Addressing Critical Knowledge Gaps in Newborn Health

Blog

By Carolyn Miles on May 5, 2015
Asia, North America


Rizelle, 17 has a three-week-old baby. She fed the baby immediately after birth so that she got the colostrum. Rizelle has had a post-natal check up and vaccinations. Roselle wants to breastfeed for a year and is planning to go to the health centre for the next dose when sheís six weeks old. Rizelle lives in a squatted home under a bridge in San Dionisio, Manila, Philippines, where they live with 30 other families. Photo: Lucia Zoro/Save the Children

This blog was originally published in The Huffington Post. Written by Carolyn Miles.

I will never forget the moment when I looked out the car window at a bustling, steamy intersection in the heart of Manila, and locked eyes with a young woman. She was holding a tiny baby while begging in the street.

I glanced down at my six-month-old son, sleeping contentedly in my arms inside our air-conditioned car. The enormous inequalities between my world and hers struck me as never before. The child in my arms was about the same age and no smarter, cuter, or better than hers. Yet due to mere circumstance of birth, I knew my son would have many more opportunities in life, while this mother and her child would struggle to survive each day to the next.

It’s been 20 years since that fleeting moment, but the vision of the mother and her child has stuck with me. It drove me to change careers and join Save the Children, where we work tirelessly to ensure that every mother and child has a fair chance in life.

These days, more and more mothers in urban areas are seeking better opportunities for their children. That’s why Save the Children’s new report, State of the World’s Mothers 2015: The Urban Disadvantage — released with support from Johnson & Johnson — focuses on the health and survival of moms and babies in cities. The findings reveal a harrowing reality: for babies in the big city, their survival comes down to their family’s wealth.

I have been back to Manila many times. I am happy to report that, along with other urban centers in the Philippines, it is an example of how cities can narrow survival gaps between the rich and the poor by increasing access to basic maternal, newborn and child services, and making care more affordable and accessible to the poorest urban families.

A child’s chance of dying before his fifth birthday has been steadily declining over the years among the poorest 20 percent of urban families in the Philippines. From when I first visited that country in the mid ‘90s until today, child mortality rates among the urban poor have been cut by more than half and the urban child survival gap has narrowed by 50 percent between wealthy and poor kids.

Sadly, the Philippines is one of just a few countries with such dramatic improvements for poor urban children. In too many countries, urban child survival inequality is worsening, even as those nations have been successful in reducing overall child mortality rates.

In my travels throughout the developing world, I’ve never had to look very far to see evidence of these differences. For example, in New Delhi, India – a city with one of the largest health care coverage gaps between rich and poor – it is not unusual to see a gleaming hospital steps away from a sprawling slum, and to have babies literally dying on the doorstep.

But it’s not just in the developing world where our report found stark disparities between the haves and have nots. In our nation’s capital, Washington, D.C., a baby born in the lowest-income district, where half of all children live in poverty, is at least 10 times as likely as a baby born in the richest part of the city to die before his first birthday. And while Washington, D.C. has cut its infant mortality rate by more than half over the past 15 years, the rate at which babies are dying in the District of Columbia is the highest among the 25 wealthiest capital cities surveyed around the world.

We all have a lot more work to do to ensure that every mother has the same opportunities for her baby, whether she lives in Manila, Washington, D.C. or anywhere else in the world.

Find out more about Save the Children’s new report at www.savethechildren.org/mothers.

By Aminu Magashi Garba on May 4, 2015
Africa

This blog was originally published by MamaYe. Written by Aminu Magashi Garba

We attended an inspiring workshop in Harare at the end of January. It was organised by Harmonisation for Health Africa, the World Health Organisation and others, and aimed to get different types of stakeholders from the same country in the same room so they could agree together on a health budget advocacy plan. These different groups included budget CSOs, health CSOs, the media, parliamentarians, and representatives from Ministries of Health and Finance. Teams from Ghana, Malawi, Nigeria, Zambia and Zimbabwe were invited.

The outcomes of the meeting were pretty exciting – each team drafted an advocacy plan and returned to their own countries to sharpen the objectives and activities. Subject to approval, the WHO will provide a US$20,000 seed grant for implementation of each country plan in the first year. The Africa Health Budget Network has also agreed to share updates among countries on the implementation of such plans. In line with this commitment, we have provided an update on each country below:

Ghana: The Ghana team is led by the Alliance for Reproductive Health Rights. The team has submitted a draft advocacy plan to WHO. Furthermore, one of the MPs at the workshop, Mr Alhaji Amadu Sorogho, called on his colleagues to use the National Health Insurance Funds at their disposal to fight maternal and newborn mortality, according to the Ghana News Agency.

Malawi: The Malawi team is led by Malawi Health Equity Network – so far they have met once since the workshop in order to finalise a strategic plan which has been submitted to WHO.

Nigeria: The team is led by Community Health Research and has held two meetings since the workshop in order to approve their advocacy plan, which has now been shared with WHO.

Zambia: Have commenced engagement – further updates in the next newsletter.

Zimbabwe: Have commenced engagement – further updates in the next newsletter.

By William Keenan on May 1, 2015
Bangladesh
Asia


A newborn baby is weighed on a weighing scale in a health facility located in a remote village in Bangladesh. Photo: Colin Crowley/Save the Children

This blog was originally published in Medium. Written by Dr. William Keenan.

After a long trip from St. Louis to Dhaka, Bangladesh, I finally made it to the Asia launch of Survive & Thrive’s Helping Babies Survive workshop! The workshop combines training in the Essential Care for Every Baby and Essential Care for Small Babies curricula and strategic planning for health systems improvement in the attendees’ home countries.

The goal of our week in Dhaka is to help strengthen health care professionals’ clinical skills and to build their advocacy skills so the participants and their colleagues can take a leading role in improving their nation’s health systems. I’m here to share my expertise as a physician and to build relationships with health professionals from across Asia.

None of my fellow American Academy of Pediatrics volunteers would be here without the Survive & Thrive Global Development Alliance partners, especially USAID’s Maternal and Child Survival Program who organized all the goings-on in Dhaka.

April 8

The opening ceremony featured a who’s who of the maternal, child, and newborn health leaders — including representatives from WHO, USAID and UNICEF. It was inspiring to see them support our launch and it was inspiring to see 80 different leaders representing seven countries involved in the Helping Babies Survive launch.

Here are some highlights:

First to speak was Dr. Bernadette Daelmans. Dr. Daelmans serves as Coordinator for Policy, Planning and Programmes, at the WHO’s Department of Maternal, Newborn, Child and Adolescent Health.

  • Dr. Daelmans called for the elimination of all preventable maternal and newborn deaths.
  • Investing in skilled newborn resuscitation, improved post-partum care, universal breastfeeding and infant infection reduction will help get us there.
  • You can find Dr. Daelmans’ full presentation here.

Dr. Nabila Zaka of UNICEF spoke about the Every Newborn Action Plan.

  • Already, 23 of the 25 countries with the highest rate of neonatal mortality have developed an ENAP plan.
  • You can find Dr. Zaka’s full presentation here.

Senior Maternal and Newborn Health Advisor for USAID Dr. Lily Kak reported on the success of the Helping Babies Breathe (HBB) program. HBB teaches health providers techniques for newborn resuscitation. The HBB curriculum set the stage for the Essential Care for Every Baby and Essential Care for Small Babies curricula.

  • 300,000 health providers in 77 countries have received Helping Babies Breathe training.

April 9

Dr. Altaf Hussain of the Ministry of Health, Bangladesh kicked off the first day of Essential Care For Every Baby (ECEB) training by describing the dramatic partnerships and investments that Bangladesh is making in newborn health. The government, universities, NGOs and professionals have teamed up in a commitment to fully implement Every Newborn Action Plan over the next two years.

ECEB training commenced with “leaders as learners” from nine Asian countries and 12 facilitators from four different countries (India, Bangladesh, Canada and the US). The polite, perhaps slightly skeptical, quiet at the beginning quickly transformed into bustling interactions as the participants joyfully mastered new skills and perceptions. The trainings will continue for another day and a half to include training in the Essential Care for Small Babies (ECSB). Attention will then be turned towards quality improvement, problem solving, and implementation over the last three days of this unprecedented meeting of Asian leadership in newborn health.​

April 10

The 78 learners and 13 faculty spent the morning completing the final portions of the Essential Care for Every Baby curriculum. Dr Nalini Singhal, course master, reminded the group of the many synergies and continuity among the Helping Babies Breathe, Essential Care for Every Baby and Essential Care for Small Babies courses. Conversations at many of the groups around the room were focused on training to performance, training the trainer constructs and transforming training to improved outcomes.

The afternoon sessions were devoted to the Essential Care for Small Babies curriculum. A tired but happy crew completed their day with discussion and practice of the problem solving approaches outlined in the “yellow” zone of the ECSB Action Plan. As the group broke for the day, the issues of implementation and quality maintenance and improvement were on the minds of many.

Dr. William Keenan is a professor in the department of Neonatal-Perinatal Medicine at the Saint Louis University School of Medicine. He is considered a pioneer in the field of neonatal resuscitation and serves as co-chair of the Helping Babies Survive Planning Group. He also serves as executive director of the International Pediatric Association. Dr. Keenan has traveled to 14 countries to train health professionals in neonatal resuscitation and other life-saving interventions.

Survive & Thrive is an alliance of government, professional health association, private sector, and non-profit partners working alongside country governments and health professionals to improve health outcomes for mothers, newborns, and children through clinical training, policy advocacy, and systems strengthening.

By Kate Kerber on April 30, 2015
Nepal
Asia


Residents salvage their belongings from their destroyed homes in Kamalbinayak, Bhaktapur, Nepal. Photo: Jonathan Hyams/Save the Children

Since the earthquake in Nepal on April 25th, over 5000 have lost their lives. Nearly two million children have been affected by the worst earthquake the nation has seen in 80 years, and its aftermath in the Kathmandu Valley and elsewhere in central Nepal. Based on the country’s population trends, in the six days since the earthquake, close to 10,000 women have given birth in uncertain circumstances, potentially distanced from loved ones and critical support networks. National trends before the earthquake would have seen 45% of these women delivering at home, with just over half of pregnant women trying to make their way to a health facility.

Pregnant women and babies receiving care in clinics and hospitals at the time of the earthquake are contending with limited beds, overcrowding and overworked staff while health workers care for survivors. It appears that numerous health facilities are without electricity; many have been damaged. Women delivering at home may be in unsafe, unhygienic conditions with little opportunity to reach extra care if complications occur. Support for mother-led interventions like skin-to-skin care for babies born too small and too soon, safe hygiene practices, and early and exclusive breastfeeding are needed now more than ever.

Nepal is making progress towards reaching every woman and baby with essential care for survival and health. Strong partnerships between government and development partners have ensured effectively-coordinated efforts in maternal and newborn health. Openness to innovations, especially those that improve availability and quality of essential services and engage communities, such as establishing local birthing centres, strengthening women’s groups, promotion and use of chlorhexidine for umbilical cord care, and providing treatment for newborn sepsis at the lowest level facilities, means the country is poised for rapid reductions in newborn mortality to match those recently seen in maternal and child deaths. A major humanitarian emergency like this earthquake will set back these efforts. Primary healthcare services don’t require the same level of infrastructure likely to be damaged in the earthquake but they do rely on people, many of whom who will be trying to locate family members and ensure their own safety.


Displaced people reside in tents provided by the army at a festival and parade ground in the center of Kathmandu on April 27, 2015. Photo: Save the Children

These early days are critical to find survivors and ensure protection for those most at risk, including pregnant women and their newborns. In the coming weeks and months they will need additional support to rebuild clinics, hospitals, roads, and other infrastructure. Amongst the many that have suffered as a direct result of the earthquake, it is important to remember that the repercussions will continue to affect thousands more. In order to help reconstruct a nation after this emergency, we must remember to care for pregnant mothers and their newborns.

The global community needs to support Nepal

If you would like to get involved in relief efforts, we encourage you to support organizations already actively working to help affected areas.

For suggestions, please visit this web site to learn more about what they do and how you can help.

By Ludmilla Reina on April 29, 2015
Ethiopia
Africa


Photo: Sandoz

Sandoz, the generic division of global pharmaceutical company Novartis, is a worldwide leader in generics. Sandoz has a strong presence in Africa and established its Ethiopian operation in 2013 led by Ludmilla Reina. Ludmilla is based in Addis Ababa, where she is Country Head, and she also manages Sandoz operations in Eritrea, South Sudan, Somalia and the Republic of Djibouti.

Childbirth usually takes place at home in Ethiopia, the second largest country in Africa, where 80% of the population lives in rural areas. If there are any complications, little help is available and as a result approximately 250 mothers and newborns die in Ethiopia every day1, 2. There is often no electricity or running water and – if there is a health center in the area – the health workers there typically have limited obstetric training and lack the physical resources required to provide proper care for women and children in need.

Despite these statistics, as I write this blog I feel hopeful – the New Life & New Hope program has been launched!

The program, developed by Sandoz in close collaboration with the Ethiopian Ministry of Health and the Ethiopian Midwives Association (EMA), aims to improve health support for mothers and to reduce child mortality. Although we may not be able to deliver a complete solution for the country’s various unmet health services needs, I am convinced that we are now contributing in a practical, effective way and providing at least part of the solution.

I started dreaming about implementing a program like this soon after I opened our Sandoz office in Addis Ababa in 2013. As I traveled the country many times with various non-governmental organizations, visiting both urban and rural areas, I quickly realized that there was a lack of the basic skills required to deliver babies safely. Knowing that many women and infants died or suffered debilitating complications as a result of circumstances that were completely preventable made me determined to create real, lasting change for Ethiopian women. That was how the New Life & New Hope program was born.

Through this program, which is fully aligned with our global aspiration to contribute in real, meaningful ways to the communities where we operate, Sandoz is sponsoring critical obstetric training for midwives. This program will help the Ethiopian Ministry of Health to achieve its own stated goals as well. By the end of 2015, we hope that approximately 200 midwives in and around Addis Ababa will have taken part in the program, with measurable positive impact on the care of approximately 80,000 pregnant women in the area. The EMA is currently identifying which of its members will participate in the training and who will be able to assist our team with implementation. We are already planning to expand the training into other, more rural areas of the country by later this year.

New Life & New Hope is not only my personal quest to help women and children in Ethiopia; it is also in line with Sandoz’s commitment to the United Nations Millennium Development Goals and to the Every Newborn Action Plan. Two of the eight goals refer to significantly reducing child mortality and improving maternal health by the end of 2015. Sandoz continues to work towards these goals by increasing global patient access to affordable, high-quality, medicines as well as to healthcare services and medical education.

This program gives us the opportunity to address one of the most serious healthcare challenges currently facing Ethiopia and training 200 midwives by the end of this year will be a great achievement. With an estimated Ethiopian population of 97 million, the task feels daunting at times – but we refuse to be overwhelmed.

The way I see it, our job is to improve and save lives. Every time we save one woman or one child, we are taking another step towards making the world a better place. We are bringing new life and new hope.

1. http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2013/en/

2. http://www.unicef.org/publications/index_75736.html