The journal Seminars in Perinatology has just published a series on the health of mothers and babies around the time of birth. The series opens with a paper reviewing progress for neonatal deaths - a mixture of good news and challenges. The global number of neonatal deaths (deaths during the first 28 days after birth) is reducing, due to successes in family planning and increasing coverage of some key interventions, BUT since there is more rapid progress in reducing deaths after the neonatal period, 41% of under five child deaths are taken up by neonatal deaths. Addressing neonatal deaths is increasingly important for MDG 4.
The huge variation in progress between regions and countries, rich and poor families, and among different causes of death means it is increasingly important that the most recent and local data be used to prioritize policy and programs.
Progress for neonatal survival in regions and countries
- All regions of the world have achieved more rapid progress in reducing neonatal deaths over the last five years, but the rate of decline differs by region, country, and within countries. China and a number of South East Asian countries have made remarkable progress. South Asia is beginning to make more progress, apart from Pakistan.
- Africa is reducing neonatal mortality at an average of less than 1% per year. This is an improvement from the 1990s, when no progress was made, but is still too slow for 1.2 million African families who lose a baby every year. However some African countries are moving much faster. More analysis of this progress could help the whole continent.
- 10 populous countries account for 2.3 million neonatal deaths, 67% of the global total. India alone has a million neonatal deaths each year. These same countries also suffer 62% of the world’s maternal deaths.
- Within countries, the poorest families are most likely to experience newborn deaths. The richest families in India have a neonatal mortality of 26 per 1000 live births compared with 56 among the poorest families, a 2.2-fold gap. If all Indian families had the same neonatal mortality rate as the richest families then nearly 460,000 fewer babies would die each year.
Progress for causes of neonatal deaths
- Progress also differs across the main causes of neonatal death. Three causes of neonatal deaths (infections, complications of preterm birth, intrapartum-related neonatal deaths or “birth asphyxia”) account for over 80% of all neonatal deaths globally.
- The most rapid reductions have been made in reducing neonatal tetanus – a dramatic change from over 600,000 deaths in 1990 to fewer than 60,000 in 2008. This is a success story associated with immunization and also use of data-based targeting of high risk districts.
- There has been apparent progress in reducing neonatal infections and diarrhea, probably linked to progress in child survival programs. As of 2010, 43 of 68 Countdown countries have updated their policy to add newborn care to the Integrated Management of Childhood Illness. Innovations in care of babies with infection, especially bringing antibiotic treatment for neonatal sepsis closer to home, could accelerate progress in reaching more families, especially the poorest.
- BUT there is limited, if any, reduction in global deaths from preterm birth and intrapartum-related (asphyxia) neonatal deaths. Reducing these deaths requires better care at birth, including obstetric care and resuscitation, and better care for small and sick babies in front line and referral facilities. There are highly effective and feasible interventions, such as Kangaroo mother care, and antenatal steroids - yet these reach very few mothers and babies in need.
Priority gaps for action and research
- The greatest challenge to saving the lives of mothers and babies is ensuring care for the 60 million births that occur at home each year – a coverage gap. There is momentum towards skilled care at birth, but this is not fast enough, especially for the poorest families – an equity gap.
- For births occurring in health facilities in many low and middle income countries, there is a quality gap. Women and babies do not receive life-saving, evidence-based care, even though they are in contact with the health system. These missed opportunities for births in facilities are the most feasible and cost-effective to address.
- More than half of the newborns who die in low-income countries do so at home. In Bangladesh, for example, as few as 15% of babies are born or die in a hospital. In northern Ghana, only 13% of neonatal deaths occur in hospital. Linking home and hospital is crucial and neonatal deaths are a sensitive indicator of these linkages since babies can die within hours or even minutes, without the right care.
- Rigorously designed implementation research –answering “how-to questions” -- will have the most effect on lives saved in the short term.
- 2010 has been an exciting year for maternal, newborn and child health. In the short time left before 2015, the MDG deadline, newborn deaths can and must be reduced. The use of data to prioritize programmatic action has the potential to result in major changes for maternal and newborn survival in many countries and for the world’s poorest families– the question is, are we using the data and will we act?
Scroll through the following presentation outlining the article. You are welcome to download the powerpoint presentation and use any of the slides and figures. Please credit the appropriate source for data, figures and images.
>Have you seen the BBC World documentary, Invisible Lives? Follow Dr. Joy Lawn as she travels to Malawi and Nepal to see how these two countries are addressing their previously unrecorded, "invisible" burden of newborn deaths. Watch it now.
>Read more: The Bill & Melinda Gates Foundation published a series of blogs from experts highlighting Global Perinatal Health and the Seminars in Perinatology series, commenting on the progress that has been made on research to help mothers and newborns survive childbirth:
- Melinda Gates: Celebrating the health of mothers and babies in 2010
- Dr. Gary Darmstadt: Global Perinatal Health
- Dr. Vishwajeet Kumar: Behavior Change - Critical for newborn survival
- Dr. Zulfiqar Bhutta: Interconnections between maternal, newborn and child health
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