Addressing Critical Knowledge Gaps in Newborn Health

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By Collins Mhango on February 11, 2015
Malawi
Africa

Surviving birth asphyxia through Helping Babies Breathe in Malawi

Shanice Lukasi had a difficult entry into the world on 1st October 2014. After a prolonged second stage of labor, her mother, Eunice Lukasi, finally delivered with the assistance of the health personnel at Nthondo health facility in TA Nthondo, Ntchisi district.
 
But the delivery was not without complications. The baby came out legs first – a case of breech birth.
 
Shanice, who was born with asphxia. Photo: Save the Children Malawi
 
“The case of Shanice was a missed diagnosis during antenatal. It came with advanced labour stage.” Said Gresham Chinula, Nurse and Midwife Technician at Nthondo Health facility. Normally, with such a case, the facility is supposed to refer the mother to the district hospital.
 
Nthondo is only forty-five minutes’ drive to the district hospital. However, with the condition Eunice was in, and the bad condition of the road, they could not refer her in time to the district hospital. To save the baby and the mother, the nurse prepared the Helping Babies Breathe (HBB) kit. HBB is an evidence-based educational program developed to teach neonatal resuscitation techniques in resource-limited areas.
 
“The objective of HBB is to train birth attendants in the essential skills of newborn resuscitation, with the aim of having at least one person skilled in neonatal resuscitation at the birth of every baby.” Says Victoria Shaba, HBB Coordinator for Save the Children. 
 
After delivery of Shanice, Gresham noted that the baby could not cry. Instead, she lay on her mother’s abdomen, unable to move or breathe. According to Gresham, the baby had asphyxia, a lack of oxygen that can cause permanent damage or even death. It was also noted that there was meconium - fetal distress – a condition where the baby is born with difficulties to breathe and cannot cry. After successfully bringing out the baby, the nurse quickly wiped the baby and then took her to the resuscitation area to stimulate breathing which did not happen.
 
Meanwhile the mother was not at peace.  She remarked. “After a difficult birth, my baby did not cry or move. I was very worried, having been told that the baby cries as soon as it is born. Hope was beginning to fade away.”
 
After wiping the baby, they started ventilation process which made the baby start breathing. The whole process took about five minutes.
 
“I quickly and thoroughly dried the baby, then covered him with a dry towel to prevent hypothermia. I cleared the mouth and nostrils with a penguin sucker, rubbed his back gently to stimulate breathing and used an Ambu bag and mask to ventilate him, assessing his progress all along,” said Gresham. “The baby started breathing on his own after about five minutes of resuscitation with the Ambu bag and mask.”
 
The equipment is surprisingly simple: The penguin sucker is a handheld instrument designed to clear the baby’s airways by sucking out fluids in the mouth and nostrils, and an Ambu bag is a manual device that, when squeezed, forces air into a patient’s lungs.
 
Thereafter, the baby and the mother were monitored until they were discharged. Based on the results of the checkups they have conducted on the baby, there is assurance that the child will grow normally as she is passing through the developmental milestones.
 
In the community where Eunice lives, people believe that such kind of births are a result of some black magic bestowed on the mother meant to kill or curse the child.
 
“As such we received a lot of ridicule and obscenities from the people around here.” Remarked Eunice. “It was very difficult to convince them that such a child was as normal as any other child.”
 
Nthondo health centre registers almost 3 such cases every month and the HBB training has equipped nurses with skills in helping such babies breathe and live their lives.
 
“Using these new skills and equipment, I have managed to successfully resuscitate several babies at this facility. I feel very happy when I do this, knowing that those new lives will get their due chance at a long life. Our new skills and tools must be made available across Malawi and the developing world.” Said Gresham.
 
HBB ensures adequate preparation during such kind of deliveries. Since 2013, there has only been one reported death case during resuscitation at the service centre.
 
Helping Babies Breathe (HBB) is one of Save the Children’s key focus areas to save newborn lives. It is one part of an essential newborn care package designed to significantly reduce neonatal mortality. The WHO (World Health Organization) estimates that one million babies die each year from birth asphyxia, i.e. inability to breathe immediately after delivery.
 
By Karen Clune on February 10, 2015
Malawi
Africa

In rural Malawi and similar low-resource settings throughout the developing world, there is no rest for health care professionals. At a health clinic two hours outside of Blantyre, the doors never close—especially when there are pregnant women in need of attention—as one doctor and four nurse-midwives keep the clinic operating 24 hours a day, 365 days a year.

The most critically ill patients are referred to the prominent teaching hospital in Blantyre. There, babies in need of close monitoring may share beds and equipment if the volume of patients is too high. The dedicated staff, systems, and equipment are overly taxed - a warehouse-sized “equipment graveyard” is full of broken medical devices, which engineers diligently try to fix. Many of these technologies are inappropriate for the Malawian context – they are designed for low-intensity use, have incompatible voltage requirements, or only display foreign languages. As a result, several homemade devices replace commercial products.

The appetite for innovative approaches was high.

The hospital had just adopted barcode scanners to enable electronic medical records and was in the process of expanding their successful Kangaroo Mother Care program. A rugged device to treat respiratory distress – Rice University’s Pumani bCPAP - was saving babies’ lives.

These were just a sample of observations we digested during a recent trip to Malawi with the most recent cohort of Saving Lives at Birth: A Grand Challenge for Development award recipients. We brought this group of innovators together to learn how to better develop, deliver and scale their life-saving innovations to reach even more mothers and infants during their most vulnerable hours. Although the “Xcelerator” workshop provided invaluable insights to our innovators, it was our surroundings that made the experience all the more inspiring. Our innovators saw firsthand the busy staff, the endless flow of patients in need, and the challenging health ecosystem in which they sought to generate positive impact. They also saw how a previous grantee’s technology was being applied and appreciated.

We need to keep finding innovators and help them deliver their groundbreaking interventions into the hands of those who need it most. On February 9th, we were thrilled to launch our fifth call for gamechanging innovations. The latest round of Saving Lives at Birth will continue to seek and support innovative prevention and treatment solutions that benefit mothers and newborns in developing countries around the time of birth. The fifth round builds upon on our successes and learnings - from the increasing need for demand-creation innovations to the value of diverse partnerships to deliver and sustain solutions, especially with partners on the ground. Round 5 will place an increased focus on advancing the most successful and transformational innovations as they transition to scale.

In its first four rounds, Saving Lives at Birth received over 2000 applications from 102 countries and awarded 91 grants based on their potential for transformational change. We’ve helped an Argentinian car mechanic turn his brilliant idea into a life-saving device to assist difficult labors, and a group in northern Nigeria empower conservative Islamic opinion leaders to become champions for maternal and newborn health Help us find the next game-changer to help mothers and babies in Malawi and around the world – submit your idea and spread the word!

To kick off this exciting new phase of Saving Lives at Birth, we’ll be taking a more in-depth look at the future of maternal and newborn health innovation during a live Twitter chat on Thursday, February 12th from 10-11 a.m. EST. We’re tapping our pool of experts and innovators to answer your questions, so join us by following @GCDSavingLives and #SavingLivesRd5. Learn more at www.savinglivesatbirth.net and by following @GCDSavingLives.

This Challenge is a partnership of USAID, the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and the U.K.’s Department for International Development (DFID).

By Eleanor Goldberg on February 9, 2015
Bangladesh, Malawi, Rwanda
Africa, Asia


An orphaned newborn of a Malawian woman who dies while giving birth to triplets is cared for at the community child care program iat Michinji District Hospital in Michinji, Malawi. Photo: Ami Vitale via Getty Images

This blog was originally published in The Huffington Post Global Motherhood. Written by Eleanor Goldberg.

A new report found that 78 percent of surveyed countries face overwhelming obstacles in reducing deaths in children. But Malawi’s notable progress proves impoverished countries are capable of keeping more kids alive.

Save the Children’s "Lottery of Birth" report, released on Wednesday, assessed 87 low- and middle-income countries’ child and maternal mortality rates.While many of the findings were deterring, the study noted that a number of underserved countries, including Malawi, have made significant strides in these health areas with replicable programs.

Since 1990, the African country has reduced its child mortality rates by 72 percent.

Two years ago, there were 68 deaths per 1,000 live births, compared with 244 in 1990.

While Malawi is still far off from obtaining equitable health outcomes among the rich and the poor, it has outpaced other sub-Saharan African countries by committing more government funds to healthcare, prioritizing maternal care and bringing medical resources to rural areas.

For example, Malawi is one of just six countries in the African Union (AU) that has met and surpassed its health-spending target, according to UNAIDS.

In 2001, the AU pledged to spend at least 15 percent of total government budget on health. Malawi has committed 18 percent to such spending. Rwanda, which is on track to meet the Millennium Development Goals for child mortality and maternal health, has also surpassed the AU health pledge, according to the Save the Children report.

Part of the reason why poor Malawian mothers and their newborns have a better shot at survival than those in nearby regions is because of the increased focus on maternal wellbeing.

In the poorest areas of the country, 63 percent of births take place with a skilled attendant present.

While advocates have pressed the need to improve that figure, it’s still far better than what many neighboring countries face.

In Niger, which has one of the highest child mortality rates, just 8 percent of women in rural areas deliver with an adept birth attendant, according to Women and Health Alliance International.

To ensure that kids in Malawi, even ones in the most remote regions, get access to basic medical care, the country’s Ministry of Health supported a program that brings treatment to children who were once inaccessible.

Since 2008, more than 3,000 community health workers have delivered medicine and other equipment needed to treat malaria, diarrhea, pneumonia and other non-fatal illnesses, to more than 10,400 communities.

Despite its successes, Malawi is still plagued with a number of obstacles, which have impeded its progress.

A government finance scandal led donors to withdraw their support in 2013.

It also struggles with issues, which other countries that have had similar gains also face.

Malawi, Bangladesh and Rwanda -- which were all heralded in the report for their child and maternal health progress -- still severely lack quality health services and well-trained health workers. Advocates say resolving that issue is key to curbing preventable deaths.

"In this day and age, it is unacceptable that so many children’s chances of survival across the world are purely a matter of whether or not they were lucky enough to be born into an affluent family who can access quality healthcare," Carolyn Miles, president and CEO of Save the Children, said in a statement. "We know that change is possible. We now have a significant window of opportunity to drive this change."

By Morooph Babaranti on February 6, 2015
Nigeria
Africa

This blog was originally published by MamaYe Nigeria. Written by Morooph Babaranti.

Evidence for Action, through MamaYe! Nigeria embarked on a youth engagement campaign titled ‘Edutainment as a tool: improving maternal and newborn survival through actions by the youths.’

The campaign targeted youths in 4 tertiary institutions in Ondo State; namely: Adeyemi College of Education Ondo, All States College of Education Ero, Rufus Giwa Polytechnic, Owo and Federal University of Technology, Akure, to raise public awareness about key factors behind maternal and newborn survival.

The campaign believes that it is high time youths started to understand and take part in policy decisions that affect their health and that of their families, contribute to policies and demand accountability from policy makers on political promises on health and wellbeing.

The event took place on the campuses of the schools, and the event featured public lectures on ‘The Role of Young People in Improving Maternal & Newborn Survival’ delivered by a selected lecturer in each of the schools, ‘debate’ by student representatives on ‘Maternal & Newborn Health: Whose Responsibility (the government or the people)?

Dance and Drama from the drama troupes of each school with various themes addressing challenges around maternal and newborn health and MamaYe! Nigeria’s film titled Blood, Bond and Politics was also shown.

Students entertain the gathering with dance and drama on maternal and newborn health

At the end of the film show, students were asked to relate events in the film to a real-life scenario and describe what they would do if they were in the same situation. This allowed the students to share their understanding of the film, its content and its application to real-life situation, especially as it is about using evidence of what works to advocate on maternal and newborn health to political post holders.

The students were also requested to make commitments in any area of activism for maternal and newborn health in the areas of blood donation and encouraging others to donate, standing up for the plight of midwives, reaching out to policy makers and advocating for safe facilities, writing articles for traditional and social media, and telling others to play a role in ensuring the survival of mothers and newborns.

Most students committed to one or two areas of playing a role, and they all signed up for SMS, social media and email updates to keep up with information around maternal and newborn health development.

An essay competition was announced at the event for students to write to a political post aspirant in their area to prioritise improving maternal and newborn health if they win elections. A total of 414 students were reached with 74 students from Adeyemi College of Education, Ondo, 171 students from All States College of Education, Ero, 75 from Federal University of Technology Akure and 94 from Rufus Giwa Polytechnic, Owo. Some of the students who sent essay entries detailed their ideas on how to improve maternal and newborn health from the perspective of a community member under a political dispensation. Winners of the essay competition will be announced at the MamaYe Day celebration in Akure in the first quarter of 2015.

The National Blood Transfusion Service, Ibadan region, was invited to the event to attend to those who chose to play a role by donating blood to save the lives of pregnant women and newborns.

By Carolyn Miles on February 5, 2015

Rabia, seven months, enjoys a sachet of nutritional peanut paste with her mom Laila. When Laila brought Rabia to this Save the Children-supported, government-run facility in northern Nigeria providing nutrition services, Rabia was too frail to be picked up -- her mother had to pick her up using a piece of cloth, like a stretcher. After two weeks in the clinic, Rabia is a picture of health. Photo: Lucia Zoro/Save the Children

This blog was originally published in Impatient Optimists. Written by Carolyn Miles.

In a rural village in northern Nigeria, a new mother named Laila is doing everything she can to care for her baby daughter, Rabia. But despite Laila’s efforts, Rabia’s future is not solely in her mother’s hands. If Rabia was instead born to a wealthy family in Lagos, for example -- the largest city in Nigeria -- she would be nearly four times more likely to survive to see her fifth birthday.

This is the lottery of birth.

All over the world, children’s chances of seeing their fifth birthday depends on where they are born, the wealth of their parents, and their ethnic identity – factors that, for them, are purely a matter of chance.

New research released today by Save the Children reveals a story of fast but unequal progress in child survival. Despite unprecedented global improvement in the past two decades, more than 75 percent of the 87 developing countries included in the study are seeing inequalities in child survival getting worse. The world’s most disadvantaged children are being left at the back of the line.

If current trends continue, children drawing the shortest straw in this lottery of birth will continue to die from preventable causes for generations to come.

Giving every child a fair chance in life is a defining challenge for our generation, and must be tackled head-on.

In September, when the UN is tasked to agree upon a post-2015 global development framework, they will have a critical opportunity to shift the global course of development, helping to ensure children are no longer left behind due to social, economic or geographic reasons. The new framework must aim to finish the job the MDGs started, putting the world on track to end preventable deaths, and by 2030, no post-2015 target should be considered met unless it is met for all social and economic groups.

Amidst this story of unequal progress, however, we have seen a glimmer of hope. Inequality is not rising in all countries. Some leading countries, such as Rwanda, Malawi, Mexico, Nepal and Bangladesh, have not only reduced child mortality at a fast rate, but an equitable one, where the progress for more excluded groups has been faster than the average national progression.

These countries should be the yardsticks by which we measure, because Save the Children’s research found that pursuing an equitable pathway to reducing child mortality is linked to faster overall progress. The countries which have improved equitably have, on average, progressed 6 percent faster over the course of a decade than those who have not.

By investing in disadvantaged children, like Rabia, now, we can change their futures, and ours.