Addressing Critical Knowledge Gaps in Newborn Health

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By Aissata Sacko on October 23, 2014
Guinea
Africa


Guinea's Donka National Hospital in the capital of Conakry. Photo: AMCGuinea 

The idea of founding a non-profit organization was to help reduce newborn, infant and maternal mortality rates with a focus on premature babies. In Guinea 80% of premature babies die within days after birth. Sometimes 3 to 5 premature babies are kept in 1 incubator and in case of an infection or disease such as Ebola, all the babies could then be affected.

I was born as a preemie, weighing only 2 lbs, and I barely survived my first few weeks of life in the country’s only neonatal intensive care unit (NICU) located in Donka Hospital, in the capital Conakry.

In 2010, I became the mother of a premature baby who was born at 29 weeks and weighed a mere 2 lbs 4oz. Unlike myself, my daughter received top notch care of Maryland’s Holy Cross Hospital in the United States.

After my daughter’s release from the hospital, I decided to create an organization to help improve healthy newborn survival rates in Guinea. Since 2010 AMCGUINEA (Assistance to Maternity Centers of Guinea) has been speaking out and raising awareness of preterm birth in Guinea and the national government is now more involved in the care of newborns than ever before.


Preterm babies at the NICU at Donka National Hospital in Conakry, Guinea. This is the only NICU in all of Guinea. Photo: AMCGuinea

AMCGUINEA, in partnership with LittleBigSouls International Charity and in collaboration with Guinean Ministry of Health, celebrated World Prematurity Day for the first time on November 17th 2013 in Guinea. This was an important milestone in Guinea’s efforts to focus more attention on improving maternal and newborn survival.

Marking World Prematurity Day on November 17, 2013 in Guinea. Photo: AMCGuinea

Recently, however, the Ebola health crisis in Guinea has threatened to undermine these efforts. Pregnant women have been deeply affected by the 2014 outbreak of the Ebola virus. Even before Ebola, pregnant women were afraid to go in healthcare facilities where the management of complications surrounding childbirth is not always adequate. Now Ebola is deepening their fears, and not without reason.

Hundreds of health care workers in West Africa have also been impacted with Ebola recently, and many have been infected by the patients they treat. Rick Sacra, one of the American doctors who contracted Ebola and later made a full recovery, was treating pregnant women in Liberia when he became infected. In Guinea, it has been reported that Dr. Youssaouf Diallo Nabanio, a neonatologist who worked at the country’s only neonatal intensive care unit, contracted Ebola and died several days later.

Health workers and civilians should all be involved in preventing the spreading of the Ebola virus in West Africa for a healthier population globally.

AMCGUINEA is dedicated to its mission to save preterm babies in Guinea and is seeking more assistance, not only to save them but also to prevent the infection of Ebola in the neonatal departments. Newborns are more vulnerable to any disease, especially when they are very viral such as Ebola.

For more information, please visit us at: www.amcguinea.org.

By Khetam Malkawi on October 21, 2014
Iraq, Syria
Middle East

Dr. Lava Abdul Rahman works with Syrian refugees at the UNFPA maternity clinic in Domiz Camp in northern Iraq. Photo: UNFPA/Millat Horiri 

This article was originally published by UNFPA. Written by Khetam Malkawi

DUHOK, Iraq – "The clinic is always crowded," said Lava Abdul Rahman, a gynaecologist at the UNFPA maternity clinic in Domiz, a refugee camp in northern Iraq.

Each day, between 30 and 35 pregnant women come to the clinic for antenatal care, she noted.

More than three years into the Syrian crisis – a catastrophe that has forced hundreds of thousands to flee to Iraq, including more than 3,800 pregnant women – refugee camps have become simply a fact of life for many.

“I am in the ninth month of pregnancy”


Ruqaya, 36, is nine months pregnant, living in
Domiz camp. Photo: UNFPA/Millat Horiri

In the Domiz Camp, in the Duhok Governorate of Iraq, the sea of temporary shelters is slowly transforming into a city. Concrete houses are replacing tents and prefabricated caravans. Shops have sprouted up everywhere.

Syrians there say they have not, and will not, lose hope that peace can be restored in their home country. But for now, life in the camp has settled into a rhythm. Weddings are held every other day, and scattered cries of newborns can be heard as one walks through the camp.

"Despite the hardships and difficulties in making a living, other aspects of life go on normally," said Ruqaya, 36, as she left the UNFPA maternity clinic.

 When she and her four children fled their home in Qamishli, Syria, she could not imagine having another baby. But "life goes on," she said. “I am in the ninth month of pregnancy now."

Ruqaya was not alone. The clinic was crowded with other pregnant women.

Faster, more convenient care

The UNFPA clinic here was established when the Domiz Camp was set up in 2012. Since then, more than 60,000 Syrians have arrived.

But until recently, deliveries had to be conducted in hospitals outside the camp. Getting there was timely and required money for transportation.

The clinic now has had the capacity to safely perform deliveries. Between 4 August and 20 September, some 200 deliveries took place there.

“Most of pregnant women want to deliver here if they do not have any pregnancy complications or need a C-section,” Dr. Rahman said. When complications arise, mothers are referred to hospitals, she added.

"We only conduct normal deliveries here," she said.

A relief

Having a maternity clinic in the camp is a relief, said Natja, a 25-year-old refugee.

"My daughter is two-and-a-half years old now,” she told UNFPA. “My husband wanted another baby last year, but I was resistant to the idea due to being in refuge, and I was afraid I would not receive good healthcare.”

But after speaking to other women who had become pregnant while living in the camp, she felt assured she would receive proper care from the maternity clinic.

She is now four months pregnant.

Wael Hatahet, UNFPA’s humanitarian coordinator in Iraq, said UNFPA provides the clinic with medics, equipment and reproductive health kits. The cost of Caesarean sections performed in referral hospitals is also covered by UNFPA, which also supports a number of maternity hospitals in the Governorate.

 

By Harriet Othieno on October 20, 2014
Uganda
Africa

On 18th July, I was part of a team from Save the Children and Mukono district that visited Mukono HCIV to provide support supervision to health workers whom Save the Children had trained in the Helping Babies Breathe Plus (HBB+) package.

When we arrived at the health centre, we met Norah Nakimuli, a Nursing Officer and registered midwife, moving quickly to the HBB+ corner, a newborn baby in her arms. We followed her to see what was going on, and she explained, “This baby has just been delivered in the theater and I have been resuscitating it.”

Norah puts the baby on oxygen

Norah said that the baby’s mother, 30-year-old Margaret Kizza of Seeta Bukerere, had been admitted at 3:00am that morning with labour-like pains which had begun the previous day. This was her fourth pregnancy. Although Margaret’s condition was generally good and she was in active labour, the fetal heart rate was low. At 5:30am, her membranes ruptured with meconium-stained liquior grade 2 and signs of face-to-pubis presentation. The doctor was informed and he ordered an emergency cesarean section.

After the operation, Norah received the baby, who failed to breathe. She wrapped and rushed it to the resuscitation corner in the theater. She positioned it well, cleared the airway using the penguin sucker and dried and rubbed its back. In spite of all this, the baby was still not breathing.

“While praying in my heart, I got hold of the ambu bag and started ventilation as I had learned in the HBB+ training,” says Norah. “Immediately the baby sneezed. The score was 3/10 at one minute, then advanced to 5/10 at five minutes and finally progressed to 7/10 at 10 minutes.” Norah was one of the participants in the HBB+ training that was conducted by Save the Children.

Norah says that all of this was done while maintaining warmth to the baby. The baby eventually started breathing and she transferred it to the labour ward for continuous monitoring as its mother recovered from general anesthesia.

“I felt very good because I saved the life of a baby who will be useful in this world,” said Norah. Margaret’s relatives were not around because she had come alone to the hospital, but Norah believed that they would be happy when they heard the story of the newborn’s survival.

She explained that Margaret would be kept in the health unit for three days on observation since she had undergone a caesarian birth. The doctor ordered antibiotics and dextrose 50% to be given to the baby and oxygen. Norah also gave the baby Vitamin K and tetracycline eye ointment.

By Severin Ritter von Xylander on October 17, 2014


Photo: Susan Warner/Save the Children 

This post is part of the Maternal and Newborn Health Integration Blog Series"Integration of Maternal and Newborn Health: In Pursuit of Quality technical meeting. 

The World Health Organization (WHO) welcomes the revitalized interest in integration of maternal and newborn health care as integration is the key to success for both improving maternal health and for ending preventable newborn deaths.

This is the very reason why WHO, together with UNICEF, UNFPA and the World Bank, have been promoting, already since 2000, Integrated Management of Pregnancy and Childbirth (IMPAC). This is the package of guidelines and tools, which respond to key areas of maternal and perinatal health programmes. IMPAC sets standards for integrated maternal and neonatal care. However, integration is not an end in itself, but should serve the purpose of improving quality and efficiency of health care services provided.

One important element of integration of health care services is that they should be centred around the mother-baby dyad, their needs and preferences. It is important that health care services are organized in a way that this will happen. For a normal pregnancy, childbirth and postnatal period this care can and should be provided by midwifery personnel with the necessary skills. Sometimes, however, the mother or the baby needs special attention and services that can only be provided by health care workers with specialized skills. But even in those cases, addressing the needs of the mother and the baby in an integrated way, remains key for success.

For example, early and exclusive breastfeeding is important for the survival, growth and development of the baby and should not be disrupted by separating the baby from her mother, if this is feasible – and in most cases this is feasible. So-called vertical health programmes, such as the expended programme of immunization (EPI) or the prevention of mother-to-child-transmission (PMTCT) have been successful in addressing certain public health priorities as they provide the necessary focus to make things happen. Sometimes they are perceived as disruptive, however, there are good examples how these programme interventions can be successfully integrated into maternal and newborn care services. Again, IMPAC provides guidance on how best to achieve this integration.

Finally, it will be important to promote a truly perinatal approach, which goes beyond highly specialized health care settings, but which will be based on the principles that only good pregnancy and childbirth care will lead to better neonatal outcomes. In conclusion, maternal and newborn health care should be as integrated as possible and as “vertical” as necessary to achieve high coverage and quality of health interventions for the mother and her baby. In the coming months WHO, UNICEF, UNFPA and partners will be working on a Every Mother Every Newborn initiative to improve the quality of integrated maternal and newborn care.

By Leith Greenslade on October 16, 2014
Africa, Asia


This newborn baby boy in Northern Nigeria was put to his mother's breast within 30 minutes of delivery to make sure he received the colostrum, the first milk a mother produces. It provides a newborn with important protection from bateria and infections. Photo: Lucia Zoro/Save the Children

We have known for a long time that breastfeeding can prevent the deaths of many babies.

Exclusive breastfeeding for the first 6 months can reduce child deaths by at least 800,000 each year - almost 15% of the total 6.3 million annual child deaths.

Breastfeeding within the first hour of birth has the potential to reduce newborn deaths by up to 560,000 - 20% of the total 2.8 million annual newborn deaths.

Babies who are not breastfed are particularly vulnerable to the leading killers of small children and are 15 times more likely to die from pneumonia and 11 times more likely to die from diarrhea, compared to babies who are exclusively breastfed.

But despite this evidence rates of early and exclusive breastfeeding are very low (around 40%) and haven’t improved much since the early 1990s, despite more than 15 years of advocacy and investment.

It’s not that women don’t understand the value of breastfeeding. Surveys repeatedly show that new mothers across many countries know that breast is best for babies.

It’s not that we aren’t aware of the reasons that mothers don’t breastfeed. Surveys repeatedly show that new mothers are concerned that they don’t have enough milk or time; that they experience pain, exhaustion and rejection from their babies; that they feel awkward breastfeeding in public; that spouses are often unsupportive and that it’s just too hard to breastfeed and work. And don’t forget that although world health authorities recommend exclusive breast-feeding for 6 months most countries don’t offer maternity leave beyond three, and typically without pay.

It’s not that new mothers are hard to reach. With more women delivering their babies in facilities than ever before it has never been so easy to reach millions of mothers in the critical hours after delivery to help them initiate breastfeeding.

Our collective failure to do so has led to a realization that we need a new approach.

UNICEF’s landmark 2013 report, Breastfeeding on the Worldwide Agenda, outlines a powerful argument for change describing the current environment as “policy rich” but “implementation poor”.

At the same time, the Bill and Melinda Gates Foundation’s flagship breastfeeding investment - Alive & Thrive - is demonstrating that large increases in breastfeeding are possible with multi-sector action to shift attitudes among new mothers, the behavior of employers and the policies of governments. With this approach, the exclusive breastfeeding rate in the Vietnamese project sites has risen from 19 to 63% and across the Bangladesh sites from 49 to 83% in just three years.

And the countries that have achieved the greatest progress in reducing child mortality and achieving Millennium Development Goal 4 have all recorded exclusive rates of breastfeeding well above the global average including Rwanda (85%), Cambodia (74%), Malawi (70%), Bangladesh (64%), Nepal (70%), Eritrea (52%), Ethiopia (50%), Tanzania (50%) and Madagascar (51%).

Inspired by these successes and also by what we have learned in the areas of global health that have made the greatest gains though intense, sustained and collective public and private sector action, especially AIDS, malaria and vaccines, it is time for public-private partnerships to drive innovation, progress and deliver results in breastfeeding.

Partnerships that start with the needs of mothers and work backwards.

Partnerships with the goal of identifying and then removing one by one the major barriers and costs of early and exclusive breastfeeding as experienced by mothers.

Partnerships that are best practice and lift ambitions and inspire action in the countries with very low rates of breastfeeding and high numbers of newborn deaths.

Let’s start with Nigeria.

With the second highest number of child deaths in the world - 800,000 - and one of the lowest rates of early and exclusive breastfeeding - 23% and 15% - what happens in Nigeria will not only matter for a large number of Nigerian children but will also matter for the achievement of global health goals.

With Nigeria’s sharply rising population driven by a very high fertility rate (an average of 6 children per woman), the under 5 population is forecast to grow by 10 million in the next 15 years.

What happens in Nigeria increasingly influences the world.

We have the right ingredients for a strong public-private partnership in Nigeria - a federal government committed to saving one million lives by 2015, trusted local NGO partners like the Wellbeing Foundation, support from the global health community; mobilized networks including the 2,500 strong Global Breastfeeding Initiative; and corporations like McCann Health, Philips, Medela, Ameda and Hygeia fully engaged with an appetite for innovation.

A new public-private partnership can tap into the thriving innovation community that is starting to push the envelope on new breast-feeding supportive technologies. MIT’s Media Lab recently hosted a “Make the Breast Pump NOT Suck” Hackathon which produced the Batman-inspired (yes…) Mighty Mom Utility Belt - a fashionable, discrete, hands-free wearable pump that automatically logs and analyses personal data; Helping Hands - a sturdy, easy to clean, minimal parts, hands free compression bra designed by nursing moms; and PumpIO - an open software and hardware platform to make the breast pumping experience smarter, more data-rich and less isolating.

This is the tip of the iceberg of the innovation needed in the category of “breastfeeding supportive technologies”.

Every year more than 140 million new mothers face the decision whether or not to breastfeed and this population is growing fastest in the countries with the highest child mortality. There are 8 million new mothers every year in Nigeria alone.

As more and more of these mothers will come under increasing pressure to go back to work quickly as women’s labor force participation rates rise, new mothers will need intensive support, and even incentives and rewards to continue breastfeeding. If they don’t, we can expect breast-feeding rates to continue to flatline or more likely, to fall.

But we don’t accept this scenario. We know that most new mothers want to breastfeed. It’s the external environment that needs to change to enable mothers to fulfill their aspirations.