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The Healthy Newborn Network Blog provides timely information and insights from the global newborn health field and seeks to promote dialogue on important newborn health issues. The blog is a platform for the HNN Editors and guest contributors to post commentaries on current happenings in the newborn health field. The content of each post and comments expressed on the HNN blog are those of the individual contributors and do not necessarily represent the views and opinion of the HNN or its Partner Organizations. >>Read a note on leaving comments
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Baby Taiyaba is today a healthy girl thanks to Sakhina’s quick actions to help her breathe.
The Asia Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care was held in Dhaka, Bangladesh on May 3-6, 2012. The theme for the conference held by MCHIP was “Make Every Mother and Child Count” and nearly 400 leading experts within maternal and child health from 30 countries in Asia and Middle-East attended the meeting.
Among the activities on the program, was a 3-hour orientation meeting on Helping Babies Breathe (HBB) which was attended by well above 100 participants.
The national HBB program in Bangladesh was also presented at the meeting. HBB is implemented in Bangladesh by the Ministry of Health, MCHIP, Save the Children, Bangabandhu Sheikh Mujib Medical University, UNICEF and others. So far, more than 7,000 skilled birth attendants have been trained in HBB and the plan is to have close to 20,000 trained by end of 2013.
We met Sakhina Begum, one of the community skilled birth attendants in Bangladesh who have been trained in HBB. Only few days after her training these newly acquired skills helped her save the life of Taiyaba.
When Mrs Rikta went into labour, her husband called a local health assistant and skilled birth attendant Sakhina Begum to assist the delivery. Within two hours, Rikta delivered a baby girl, her second born. When Sakhina dried and wrapped up the baby’s body, she felt no breathing and heard no cries of the baby. Rather, everyone in the labour room started crying thinking the baby had little chance to survive.
Luckily, Sakhina had attended the HBB training only a week before attending this birth. She used her training and kept the newborn on the mother’s abdomen, trying to stimulate the newborn by rubbing the skin over the backbone, but the baby was still not breathing. She quickly did the next — what she had been trained to do — resuscitation using a bag and mask. She immediately took out a penguin suction and the bag and mask resuscitator that was given to her during the HBB training, and tried to resuscitate the newborn. Within a minute the baby cried out!
Here Taiyaba is together with her very proud and loving parents and Sakhina, the community skilled birth attendant.
MamaNatalie was also presented in a practical skills session attended by approximately 100 participants. There was a lot of activity during the session; many participants got the chance to practice using MamaNatalie for the first time, both practicing being a birth attendant as well as how to operate MamaNatalie and act the delivering mother.
The experiences from the field testing of the Helping Mothers Survive Bleeding After Birth program in India, Tanzania and Malawi was also presented and discussed, and country teams from among others India, Afghanistan, Myanmar and Indonesia discussed potential for the program in their relevant countries.
All in all; a very interesting meeting, bearing high hopes for continued improvement of maternal and neonatal health in Asian and Middle-Eastern countries.
Watch the story of Taiyaba in their own words:
A new father cradles his newborn, India. Photo: Ted Mathys, 2009 The Advocacy Project Fellow
In a rural village in Uttar Pradesh, India, there is a simple health innovation that works: fathers-to-be are sent a letter in the voice of their unborn child asking the father to take care of the newborn and mother’s health . Although hugely successful, in part because of the involvement of men in health-seeking behaviour, it’s only been introduced in certain districts. If health innovations such as this were rolled out or adopted across similar districts, a large number of people would benefit, potentially saving the lives of mothers and newborns across India.
I study the scale-up of innovations. My work is about understanding the best ways to ensure health innovations reach more people, including how to overcome barriers to achieving this.
It’s in this capacity that I flew to beautiful La Jolla in California for an inspiring Bill & Melinda Gates Foundation meeting on ‘Achieving Lasting Impact at Scale’; it helped me to see my work differently and gave IDEAS (Informed Decisions for Actions) an exciting new opportunity to contribute to accelerating the uptake of innovations.
Is the health system ready for your innovation?
All of us at the meeting wanted to find out what organisations can do to get a country’s health system ready to take on a health innovation that works on the small scale. Which theories and models can be used to predict the spread of health innovations? What are the challenges to using these models and how can we test them in real world settings?
A new model on how to test whether health systems are ready for the spread of health innovations in low-income countries was presented at the meeting by Kaiser Permanente’s Centre for Health Dissemination and Implementation Research. Their model focussed on how an organisation with a successful health innovation can build relationships and trust with other organisations in order to help people accept this new health approach. It helped me to think about the relationships between the different groups of people that are instrumental in getting health innovations taken up at scale.
How can IDEAS accelerate scale-up?
IDEAS aims to improve the health and survival of mothers and babies through generating evidence to inform policy and practice. Working in Ethiopia, North-Eastern Nigeria and the state of Uttar Pradesh in India, IDEAS uses measurement, learning and evaluation to find out what works, why and how in maternal and newborn health programmes.
I will soon start to collect data from in-depth interviews with key stakeholders in all the countries IDEAS is working in. I’ll be asking them what helps and hinders the take up of innovations. This data could help to predict how innovations that improve newborn health get picked up at the large scale and also how organisations could accelerate this scale-up.
Sadly, I had to leave the beautiful beaches of La Jolla and return to the UK with its temperamental May showers. Nevertheless, I am looking forward to continuing the conversation on how to achieve family health impact at scale. By the end of the year we expect to have some real data to help us find out how successful health innovations can be scaled-up to benefit more people.
The following post was written by Kylie Hodges, originally posted on Impatient Optimists. It is part of a Blog Series leading to World Prematurity Day on November 17, discussing prematurity and highlighting the actions needed to prevent and reduce preterm birth, the leading cause of newborn deaths. Join us as we discover that everyone has a role to play.
On the way to the unit at the hospital where I gave birth, you pass the Neonatal Unit. On the door hangs a reclaimed old sign from the 1950s. It says “Premature Baby Unit.” There’s no doubt about what that locked door keeps hidden from view. Every time I walked down that corridor while pregnant, I said a prayer for those babies and those families watching and waiting for their preemies to grow, to get strong, and to come home.
In May 2009, at 26 weeks and 6 days into my pregnancy, I went to the hospital at 3 in the morning, fairly certain I was being a neurotic first time mother.
I had a headache and I felt revolting—there’s no other way to describe it. I was a bit concerned as my blood pressure had been fairly high at times during my pregnancy. The kind staff initially thought the same. They thought it was just a migraine, or maybe sinus pain, but they did some tests. Suddenly, about two hours after arriving, the room filled with very concerned looking doctors and nurses. I had rare rapid onset preeclampsia. I was very sick. A scan revealed my baby was in deep trouble. He was no longer receiving nutrition from me. He had stopped growing. He was tiny.
The decision was made to deliver my baby. His estimated weight was 800 grams, not even 2 pounds. My husband and I were terrified, but we stayed focused. I received steroids to help improve the baby’s lungs. I was given magnesium sulphate to prevent seizures. I was on a fluid drip. I was kept stable for 12 hours to help give the steroids time to work.
At 10 am my baby was delivered. The room was silent, everyone was very concerned. The baby was much smaller than estimated. Suddenly I heard a noise. I turned to my husband and said, “I’m sick of this; I’ve listened to labouring women all night, now I can hear babies crying.” There was a little pause, I could see eyes behind masks glistening, and my husband smiled and said, “That’s our baby.”
Joseph is the name we chose to give our baby; we had chosen the name ages ago; convinced we were having a boy. The name means “God will enlarge.” Joseph weighed 650 grams at birth, so we thought the name was very appropriate and it gave me hope that we had chosen that name so early. Perhaps it was a sign.
One of the doctors who delivered him was a great big Ghanaian chap who held my hand afterwards and said, “Joseph is a warrior name in my village. You have picked a good one, and he will be strong.”
Finally, later that day, I saw Joseph. Nothing can prepare you for seeing such a small baby. He was tiny. His skin was transparent. I could see his veins. He kicked at times, and I could still feel them inside, it was so strange. Unlike a lot of mums of very premature babies, I bonded straight away. It was us against the world, and he had the fight of his life on his hands.
With preemies, a lot of things can go wrong. They are not ready for the world, and a lot of development still has to occur. It’s a difficult balance for staff on the unit to balance the needs of the parents with the needs of these tiny babies. I felt separated from Joseph; I couldn’t hold him. I had to express my breast milk with a pump. It all felt very unnatural and scary.
But Joseph slowly made a full recovery. He spent 76 days in the neonatal unit before coming home with us.
For us, having a premature baby was a terrifying experience, but we were surrounded by a very experienced medical team, in a very well resourced hospital. My baby had access to an amazing medical team; he was treated as a person. This is not the reality for huge numbers of women and their babies around the world. If I had been in sub-Saharan Africa, I may not have been diagnosed. And if I was, the most they probably could have done is to save my life, not my baby’s.
This has to change. It’s unacceptable that this divide exists, and it’s something that makes me feel intense guilt and sadness.
When Joseph finally came home the enormity of everything that had happened hit me like a tonne of bricks, and I found it hard to come to terms with what had happened. I was so scared of losing my son. He is now nearly three, and has no problems as a result of his prematurity, because of the amazing care we received at the hospital. He is just like any other little boy. And I am so proud of him. I want mothers of all children to know the joy and feel the pride of watching their premature babies grow up as well.
Written by Bob Black, Li Liu and Joy Lawn
Our new global estimates are published this week in The Lancet giving and the first ever trend analysis for child causes of death over the last decade. The good news is that 2 million fewer children under the age of 5 died in 2010 than in 2000. The bad news is that the overall rate of reduction is not fast enough to reach Millennium Development Goal 4 and that some regions, and some causes of death are being left further behind.
Preterm birth complications are now 2nd leading cause of all childhood deaths. Photo: Jane Hahn Getty Images/Save the Children.
For newborns, progress in reducing deaths has been especially slow. Over 3 million newborns died in 2010. This was only down by 600,000 from 10 years earlier. Newborn deaths now account for 40% of all under five childhood deaths, up from 38% in 2000.
Now preterm birth complications is the second leading cause of death among all children (14%),following pneumonia (18%), with diarrhea the third highest cause at 11%.
Causes of death for newborns (first 4 weeks) and children under 5 years, worldwide for the year 2010,
Li Liu et al Lancet 2012.
The leading causes of newborn deaths are:
No neonatal cause of death—except for tetanus—declined at a rate fast enough to meet MDG 4. Preterm birth complications only dropped by 2% per year from 2000 to 2010. The rate would have to more than double to be on track.
Regional and national estimates are also available. As expected there is a lot of variation in the causes of death. In 2010 the fraction of all under-five deaths that are newborn varied across regions, ranging between 30% in Africa to 54% in Western Pacific. In Africa, malaria causes 15% of all childhood deaths, second only to pneumonia. Of the ~ 159,000 deaths in children under five due to HIV/AIDS, almost all were in Africa.
The regions with the highest burden of child and newborn deaths have the least data. For instance in 2010, less than 4% of neonatal deaths were in countries with nationally reliable death certificates for most deaths. Registering every baby at birth gives identity, improves the data and enable better accountability for survival.
Our analysis was done by the Child Health Epidemiology Reference Group (CHERG), which is an expert panel formed by the WHO and UNICEF. CHERG.org gives a complete list of past global estimates and cause specific analysis.
Learn more:
Photo: Michael Bisceglie/Save the Children
Female Community Health Volunteer (FCHV) Bhagirathu counsels 18 year-old mother, Hemanti Dangora on breastfeeding her 28 day-old baby. Bhagirathi counsels mothers in the Kanchanpur Districton of Nepal on immunization, family planning and breastfeeding.
This week, Save the Children released its State of the World's Mothers 2012 report. In it is highlighted the need for immediate and exclusive breastfeeding for a newborn. According to the report, six months of exclusive breastfeeding increases a child's chance at least survival six-fold. Pregnancy and infancy are the most important periods for brain development. Mothers and babies need good nutrition to lay the foundation for the child’s future cognitive, motor and social skills, school success and productivity.
The report details a vicious cycle of young mothers, who may themselves have been stunted in childhood, going on to give birth to underweight babies who have not been adequately nourished in the womb. If a mother is impoverished, overworked, poorly educated and in poor health, she may not be able to feed the baby adequately, with largely irreversible effects. The report highlights that the best method for breaking this cycle and protecting the pregnant mother and her baby from malnutrition is to focus on the first 1000 days starting from pregnancy.