Photo: Ian P. Hurley/Save the Children
Long-time Village Health Team (VHT) member Zeffa Sowobi, right, begins filling out a family maternal/newborn card for expectant mother Justina at her home in Nabitovu village outside Iganga, Uganda. Zeffa was there to counsel Justina about the how to prepare for giving birth and how to make arrangements to have the baby at a health facility under the care of nurses and midwives. This will be Justina's third child. Zeffa will visit the home one more time, for a total of three antenatal home visits.
It is hard to believe that despite the tremendous progress that has been made on newborn survival over the past decades, the world had never been brought together to review, learn, share lessons and build a common understanding for the future of newborn survival, addressing this previously neglected public health issue in the context of the continuum of care and other determinants of health.
The first-ever global newborn health conference was held from April 15-18 in Johannesburg, South Africa. The conference, themed “Accelerate the Scale-Up of Maternal and Newborn Health Interventions to Reduce Mortality”, had participants from multiple backgrounds.
From over 40 sessions and countless of interactions with country teams, one couldn’t help but feel inspired. In her presentation, Professor Joy Lawn identified the big 5 causes of deaths to target if we are to reduce the deaths of children and women. These are;
- Childbirth complications e.g. haemorrhage, obstructed labour (causing the lives of ~2.12 million);
- Preterm birth complications ~1.1 million;
- Infections e.g. Mother - HIV, syphilis, malaria, maternal sepsis; Baby - sepsis, pneumonia, diarhoea, tetanus ~1.12 million;
- Maternal chronic conditions (NCDs) e.g. hypertension, diabetes (linked to preterm and to small for gestation a;
- Nutrition (under-nutrition and obesity). The light of this comes at the time when we have evidence-based solutions.
At the conference, interventions known to have the greatest opportunity to save most babies from preventable deaths were discussed and these are; Kangaroo Mother Care, antenatal corticosteroids, antibiotics for neonatal sepsis, clean cord care and neonatal resuscitation. These have now been simplified and, if integrated into systems, in view of the Reproductive, Maternal, Newborn and Child Health (RMNCH) continuum of care and effectively delivered at scale, can save over one million lives of newborn babies each year. Care for mothers and babies is inextricably linked and especially at the time of birth – the most opportune moment for investing efforts for maximum impact. The strongest link is between mother and newborn, also when it comes to delivering care.
"Proper care at birth saves the lives of a mother, a baby and prevents stillbirths, hence providing a triple return on investment", Professor Joy Lawn, MARCH, London School of Hygiene and Tropical Medicine
The ability to link in with other programmes will advance efforts to save newborn lives and accelerate progress towards reaching scale. Both policy and programmatic integration of high impact newborn interventions with HIV programs (PMTCT), Malaria control programs and family planning can tremendously drive scale-up of interventions. Presentations at the conference addressed the interconnectedness of looking at the full spectrum to help turn the tide in newborn health. Countries have been advised to explore and seize such opportunities as means of maximising resources, political will and opportunities for improving maternal and newborn care.
You cannot underestimate the power of the private sector and professional associations to drive change for mothers and newborn in the world. Innovations like the Helping Babies Breathe (HBB) program from the Laerdal Foundation and the American Academy of Pediatrics is one such an effort to count on and more, especially collaborations in the areas of innovations, are needed. In fact, there were demonstrations of how the HBB intervention works for those attending the conference to learn more firsthand.
Sustainable impact through the pursuit for effective coverage at scale – I am here defining “effective coverage” of maternal and newborn interventions as being able to reach all mothers and newborns in need with adequate, quality high-impact interventions.
Are we there yet? It is one thing to reach mothers and their newborns with interventions, and another to have significant impact on reducing deaths and disability. Increasing intervention coverage is important, but will result in mortality reduction only if interventions are delivered at adequate quality levels. Panelists at the conference also stressed that quality of care is thus yet another dimension calling our attention in this quest.
Overall, many developing and high burden countries have seen significant increase in facility births over the past decade; a similar trend has been seen with consistently high rate of 1st ANC visit.
However, this increase has not translated into commensurate reductions in maternal and newborns deaths!
The birth day is the riskiest day for both mother and baby. The time of birth is the most opportune moment we have to save the most of babies and mothers yet it is when we still lose them most! Even when mothers present to us in health facilities and entrust us their lives and those of their babies, we are unable to save an unacceptably high number. The package of care is defined, simplified and even increasingly clearer now than before;. Now we know that there are huge quality gaps at the time and these at the same time present to us as opportunities to seize – what took us so long? The time to reach effective coverage is now – coverage that delivers the promise.
Taking it home - Through the country action planning support sessions at the conference, countries that participated were further enabled to make the difference that is desperately needed. The groundwork was laid towards informing national priority setting by setting ambitious, realistic and achievable targets for newborn health. Overall the conference enabled tremendous sharing of rich and invaluable experiences and learning.
There emerged ideas and key messages to work with as we work to accelerate progress towards reaching effective maternal and newborn interventions at scale. This includes policy and agenda setting, data for decision making (including research and evidence), innovation and the role of private sector, systems and implementation were all adequately covered.
Personally, I was left with the understanding of the critical implications of the following as key for taking high impact newborn interventions to scale and accelerating the reduction of maternal and newborn deaths;
- Targeting the biggest causes of deaths with known, high-impact interventions
- Focus on the RMNCH continuum of care and other policy and program integration that maximises the number of women and newborns reached
- Mobilising the global and national action for accelerated reduction of newborn deaths (in context of RMNCH) and the opportune timing of the Global Newborn Action Plan
- The importance of country-led actions and planning for accelerated change
- The power of multi-sectorial partnerships
- It is the simple things that can avert most newborn deaths
Follow Patrick Aliganyira on Twitter - @aliganyira
The newborn period is probably a complicated time for a baby and its parents. Lack of knowledge in caring for newborns properly may be an important factor behind the largest share of child death in Bangladesh by newborns, which is during the first 28 days of life.
Newborn care is essential in helping to prevent many causes of newborn deaths. Particular focus needs to be given to accessing quality emergency care for sick newborns, care for low birth weight babies and essential newborn care for all newborns so that they don’t fall sick and if they do, the right treatment can be provided.
The WHO estimates that approximately one to five percent of babies will require resuscitation at birth and many of them may die or suffer long-term disabilities if not resuscitated in the first minute of life (the Golden Minute). In Bangladesh, 10% of the babies born suffer from breathing difficulties or birth asphyxia, which can be addressed using a simple bag-mask resuscitation technique. Often oxygen and other complex techniques aren’t necessary to save most of these newborns.
Save the Children in Bangladesh has been rolling out the Helping Babies Breathe (HBB) training curriculum specially to address this newborn complication since August 2011. Currently, 15,594 health workers from public, private and NGOs have completed traninig. A total of 30000 caregivers across country are set to be trained. Additionally, this training has also been incorporated in pre-service and in-service curriculums.
The State of the World's Mothers report, released by Save the Children, presents new data on the staggering toll of newborn deaths on the first day of life. The report also shares stories from mothers and families affected by this tragedy, in the United States and around the world. This is one of those stories, by mother Angela from Oregon. She tells the story of her daughter Charlotte, who would be celebrating her third birthday next week. Originally published in her blog, cross-posted with permission.
- "The US ranks as the 30th best place to be a mother."
- "The US has 60% of all first-day deaths, but only 38 percent of live births."
- "Newborn deaths now make up 43% of child deaths (under 5)."
- "When first-day deaths in the United States are compared to those in the 27 countries making up the European Union, the findings show that European Union countries, taken together, have 1 million more births each year (4.3 million vs. 5.3 million, respectively), but only about half as many first-day deaths as the United States (11,300 in the U.S. vs. 5,800 in EU member countries)."
- Girls 10-14 are five times more likely to die during pregnancy or childbirth than women 20-24.
- The infant of a mother under the age of 18 is 60% more likely to die in its first year of life.
- Stillbirths and newborn deaths are 50% higher among infants born to adolescent mothers than among those born to mothers aged 20-29 years.
- Complications from pregnancy and childbirth are the leading cause of death of girls 15 – 19 worldwide.
This blog was originally published by Impatient Optimists. Written by Gary Darmstadt.
Where is the best place on earth to be a mother? Save the Children’s report, State of the World’s Mothers, released today gives us the answers. You will also find the extreme opposite—the worst place in the world for mothers and children. In both cases, the report makes clear that the state of the world’s mothers is about the state of the world overall. As Melinda Gates notes in the foreword to the report, when we invest in women, we invest in the health and lives of children and improve the human condition. The health of women and children are inextricably linked.
This is the 14th annual State of the World’s Mothers report which sheds light on these issues, but this year breaks them down even more, for the first time specifically revealing the risks during those critical 24 hours after birth (the "first moments", notes the report) – the birth day. It’s a day when mothers should be celebrating but, unfortunately, it’s also a day in many countries where mothers and newborns face the greatest threats to survival.
“It’s a day when mothers should be celebrating but, unfortunately, it’s also a day in many countries where mothers and newborns face the greatest threats to survival.”
We have the opportunity to save millions of lives if the global community comes together on behalf of mothers and newborns.
This report gives us hope that it is possible to give a newborn a better chance of survival. It highlights four simple, life-saving treatments that if taken to scale could save more than one million newborns each year:
- Umbilical cord cleansing to prevent infections using chlorhexidine
- Helping babies who are born early to breathe using antenatal corticosteroids; resuscitation devices to help babies breathe at birth when necessary; and injectable antibiotics to treat newborn infections.
- Kangaroo Mother Care which keeps the baby warm encourages breastfeeding and fights infection.
- Early and exclusive breastfeeding is also one of public health’s best buys and would save many more babies.
It’s equally important to ensure that we continue to focus on safe care for women during pregnancy and childbirth and to increase the number of health workers in regions of the world where there are shortages.
“This report gives us hope that it is possible to give a newborn a better chance of survival.”
The release of this report and this information is monumental, considering that a decade ago we barely understood the causes of newborn mortality and were intimidated by what was perceived to be a need for highly specialized care for a newborn. We now know that is not true.
It is heartening for me to see this inspired commitment to newborn health and the critical connections made between the health of women and newborns. This report, coming on the heels of the Global Newborn Health Conference and paving the way for the Women Deliver Conference, keeps mothers and newborns front and center, a place they deserve to be.
A healthy start to life paves the way for a healthy childhood with more opportunities for a good education, which then leads to healthy, productive adults, contributing to stronger economies and having healthy babies themselves. It’s a virtuous cycle, with healthy newborns at the nexus of the continuum.
We now have the opportunity to ensure that each baby born around the world has the pleasure of celebrating his or her first birthday, then the fifth, then the tenth, and on into adulthood. We have the chance to rally on behalf of women and girls as well. Now is the time to focus on saving the lives of our mothers and newborns.
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The Healthy Newborn Network Blog provides timely information and insights from the global newborn health field and seeks to promote dialogue on important newborn health issues. The blog is a platform for the HNN Editors and guest contributors to post commentaries on current happenings in the newborn health field. The content of each post and comments expressed on the HNN blog are those of the individual contributors and do not necessarily represent the views and opinion of the HNN or its Partner Organizations. >>Read a note on leaving comments
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