Addressing Critical Knowledge Gaps in Newborn Health

Blog

By Nynke Van Den Broek on April 16, 2014
Malawi
Africa

Photo: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine

Although significant progress has been made in the past decades to reduce child mortality worldwide, the rates of decline for neonatal mortality are happening at a slower pace. Figures from the World Health Organisation (WHO) suggest that prematurity accounted for 17% of the 6.9 million under-five deaths worldwide in 2011; it also accounted for one-third of all neonatal deaths. Consequently, strategies for tackling preterm birth have remained important keys to unlock global child mortality challenges.

Apart from being responsible for a significant number of under-five and neonatal deaths, for survivors, preterm birth has also been associated with an increased risk of childhood problems including stunting, increased morbidity and developmental delay as published in a recent study from Malawi.

A good understanding of the factors associated with preterm birth is essential in devising strategies for reducing morbidity and mortality associated with preterm birth.

Another recently published study from Malawi found a significant association between preterm birth and a history of previous preterm and persistent malaria (despite prophylactic anti-malarial treatment). Similarly, mothers under the age of 20 and anaemia were reported to be associated with early preterm birth.

In contrast, weight gain had a protective effect against preterm delivery. Importantly, this study did not find a statistically significant association between HIV infection and preterm birth.

Because there are very few studies that demonstrate statistically significant reduction in preterm births as a result of preventive measures, attention has now shifted towards interventions to improve survival of preterm babies.

In a systematic review of ‘approximately’ 2000 interventional studies, Barros et al identified 11 interventions to improve survival of preterm babies in low- and middle-income countries. These include four interventions to be provided during pregnancy and at the time of birth: prophylactic steroids, antibiotics for premature rupture of membranes, vitamin K supplementation at delivery and delayed cord clamping.

The other seven interventions are: case management of neonatal sepsis and pneumonia, room air for resuscitation, hospital-based kangaroo mother care, early breastfeeding, thermal care, surfactant therapy and application of continued distending pressure to the lungs for respiratory distress syndrome.

At this point, it is important to mention that, as highlighted in the Every Newborn Action Plan, interventions put in place around the time of delivery have the greatest effect on reducing neonatal mortality.

In our experience at the Centre for Maternal and Newborn Health (CMNH) at Liverpool School of Tropical Medicine (LSTM), it is crucial to improve knowledge and skills of health care workers to provide essential maternal and newborn care at and around the time of birth. This improves both coverage and quality of maternal and newborn health services.

The CMNH, in collaboration with the Royal College of Obstetricians and Gynaecologists (RCOG) and the Department of Making Pregnancy Safer at WHO Geneva, has developed a short competency based ‘skills and drills’ training package for health care providers.

The package is being delivered through the ‘Making it Happen’ (MiH) programme, and it focuses on the signal functions of emergency obstetric and early newborn care. With the support of UK Department for International Development (DFID), the programme has been rolled out in 12 African and Asian countries.

Finally, as with all interventions, it is important to bear in mind the resource constraints in most developing countries where preterm babies have the least chance of survival. What could be your most significant barrier(s) to implementing some of the strategies mentioned above?

 
This blog was written by Professor Nynke van den Broek, author of Factors Associated with Preterm, Early Preterm and Late Preterm Birth in Malawi. Professor Nynke van den Broek is a professor in sexual and reproductive health, an honorary consultant obstetrician gynaecologist and the head of the Centre for Maternal and Newborn Health at the Liverpool School of Tropical Medicine. 
By Pragya Vats on April 15, 2014
India
Asia


Photo: CJ Clarke/Save the Children

This blog was originally published by the EVERY ONE Campaign. Written by Pragya Vats.

Reshma, 20, lives in a slum cluster in New Delhi. Her first pregnancy ended in her child dying, due to complications during the birth. She did not have assistance from a trained birth attendant: her baby was delivered by an untrained midwife at home, and was stillborn.

“My daughter's head got stuck," Reshma says. "She couldn’t get out. She suffocated inside and died right there. How do I feel? If a mother loses her child, how does she feel? For nine months I carried her in the womb and I couldn’t save her.”

That's one child every 20 seconds: the highest rate anywhere in the world. More than 300,000 babies die each year on the first day they enter the world. These deaths are very far from inevitable. Half of India’s women give birth without skilled birth attendants, which puts both mother and child at risk.

Like parents everywhere in the world, Indian mothers wish for their children to be safe, happy and healthy. It’s what they all want for their children. And it’s not too much to ask. Why is life still a lottery for children who are poor?

There is a lot to be done to make India a safer and healthier place for a mother or a newborn. We have the resources and the knowhow and we can save these precious lives.

India’s economic growth is phenomenal. Its future is bright. So why is the nation failing its children? Many Indians are demanding an answer to this question.

Just like a child, a nation can’t grow big and strong without a nurturing start, and in a country’s case, that nourishment is healthy children. If we are to lead as a nation we must invest in our children and hence in the country’s future.

When I meet mothers like Reshma and hear their stories, it reminds me that so many of us are lucky enough to take it for granted that we will have trained help to give birth to our children, just as our mothers did to give birth to us. The right to life is fundamental and should be universal; unless we all agree on that, solutions to these problems will remain elusive for years to come.

India is gearing up for elections; and this time, they will not be business as usual. We must demand answers from our political representatives and hold them accountable so they keep their commitments over the next five years. 

By Sylvia Nabanoba on April 11, 2014
Uganda
Africa

In Uganda alone, over 15,000 babies die on their first day of life. That is why partners such as Save the Children in Uganda have worked hard to make investing in programs and people that work to end preventable newborn deaths a top priority.

On February 25th, Save the Children, through the EveryOne campaign, launched a report entitled Ending Newborn Deaths: Ensuring Every Baby Survives. This report shows that while progress has been made in reducing child mortality, there is still much work to be done. Newborn mortality is not decreasing as quickly as that of older children. In 2012, 2.9 million babies died within 28 days of being born: that’s two out of every five child deaths. Of these, 1 million babies died on their first – and only – day of life.
 
Musician Bobi Wine (Robert Kyagulanyi) and his wife Barbie (Barbara Kyagulanyi), attended the launch of the report to help advocate for the survival of newborns.
 
The launch took place in Nakaseke Hospital – an appropriate venue considering that the hospital has built the capacity of health workers over the past year. Health workers are trained in the Helping Babies Breathe program, where they were taught how to resuscitate babies who are not breathing at birth. The hospital was provided with resuscitation equipment and neo-Nathalies, dolls that are used to simulate the resuscitation process. Health workers in Nakaseke are also trained to counsel mothers on Kangaroo Mother Care, a method using skin-to-skin contact proven to be beneficial in the care of premature babies.
 
(Pictured above: mums cradle their babies that were born prematurely but saved through kangaroo mother care)
 
Nakaseke Hospital was also involved in the implementation of Uganda’s ACT for birth project. This project was aimed at improving the quality of care for mothers and babies during childbirth. A report released at the end of the project in 2013 showed that before the project began, the hospital was losing, on average, three mothers a month due to complications during childbirth. Since the project’s inception in 2011, however, only one mother had died due to causes related to childbirth.
 
Overall, the launch was an important opportunity to highlight the impact that affordable, low-tech care can have on newborn and maternal mortality in Uganda. The presence of ambassadors like Bobi Wine and his wife help Save the Children, hard-working health workers, and hospitals like Nakaseke to raise the issue of newborn deaths to the national level. The photos show the passion and joy expressed by all participants at the launch event.
 

(Pictured above: midwives dance to the tunes of Bobi Wine)

By Areba Panni on April 10, 2014
Bangladesh
Asia


Photo: The MaMoni Project

This blog was originally published by MCHIP. Written by Areba Panni.  

Sylhet District—Community Health Worker Mishu Rani Dhar had visited Chandra Ban twice during the woman’s pregnancy to provide antenatal care. And when she heard the 30-year-old mother was giving birth to twins – a boy and a girl – at home with the help of a traditional birth attendant, Mishu rushed to Chandra’s home.

She brought with her another health worker and a paramedic to provide postnatal counseling and to assess the condition of the babies. Thankfully, the trio arrived shortly after the birth: an assessment revealed signs of birth asphyxia in both babies, who weighed only 1,700 grams (3.7 pounds). Mishu—who was trained by the MaMoni project in maternal and newborn health, family planning, and infant/young child nutrition—knew these danger signs implied a high level of risk.

The MaMoni Project is a USAID award to USAID's flagship Maternal and Child Health Integrated Program (MCHIP) that provides integrated safe motherhood, newborn care, family planning, and nutrition services. It is implemented by Save the Children in Bangladesh and two local nongovernmental organizations in collaboration with the Ministry of Health and Family Welfare. 

Mishu and her colleagues urged Chandra and her husband, Abdul Jalil, to take the newborns to Jaintapur Upazila Health Complex (UHC). This government-owned facility has the only special newborn care unit (SCANU) at the sub-district level in the country. Established by MaMoni, the SCANU is equipped to effectively manage the health of pre-term and low birth weight babies, as well as those with birth asphyxia. The unit includes radiant warmers and the latest phototherapy machines with digital displays, skin sensors, and oxygen hoods. MaMoni also supports a team of four medical officers and six nurses/paramedics who provide 24-hour services at the SCANU. 

Nevertheless, a combination of cultural beliefs and superstitions kept Chandra and Abdul from seeking these services. “I wanted to save the newborns,” Mishu recounts. “For a week we tried to convince the family to take them to the SCANU. I cooked for them, fed them, and did all I could.”

But when these attempts to convince the couple failed, Mishu and her colleagues spoke to MaMoni field staff, who requested the help of community action group members. Eventually, intervention by the head imam of the local mosque and a community volunteer had a positive effect on the couple’s decision. 

However, Abdul and Chandra still could not leave their four children at home alone. In response, Mishu took quick action again: with the help of MaMoni staff, she transported the babies to the pick-up point, and then by boat to the SCANU. There, the twins were treated for five days before returning home.

The SCANU serves a population of 174, 449, including more than 28,000 married women of reproductive age. From March 2013 to February 2014:

 

  • There were 4,876 deliveries, of which 178 were stillbirths.
  • 623 newborns were referred from the community for complications, of which 501 were referred and admitted into the newborn care unit.
  • The causes for admission were: sepsis (39%); birth asphyxia (33%), pre-term birth (20%); and other causes (8%).

During this period, 19 newborns died at the Jaintapur UHC compared to 118 neonatal deaths during the same time for the Upazila.

“My husband is very supportive [of my efforts],” Mishu said. “He told me not to worry about him and think about his meals, but instead go and do my job the best I could. After all this effort, if any newborn dies, there is a feeling of tremendous loss.”

By Ivonne Piedras on April 9, 2014
Mexico


Photo: Save the Children Mexico

This blog was originally published by the EVERY ONE Campaign. Written by Ivonne Piedras.  

Last month the report Breastfeeding and Maternity in Mexico: Challenges to Inequality was launched, adding to the efforts of the international launch of Save the Children’s latest report Ending Newborn Deaths.

Mexico, despite being a middle-income country, is characterized by the widening gap of inequality among the population and this inequality has been a great impediment to the progress in reducing poverty, malnutrition, child mortality and increasing access to education. This inequality has a direct impact on child and maternal survival. Nobody, least of all children, should be excluded from a system that guarantees their right to survival.

In this report we found alarming figures: each year 35,000 children under the age of 4 years die from preventable causes, about 28 thousand within less than one year and 46% of these deaths occur in the first month of life.

In some parts of Mexico, which have been historically marginalised, the mortality rate of infants under one year exceeds the national average. We are facing an injustice of prevailing inequalities in a country that is able to eradicate them.

Many of these lives could be saved if newborns received breastfeeding within the first hour of their lives. But what is the situation of breastfeeding in Mexico?

In 2012 the percentage of exclusive breastfeeding corresponded to 14.4 % in urban areas and in rural areas to 18.5 % - that means that 80 % of children in Mexico did not receive exclusive breastfeeding. Speaking of breastfeeding also means talking about maternal health and mortality.

For the past 10 years, Mexico has not seen a sustained reduction in maternal mortality. Also there are still gaps in access to health services and lack of support for community health workers and traditional birth attendants. Mothers who have access to health services and who give birth with skilled health personnel are more likely to breastfeed their children and they will have more chance to survive.

In the press conference Isabel Crowley, UNICEF Representative in Mexico, emphasised that Mexico is close to achieving the MDGs 4 and 5 with respect to infant and maternal mortality, however there are still huge disparities directly associated with poverty and marginalisation that prevent faster progress.

That's why Save the Children in Mexico made a public appeal to the authorities to promote breastfeeding through public policies on a large scale.

The first step would be to include a commitment to promote this practice in Objective II of the National Crusade Against Hunger, a National Strategy which aims at reducing poverty, malnutrition and social exclusion.  Save the Children also delivered the report to the Ministry of Social Development in Mexico, the government body in charge of implementing the Crusade Against Hunger.

In addition, we called national leaders, the private sector and civil society to join the "Five Promises for Newborns” that Save the Children will promote in the Health Assembly. Mexico must continue its efforts to eradicate child and maternal mortality. We cannot allow more preventable deaths of children to happen. It is the duty of the state to ensure all conditions are met to prevent child deaths.

Maria Josefina Menéndez, CEO Save the Children in  Mexico, Cecilia Occelli, the president of the National Council of Save the Children in Mexico, Roy Caple, Member of the Council, Anthony Caswel, Director of Advocacy and Isabel Crowley the Representative in Mexico of UNICEF participated in the press conference of the report launch. The conference was complemented by a social media strategy, showing very good results in reaching the public.

We continue our efforts to improve child and maternal survival.