Addressing Critical Knowledge Gaps in Newborn Health

Blog

By Kathryn Millar on July 14, 2014


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

This blog was originally published by the Maternal Health Task Force. Written by Katie Millar

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

By Edith Uyovbukerhi on July 11, 2014
Ghana
Africa

Photo: LittleBigSouls 

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!

By Meshack Ndolo on July 9, 2014
Kenya
Africa

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.

Learn more in IntraHealth's 2013 Annual Report.

By Estela Coutinho on July 8, 2014
Portugal
Europe

This blog was written by the founding members of XXS – Associação Portuguesa de Apoio ao Bebé Prematuro  

We, parent groups all around the world, are the most authentic advocates for the Every Newborn Action Plan.

With first-hand experience, we are the experts in day-to-day care for our newborns and preterm infants. If a baby is born premature, sick or dies that might cause an impact in the parents and their families’ lives which can change them forever. If they become active to fight for the cause of our babies and our families, they have unique experiences and put their heart and soul into it.

We, parents, and our children are the faces and stories to facts and numbers. This is why we can powerfully complement the work of health professionals and policy makers. Parent groups also lay the groundwork for change in their local community. Through continuous work in hospitals, with politicians and local multipliers we also gain respect and awareness for our organisations and for the problem of preterm birth.

Even more can be achieved when parent organisations work together on a national and international level. A good example from Europe is the work of national parent organisations that have collaborated together with the European Foundation for the Care of Newborn Infants (EFCNI). In joint projects, parent organisations from all over the continent have unified their voices to improve the situation for preterm and sick newborn children and their families. World Prematurity Day each November 17th has been a unique opportunity to connect with and advocate for change. Parent organizations have also been working to improve the standards of care for preterm and sick babies.Our organisation XXS - Associação Portuguesa de Apoio ao Bebé Prematuro – was started 6 years ago in Portugal. We were a small group of parents, who went through rough times with our own preterm babies. We experienced many things we desperately wanted to change, so we took matters in our hands and started to fight.

Working together with EFCNI and other parent organisations helped to strengthen our voice. One important step in that process was collaborating on World Prematurity Day activities. Year after year XXS became more popular and last year we could win internationally renowned soccer player Cristiano Ronaldo and fado singer Mariza to raise their voices on behalf of our organization for preterm babies. In March 2014, we celebrated a great milestone in improving neonatal healthcare with the launching of the C.A.R.E. project together with our national government. The project includes prevention campaigns, information and awareness for preterm birth, training courses to skill development, improvement of accommodation for parents in Neonatal Intensive Care Units (NICUs), and pilot projects thatfocus on developmentally supportive care. 

Going forward we plan to further our own work on the C.A.R.E. project while also helping to implement the Every Newborn Action Plan and continue our involvement as part of EFCNI. We will also focus on the creation of parent groups in different hospitals in Portugal. We see this as an important way to support, inform and develop the power of parents and communities, one of the strategic objectives of the Every Newborn plan.

Since our creation we have learned that what starts small can have a huge impact with hard work, ambition and the will to make a change. Parents are critical in that process and they and their families will continue to inspire and drive that work.

About XXS:
XXS – Associação Portuguesa de Apoio ao Bebé Prematuro (XXS) is a Portuguese nonprofit association founded in 2008. XXS was created by a group of parents who lived the experience of prematurity in the first person and adopted a mission to help premature babies and their families overcome those who may be the most difficult times of their lives!

All we, the founders, are volunteers and we all have different professional backgrounds, we are managers, architects, journalists, IT professionals, health care professionals. However, we have one thing in common: all of us lived the experience of premature child birth in 1st person, we all are parents of premature babies born between 23 and 35 weeks gestation or are even ex-premature babies ourselves!  

By Alice MacDonald on July 7, 2014
South Africa

Newborn health advocates stand in front of the Blanket of Hope at the Partnership for Maternal Newborn and Child Health (PMNCH) Forum in Johannesburg, South Africa.

This blog was originally published by the Every One campaign

On the eve of the Partnership for Maternal, Newborn and Child Health Forum being held in Johannesburg this week, Save the Children along with 10 other South African civil society and professional associations hosted a high-profile event bringing together decision makers, activists, health workers and celebrities to call for renewed efforts to end newborn deaths in South Africa and globally.

Gugu Ndebele, CEO of Save the Children South Africa welcomed guests explaining "In South Africa we have a history of coming together to fight injustice and that is what we are doing tonight – joining forces to campaign against the injustice of babies failing to survive the first month of life and mothers dying in childbirth.”

The South African Minister for Health, Dr Aaron Motsoaledi a champion of the Every Newborn Action Plan being launched at the Partners Forum today, underlined the government’s commitment to improving newborn survival and pledged to work harder to ensure that every newborn has the best start in life.

Margaret Chan the Director General of the World Health Organisation spoke about the importance of the Every Newborn Action Plan, as well as meeting existing commitments to MDGs 4 and 5 to see a reduction in child and maternal deaths by 2015. Ethiopia’s Minister of Foreign Affairs, Dr Tedoros Adhanom joined the event and spoke about how his country has managed to meet MDG 4 through policies including increasing the number of health workers across the country. Renowned newborn specialist Professor Joy Lawn spoke about the simple solutions that can save the lives of millions of babies around the world. Sibongile, a young mother from Soweto shared her moving story about the pain of losing her daughter and the need for mothers to access expert care during pregnancy to avoid possible birth complications. The event also included a performance from the renowned South African musician and UN Ambassador, Yvonne Chaka Chaka.

The event was the first time the Blanket of Hope was unveiled. The blanket is made up of squares knitted by mothers, midwives and activists from all around the word in solidarity with mothers and newborns, and was sown together, in large part, by mothers and midwives last week in Johannesburg. The blanket is a symbol of the warmth, comfort and care that we want to ensure every baby and mother receives, no matter where they live. The blanket will continue to be displayed throughout the Partners’ Forum.

Crucially, at the event, guests including all the speakers pledged to play their part in ending newborn deaths. The host organisations also launched a South African civil society pledge committing to supporting the delivery of critical actions such as guaranteeing all women give birth attended by a skilled health worker, harnessing the power of parents, families and communities for change, and holding government and health providers to account for the commitments made to women and children.