Deaths of Newborn Babies, a Big Concern in Bangladesh

The following post was written by Dr. Sayed Rubayet and Dr. Javedur Rahman

The national launch of ‘A Decade of Change for Newborn Survival’ took place on July 4, 2012 and received wide media attention nationally (see related articles below). In Bangladesh, 83,000 babies die in the first month of life each year. Even though this number has decreased significantly in the past decade, too many families are still suffering unnecessary loss of preventable newborn deaths.

Bangladesh has made commendable progress in reducing child mortality and the country is on track for Millennium Development Goal (MDG) 4 for child survival. However, the rate of mortality reduction for children in the neonatal period (0-28 days) is less than half that of older children (4% versus 8.6%). Nonetheless, Bangladesh has made more rapid progress in reducing neonatal mortality in the last decade than its neighboring countries, declining at a faster pace than the regional and global averages (2.0% and 2.1% per year, respectively).

The landmark publication includes a comprehensive analysis of newborn survival in the Bangladeshi context, examining changes in mortality, coverage, funding, and other contextual factors from 2000-2010. The paper is part of a supplement published in the public health international journal Health Policy and Planning, along with a series of seven other papers on newborn survival including four other country case studies and a multi-country analysis.

From 2000- 2010, many positive developments took place in Bangladesh to address the high number of newborn deaths, including the development of a National Newborn Health Strategy, operational research, and improvement of community based care, all of which helped changed the trajectory for millions of children. However, tens of thousands more can be saved from early death, with the proper resources and education programs.

Save the Children in Bangladesh convened leading experts and health journalists for the national launch event to discuss a decade of change and future implications for newborn survival in Bangladesh. Jointly with The Daily Star, the country’s largest circulated English newspaper, a roundtable discussion brought together the country’s leading experts on newborn health and policy from Government, academicians, various NGOs representatives and leading health journalists.

Speakers advocated for the incorporation of a fully-fledged pediatric section to the undergraduate curriculum for doctors and trained nurses to reduce infant death rates. They vouched for breastfeeding immediately after birth, which has been shown to drastically improve the odds of survival among low birth weight babies. Speakers also stressed the need for proper country-wide awareness campaigns regarding neonatal and maternal care issues.

Shams El Arefin, Director, Center for Child and Adolescent Health of International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR, B), stressed both the important role of health workers in educating people in remote areas on how to take care of newborn babies, and also the importance of health services being extremely reliable. Dr Sayed Rubayet, Senior Manager of Saving Newborn Lives (SNL) and Helping Babies Breathe (HBB) was quoted as saying that “future gains for newborn survival in Bangladesh rest upon increased quality of programs and facility-based services, nationwide implementation of community based programs. Even moderate increases in outreach interventions (20%), such as postnatal care, could save up to 7000 newborn lives in 2015.”

Actions Bangladesh can take now to address newborn survival:

The major cause of newborn mortality in Bangladesh is now preterm birth and its complications. It accounts for 45% of all causes of newborn death. Intra-partum problems or complications during childbirth or delivery that predominantly include birth asphyxia or breathing difficulty in newborn make up 23 % of cases followed by severe infections like respiratory infections that account for 20 % of cases. By focusing on preventing and treating the 3 main causes of death, which account for 88% of all newborn deaths in Bangladesh, we can save many newborns.

Fighting preterm birth

Preterm birth is emerging as a major challenge to newborn survival. We can prevent it by reducing its risk factors and causes like multiple pregnancies, infections, diabetes and high blood pressure, prior history of preterm birth, underweight, obesity, smoking, maternal age (either under 17 or over 40), genetics, twin pregnancy and pregnancies spaced too closely together.

In addition, improving quality care before, between and during pregnancy by strengthening family planning services, increased empowerment of women, especially adolescent girls, can help to reduce premature birth rates. As preventing preterm birth is not yet fully understood, more investment in research and innovation for better understanding of the causes and mechanisms are required to advance the development of solutions.

Studies showed that existing cost-effective interventions such as Kangaroo Mother Care (KMC), breastfeeding support, basic care for infections and breathing difficulties could reduce deaths among preterm babies by over three-quarters, even without the availability of costly neonatal intensive care. Click here for more details on preterm birth.

Battling intrapartum-related deaths

Death at the time of birth, often from the inability of a baby to breathe in the moments after a live birth, is one of the main causes of newborn deaths. Yet, it can be managed by applying certain simple techniques with inexpensive equipment. Helping Babies Breathe (HBB) provides simple, evidence-based training for birth attendants to assist or initiate breathing in a newborn baby. In Bangladesh, the Ministry of Health and Family Welfare, with support by partners including Save the Children, USAID, UNICEF, Bangabandhu Sheikh Mujib Medical University (BSMMU), are pioneering HBB and it has shown to be very successful in managing these babies in low cost setting. Click here for more information on HBB.

Reducing newborn infections

Most newborns who die from infections can be saved by improving hygiene and reducing exposure to life-threatening bacterial infections particularly in the first week of life. A promising intervention is the use of chlorhexidine, an inexpensive antiseptic shown to control and prevent infection of the umbilical cord. Click here to learn more about it.

In addition, making antibiotics available to newborns who become sick can reduce deaths especially in remote areas or in situations where immediate referral to a hospital is not possible, and evidence shows that injectable antibiotics can reduce two thirds of deaths. Currently, there is research being done in Bangladesh to examine whether newborn infection can be identified by the community health workers and if the family is not willing to or unable to visit facility; whether they can provide the treatment with injectable antibiotics or not.

A high level political commitment for achieving MDG 4 propped up the ministry to prioritize newborn health initiatives in its sector program, HPNSDP 2011-2016 (Health Population Nutrition Sector Development Program). The policy environment is conducive to implementing newborn care initiatives, and the important task now is to actually implement them in the field. Proper distribution of health workforce; conducting their training and revisiting the job responsibilities; ensuring proper monitoring and supervision mechanism and ensuring coordination of different departments of the MOH and NGOs are the major area to address. While implementation is the toughest part of the journey, Dr. Md. Altaf Hossain, Program Manager IMCI of Directorate General of Health Services, gave an encouraging message at the Roundtable event on how the MOH plans to combat the major causes of neonatal mortality:

“We are working for reducing death due to asphyxia. Save the Children, USAID and Unicef are helping us to scale up this program nationally. We will complete giving training to all skilled birth attendants about asphyxia by next year. We are also addressing low birth weight. We have some practice of kangaroo mother care. We have a plan to scale it up robustly. Using Chlorhexidine in cord care is also important. If professional bodies agree, the government will incorporate it in our national program.”

Selected Media coverage:

• The Independent:Newborn survival in Bangladesh and A Decade of Change
• BDNews 24: Early births can derail newborn deaths cut
• UNB Connect: Health experts for appropriate steps to save newborns
• The Daily Star: Death of newborn babies a big concern and Preterm Birth, an emerging threat to newborn survival