Photo: Greg Funnell/Save the Children
The release of the Roll Back Malaria (RBM) Partnership’s report, “The Contribution of Malaria Control to Maternal and Newborn Health,” made yesterday, July 10th, 2014, an important day for malaria in pregnancy research and programming. Pregnancy was previously identified as a particularly vulnerable time to contract malaria for both mom and baby, but this is the first time the RBM Partnership has released a thematic report specifically dedicated to how malaria affects pregnant women and their newborns.
The report was launched during the United Nations Economic and Social Council (ECOSOC) in New York by UN health and development leaders. The purpose of the report launch was to forge new partnerships and strengthen existing ones to expand malaria services to one of the most vulnerable populations, pregnant women.
An existing solution, with poor delivery
Intermittent preventative treatment during pregnancy (IPTp) and insecticide-treated mosquito nets (ITNs) have long been the standard for malaria prevention in pregnancy. In 2012, the World Health Organization (WHO) updated these standards by increasing the number of IPTp doses to four during pregnancy. This treatment, delivered during antenatal care (ANC), has existed for decades, but delivery is still poor. Although 77% of pregnant women receive at least one ANC visit in most countries, rates of IPTp and ITN use by pregnant women fall far below global and national targets.
Why is malaria prevention part of maternal health?
Malaria is both a direct and indirect cause of maternal mortality. Each year 10,000 pregnant women die of malaria infection. In addition, malaria is a major cause of anemia, which puts a woman at greater risk for post-partum hemorrhage, the number one cause of maternal death. WHO’s recommended treatment, four doses of IPTp and use of an ITN, can reduce severe maternal anemia by 38% and perinatal mortality by 27%. The treatment’s effectiveness plays a significant role in leading global progress on decreasing maternal mortality. But malaria prophylaxis saves not only women’s lives, but newborn lives as well.
Protecting health before birth
IPTp and use of ITNs can reduce a newborn’s risk of dying from malaria by 18% in the first 28 days of life; it also provides a 21% decrease in low birth weight, a risk factor for neonatal death. Every year, 75,000 to 200,000 infants die because of a malaria infection during pregnancy. Also, an additional 100,000 neonatal deaths, or 11% of global neonatal mortality, are due to low birth weight resulting from Plasmodium falciparum, or malaria, infections in pregnancy.
Although scale-up of IPTp and ITNs did not meet the global coverage target of 80%, malaria prevention efforts between 2009 and 2012 saved about 94,000 newborns. If global targets had been met, this number could have tripled, with 300,000 neonatal deaths prevented. In addition to preventing neonatal deaths, IPTp and ITNs can reduce miscarriages and stillbirths by 33%.
Although the WHO has given clear guidelines through Focused Antenatal Care (FANC), there is often fragmentation across ANC delivery platforms. Fragmentation makes it difficult to effectively deliver prophylactic malaria interventions through ANC. Solutions to this problem include integration of both funding and service-delivery for malaria, ANC, and maternal health interventions. In addition, countries must harmonize malaria control and maternal health efforts in national policies, guidelines, and funding. Malaria prevention is not just an addendum to current maternal and newborn health interventions, it ensures maternal and newborn health. With integration we can save lives.
This blog was originally written and published by Jennifer James on SocialGoodMoms.com, a global coalition of 2000+ mom bloggers who spread good news about the work non-profit organizations and NGOs are doing around the world. Ms. James recently led a trip to Ethiopia as part of The International Reporting Project (IRP). The IRP provides opportunities for journalists to report internationally on critcal issues that are under covered in the news media. The blog below was written during her trip.
It may seem a little quiet around SocialGoodMoms.com, but for good reason. I am co-leading a group of journalists throughout Ethiopia who are reporting on newborn health with the International Reporting Project. Putting together a robust itinerary for the journalists has been a capstone to all of the knowledge I have gained since learning about the importance of saving newborns.
The timing of this trip is perfect in the midst of such important achievements for newborns including the adoption of the Every Newborn Action Plan and the Partners’ Forum that will take place at the beginning of July in Johannesburg.
Thus far the journalists have seen Kangaroo Mother Care and the best NICU in the country at Black Lion Hospital, Addis Ababa’s largest hospital. They have seen how orphaned newborns are placed in homes with SOS Children’s Villages. They have also looked at obstetrics services and family planning with Marie Stopes’s largest clinic and community-based Blue Star clinics in urban areas. Yesterday, we spent a full day with Save the Children in Mosebo village (about 43 kilometers from Bahir Dar) and how they are advocating for Kangaroo Mother Care in rural areas as well as ways in which they are working with Health Extension Workers to save more newborns and their mothers.
The trip goes ended on June 27th. See more about the journalists at #EthiopiaNewborns and stay tuned for more blogs from the IRP journalists.
New mother Vania, 28, holds her newborn baby daughter at the Hospital Regional Sul Banco de Leite, Sao Paolo, Brazil. Photo: Abbie Trayler-Smith/Save the Children
For the first time it can be said that fetal growth and birth size is not predetermined by genetics, but by the health status of the mother. Fetal growth and birthlength are incredibly similar when babies are born to well-nourished, well-educated mothers—despite diverse ethnic and genetic backgrounds.
Today INTERGROWTH-21st, an international study led by researchers at Oxford University, published its first results paper of the project, which proves the previously held belief that size and growth of babies differ due to ethnicity and race is not true. This has tremendous implications on the importance of maternal health care and interventions.
“Currently we are not all equal at birth. But we can be,” said the lead author Professor Jose Villar of the Nuffield Department of Obstetrics & Gynaecology, University of Oxford. “We can create a similar start for all by making sure mothers are well educated and nourished, by treating infection and by providing adequate antenatal care. Don’t tell us nothing can be done. Don’t say that women in some parts of the world have small children because they are predestined to do so. It’s simply not true.”
In order to study fetal and infant growth around the world, researchers studied nearly 60,000 pregnancies in eight defined urban areas in Brazil, China, India, Italy, Kenya, Oman, the UK and the USA. Using identical methodologies and equipment, researchers performed ultrasounds from early pregnancy through delivery to measure fetal bone growth and at delivery measured birth length and head circumference. This representative data is the first of its kind.
But why is it so important to have these standards and understand what affects fetal and infant growth? Currently no single global standard for fetal growth exists, instead there are at least 100 differing standards, posing problems for both identifying and treating undernourished newborns. “This is very confusing for doctors and mothers and makes no biological sense. How can a fetus or a newborn be judged small in one clinic or hospital and treated accordingly, only for the mother to go to another city or country, and be told that her baby is growing normally,” said Professor Stephen Kennedy, University of Oxford, one of the senior authors of the paper. The standard produced by the INTERGROWTH-21st fixes this problem. The standard serves as a global standard for fetal and infant growth—the first of its kind—and is consistent with existing WHO standards for infants. For example, the mean length at birth of the newborns in the INTERGROWTH-21st study was 49.4 ± 1.9 cm, compared with 49.5 ±1.9 cm in the WHO infant study.
The INTERGROWTH-21st growth standard will help maternal and neonatal practitioners around the world address the problem of poor growth. As of 2010, 27% of births around the world, or 32.4 million babies a year in low- and middle-income countries, are born already undernourished. Poor growth evident by small for gestational age babies has a significant implication on an infant’s start to life—putting them at increased risk of illness and death compared to babies well-nourished at birth. Small birth size also increases a person’s risk of diabetes, high blood pressure, and cardiovascular disease in adulthood. In addition, caring for undernourished newborns puts incredible strain and economic burdens on health systems and societies.
Until now it was thought disparities in growth were largely determined by unchangeable factors, like genetics. Now we know the ability to close disparities and ensure fetal and infant growth and health is in our hands. Professor Zulfiqar Bhutta, from The Aga Khan University, Karachi, Pakistan and the Hospital for Sick Children, Toronto, Canada, who is the Chair of the Steering Committee of this global research team, says: “The fact that when mothers are in good health, babies grow in the womb in very similar ways the world over is a tremendously positive message of hope for all women and their families. But there is a challenge as well. There are implications in terms of the way we think about public health: This is about the health and life chances of future citizens everywhere on the planet. All those who are responsible for health care will have to think about providing the best possible maternal and child health.”
Poor growth is not inevitable. Knowing that all babies can grow at the same rate empowers us to provide appropriate care—evidence-based care that ensures healthy mothers, healthy babies.
To read the full article on these new standards, click here. In addition, more information about the INTERGROWTH-21st Project, including updates on the release of the new growth standards, can be found at its website: www.intergrowth21.org
Prematurity is not a disease and does not discriminate. It affects rich and poor, African and non-African alike. Parents of premature babies are like any one of us. Ordinary people thrown into extraordinary situations and get through with courage, determination, love and hope. That vulnerability and fragility of babies born too soon evokes a peculiar natural reaction to nurture and protect. Every breath counts!
A significant high percentage of the births and deaths of premature babies are from our continent of Africa. Unfortunately, given the statistics for sub-Saharan Africa and Asia, where you are born does play a significant role in your chances for survival.
Despite these sobering statistics, Africa is a continent where miracles do happen, where determination, love and hope triumph over lack of resources, adversity and poverty.
Some of these stories of hope happen in an everyday manner and are told and experienced with no fanfare. Like the story of Dei, who had a baby at just over 26 weeks at home and spent over 48 hours being transferred from one hospital to another as she tried to get help to save her barely alive micro preemie. She finally gained admission in one of the major hospitals in Accra, Ghana and was grateful to have her baby share an incubator with two other “bigger” babies. Dei lived in the hospital grounds for the almost 11 weeks her baby Asantewa was in NICU. When there was no space in the incubator she was encouraged to practice Kangaroo Mother Care (KMC) and keep her baby close. With the skill of dedicated neonatal intensive care unit (NICU) teams, support from family and prayers, Asantewa made it through despite the odds with no long-term complications to be discharged from the NICU.
Ruth a young married nurse had her first baby prematurely at 28 weeks. Even as a nurse, she found the NICU experience daunting. From jaundice to infections, to limited communication on her baby’s progress to worries about breastfeeding, her NICU experience was filled with tears day in and out as she struggled to come to terms with her baby’s fight for survival. Through support and encouragement she was able to be her baby’s voice in NICU, working side by side with NICU nurses and doctors and as her baby developed and thrived, leaving NICU after 5 weeks.
LittleBigSouls (LBS) is a not-for-profit organisation, founded from a tragedy of neonatal loss experienced in Africa. We are the voice for the premature baby born in Africa. Our clarion call has always been to advocate for babies on the continent, raise awareness on the issue of prematurity and provide resources, measures and tools that will enhance the chance of survival of each preemie born on the continent.
Through our NICU Connect program we work closely with NICU’s where we interact with medical care teams and preemie parents to provide support and resources to enable adequate care.
We encourage and promote the application of proven low-cost interventions like KMC and are raising funds to build a Kangaroo Mother Care Centre for a major hospital in Ghana. The KMC Centre will include a Mother’s Nest. We are resolute about making this a reality in the face of huge challenges that Africa faces.
For World Prematurity Day (WPD) this year LittleBigSouls will champion their “Together as One! Every Breath Counts” Campaign. In the spirit of WPD we will be coming together as one to raise awareness for prematurity by lending all our individual and collective voices to emit one loud resonating roar calling for an end to prematurity and its effects.
Our activities will build on its actions over the last four years in Nigeria, Ghana, Guinea, Dubai, South Africa and Zimbabwe to include more African countries.
Events include: The collaborations with the Federal Government of Nigeria and other organisations for WPD; The annual LittleBigSouls “Walk for Love, Walk for Babies” in celebration of WPD in as many countries in Africa; “Climb for Preemies’, a climb up the highest peak in Ghana, Mount Afadjato. This event is symbolic of the intense and upward journey preemies make through NICU to grow, thrive and be healthy; The Light Up Purple Campaign across Africa; NICU Connect WPD events in over twenty selected NICU’s across Africa.
Our goal is to see and hear more and more stories of positive outcomes for babies born too soon in Africa. LittleBigSouls works to contribute to that future. The reality is that, for every success story, there is an inevitable tragic one. For some of those, the experience of losing a preterm baby in preventable circumstances spurs them on to join forces with parent groups to ensure that we continue to support from a place of knowing and secondly that we work towards leveling the playing field to give babies born in Africa a fighting chance at life.
Every Breath Counts!
Students gather around David Cheruiyot (second from right), a clinical instructor at Tenwek School of Nursing, as he trains nurses from other hospitals around the country on techniques for dealing with maternal and newborn complications. Photo: Trevor Snapp for IntraHealth International
When my team comes to work each day at the IntraHealth International office in Nairobi, we focus on strengthening Kenya’s health workforce. This may include human resource management, improving and linking pre-service and in-service training for health workers, reducing bureaucratic obstacles to efficient and equitable hiring processes, or helping the Ministry of Health use HR data to make decisions and advocate for the budget it needs to hire and train more health workers.
On any given day, I may work with Government of Kenya officials, donors, public health specialists, technologists, social entrepreneurs, or health workers. Except for family gatherings and visits to health clinics, I don’t get to interact with many mothers or babies.
But when I read my organization’s new 2013 annual report, I was reminded of three things.
First, our work in Kenya fits into a larger picture of global change and impact. I am proud of Kenya’s contribution to the 178,000 health workers worldwide that IntraHealth reached last year.
Second, our work isn’t ultimately about innovating to improve education and training or improving workforce planning. It’s about bringing high-quality health care to the 356 million people—including millions of mothers and babies—who visited those health workers IntraHealth reached last year.
Finally, I’m reminded that behind these big numbers are individuals.
Individuals are behind the training program we developed at Tenwek Hospital in 2013, as featured in the report. Our FunzoKenya project partnered with the high-achieving hospital to serve as a training center for health workers throughout the district, many of whom work in underserved rural communities. This model provides hands-on training and experience with clients that can be hard to acquire or to simulate.
As I look through photographs of those health workers, students, mothers, and newborns, I am reminded that every mother and newborn deserves a high level of care. We know that universalizing access to basic, essential newborn care could reduce newborn deaths by 71%. We also know that scaling up the education, training, and production of midwives—and bringing facility-based care closer to home for mothers—has been key to reducing maternal and newborn deaths in several countries. It can for Kenya too!
For every 100,000 live births in Kenya, there are 400 maternal deaths and 270 neonatal deaths. That’s down from 490 and 330 in 1990. But it shows that an unacceptable number of women and newborns are still dying every year. We are making progress, but many mothers in Kenya—particularly in rural areas—continue to deliver at home, and Kenya is far from reaching the Millennium Development Goal target of reducing maternal deaths by three-quarters.
We’re partnering with the Government of Kenya, local partners and experts, entrepreneurs, faith-based organizations, and training institutions to prioritize the health workforce and health systems needed to achieve Kenya’s 2030 Vision and its focus and commitment toward improved maternal and newborn health.
Together, we’ll make sure all of Kenya’s mothers and newborns get the quality of care they deserve, when and where they need it.
Featured HNN Blogs
About the Blog
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
Recent Member Responses
I totally agree with the above article. As we all known the IMR data, apart from above suggested strategy i.e. strengthening of Village Health and...
Thank you for your comments; I agree with you that we are not reaching women as much as we should be to improve knowledge and behaviors for safer...
No doubt technological gains in maternal, newborn care, have improved newborn survival in last decade . Many simple interventions like kangaroo...
Your information is very useful to us. Our product is as used to protect children with lot of care By-...
The stdndard practice for cord care has been not to apply anything on the cord.after cleaning baby and bath cord is left to dry, this has been...