two cohorts regarding maternal age, education or area of birth. Drying of the newborn increased almost tenfold (8.4%, n=113 to 74.9%, n=1011) while suctioning of the mouth/nose decreased fivefold (80.3%, n=2442 to 14.4%, n=437) following HBBT^+RPPSP. Pre-HBBT^+RPPSP9/18 (50%) newborns who had mouth-to-mouth ventilation died, compared with 13/119 (11%) who received bag-mask ventilation post-HBBT^+RPPSP. Excluding 11 macerated fetuses, there were 55 perinatal deaths: 14 FSB/18 ENND (6 months pre-HBBT^+RPPSP) and 10 FSB/13 ENND (18 months post-HBBT^+RPPSP). FSB rates decreased from 10.5 to 3.3 per 1000 births ((χ²)=8.6209, p=0.003), while ENND rates decreased from 13.5 to 4.3 per 1000 live births ((χ²)=10.9369, p=0.001) pre-HBBT^+RPPSP and post-HBBT^+RPPSP, respectively.

In a selected group of VMWs, HBBT^+RPPSP was associated with improvements in newborn resuscitation and perinatal outcomes. HBBT^+RPPSP could have immense benefits if propagated nationally to all 17 000 VMWs in Sudan.