Addressing Critical Knowledge Gaps in Newborn Health

Blog

By Ian Hurley on April 10, 2015
Africa, Asia

 Women wait with their children to see a doctor at a mobile health clinic in the Okhla Industrial Area slum in Delhi, India. Photo: SuzannaLee/Save the Children

IPPF, the White Ribbon Alliance, Save the Children and World Vision are joining with partners to host community and national Citizens’ Hearings this spring - as well as a global Citizens’ Hearing during the World Health Assembly in Geneva this May and one at the United Nations General Assembly in New York this September. These organizations, other partners and the public are calling governments to account for their delivery on MDGs 4 and 5, and are pushing for a strong accountability framework in the new Every Woman Every Child Global Strategy 2.0 and within the Sustainable Development Goals.

Citizen Hearings have already taken place in India, Indonesia, Nepal, Nigeria, Tanzania and Uganda

This forum has given people at the local and national level the opportunity to highlight the challenges to improving maternal, newborn, child and adolescent health in their area. Citizens have engaged with parlimentarians, ministries of finance, ministries of health, and representatives from other government bodies. 

Stay tuned to CitizensPost.org for information on upcoming hearings in Malawi, Bangladesh, Ghana, South Africa, Lesotho, Guinea, Sierra Leone, Pakistan, Afghanistan and many more countries. 

If you are interested in coordinating your own Citizen Hearing, there are toolkits available in English, French and Spanish

By Sylvia Nabanoba on April 7, 2015
Uganda
Africa


The author, Sylvia Nabanoba, and her newborn son Nathan.

I clenched my fists and tightly closed my eyes. After about one minute, I slowly stretched my fingers and opened my eyes. I heaved a sigh of relief. That contraction had passed.

Another contraction came and the process repeated itself. It was during one of those moments of relief that my eyes caught a sign hanging on the wall. The sign was in the corner above a small mattress lying next to the delivery bed that I was on. This was in a labour ward at Case Medical Centre in Kampala.

‘Helping Babies Breathe’, the sign read. In the midst of my pain, I smiled. I knew that sign very well. I had worked with our Helping Babies Breathe (HBB) senior officer, Harriet Othieno, to create it. We had considered it good to brand the resuscitation corners for babies that were being put up in and outside of labour wards. This is because these corners were largely a result of the training that Save the Children and partners were giving to midwives on how to resuscitate babies that have difficulty breathing at birth.

I felt like a guardian angel was watching over me. I had always known that the HBB+ project carried out training, but was not aware of it reaching beyond health centres in rural areas. I did not know that even health workers from hospitals in urban areas received this kind of training, because I thought they had everything they needed to save babies.

My labour did not progress as well as the doctor had thought, and before long, I was bleeding. The bleeding worried the midwives, who immediately summoned the doctor. A decision was made to take me for an emergency caesarean operation, with the doctor explaining that if we delayed, the baby could die. I was operated on, and gave birth to baby Nathan. Later, the doctor explained that the bleeding had been caused by a condition called abruptio placentae, or placental abruption, whereby the placenta had begun separating from the uterus before the baby had been delivered.

It was on discharge from the hospital that I learnt that my baby’s apgar score had not been very good. In fact, he had had to be resuscitated.

This experience has made me even more proud of working for an organization such as Save the Children, and of the partnership that has ensured the HBB+ programme reaches hospitals throughout the country. I only wish every mother and newborn all around the world could have access to skilled health care when they need it. Every mother deserves to live, and every mother deserves a live baby.

Sylvia is a Communications Manager for Save the Children in Uganda.

By Mariam Claeson on April 2, 2015
Africa, Asia

This blog was originally published on the Huffington Post Global Motherhood

Every once in a while, a major innovation comes along -- one that has the potential to change the lives and health of families all over the world -- especially in remote, hard-to-reach areas.

For several years in the 1980s, I traveled the globe as a clinician (and later as a public health officer) to care for mothers and children in Africa, Asia and the Middle East. Each setting was different. But in each place, caring for pregnant women and newborns with complications was among the most difficult challenges my colleagues and I faced.

One of the most challenging conditions we dealt with was newborns suffering from bacterial infections. It remains a major public health challenge even now. In remote regions, most mothers delivered their babies at home without access to a skilled birth attendant and quality care. Babies would develop serious infections in the days and weeks following delivery, sometimes caused by unsanitary conditions during childbirth or an infection carried by the baby's mother. Most newborn deaths were caused by infections, and today, they still claim more than 629,000 newborn lives every year, accounting for a third of all newborn deaths.

The treatment for severe infection (sepsis) in newborns is well-established -- a total of 14 injections given over seven days, twice a day, by a doctor while the child is in the hospital. But often, in low-resource settings, newborns and their families lack access to health facilities due to financial or logistical challenges. They come to the hospital as a last resort, and often too late for treatment to be successful.

This week, The Lancet medical journal published a new study detailing a simplified treatment with antibiotics that is a true breakthrough in the global approach to neonatal infection. Researchers, aiming to identify an alternative way to deliver life-saving medicines, studied what would happen if the antibiotics were administered differently. The study found that two alternative simplified regimens, which require either two or seven injections, in addition to oral antibiotics given at home were just as effective as 14 injections in treating newborn infections. The regimens, studied in clinical settings in Africa and Asia where neonatal deaths remain stubbornly high, were found to be safe, simple and more accessible. The results show that when given proper instruction from health care providers, families were willing and able to care for their newborns with oral antibiotics at home.

This innovation could bend the curve in favor of neonatal survival. It could make a dent in saving some 300,000 newborns every year.

When mothers are healthy and when children thrive, the positive benefits last a lifetime. For families with sick newborns who cannot make it to a hospital, or for those who cannot stop working or need to be home for other children, it means more days at home instead of in the hospital. The costs of catastrophic illness, such as a week-long hospital treatment of a sick newborn, push many households below the poverty line.

Despite the tremendous gains in saving the lives of children globally, the rates of newborn deaths haven't fallen as quickly. The Every Newborn Action Plan released last year laid out a roadmap to end preventable newborn deaths. Today's Lancet study provides evidence that there is in fact an alternative to the arduous treatment currently used that would help the world reach this ambitious goal.

I often think of the babies whose lives couldn't -- and still cannot -- be saved because they lacked access to the treatment they needed. This simplified antibiotic treatment puts an alternative, less cumbersome course of treatment into the hands of front line health workers and families in the most remote areas of the world -- and will allow newborns to receive the lifesaving care they need and deserve.

Follow Mariam Claeson on Twitter: www.twitter.com/MariamClaeson

By Kathryn Millar on April 2, 2015

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

Newborn size at birth standards are now available from the INTERGROWTH-21st project. This package includes size charts, standards and z-scores for newborn length, weight and head circumference at birth for boys and girls.

These standards—based on a multicenter, multi-ethnic, population-based study—are the first global standards for newborn growth and debunk the myth that fetal and newborn growth differs by race and country of origin. In fact, results from the INTERGROWTH-21st project show that if a woman is healthy, the size and growth of her newborn should be consistent, no matter where she lives.

The newborn size at birth standards are currently in use at Oxford. In addition, these standards are being introduced and piloted at INTERGROWTH-21st study sites and medical centers in the Boston area. We encourage all clinicians to use these standards worldwide.

Next steps to implement these standards in your facility:

Forthcoming tools:

  • Interactive resources such as online calculators and mobile phone tools
By Peter Waiswa on March 31, 2015
Uganda
Africa

This blog was originally published in Impatient Optimists. Written by Peter WaiswaStefan Peterson and Mariam Claeson.

This is an exciting time for advances in newborn care. Today a special issue on Newborn Health in Uganda in Global Health Action is being launched to share the experience of how to scale up a cost-effective package of newborn care that involves families, community health workers and health facilities. What this study shows is that it is both possible and feasible to improve life-saving practices during pregnancy, childbirth and in the first weeks of life among families in poor rural communities.

Long-time Village Health Team (VHT) member Zeffa Sowobi, left, talks with expectant mother Justina at her home in Nabitovu village outside Iganga, Uganda. Zeffa was there to counsel Justina about the how to prepare for giving birth and how to make arrangements to have the baby at a health facility under the care of nurses and midwives. This will be Justina's third child. Zeffa will visit the home one more time, for a total of three antenatal home visits as is the protocol in the UNEST study. Photo: Ian P. Hurley/Save the Children

We have known for a long time about what works in newborn health, but we have struggled with how to implement what we know effectively.

The results of this community randomized trial, the Uganda Newborn Study (UNEST), show that home visits in pregnancy and soon after delivery resulted in improved breastfeeding practices, skin-to-skin care immediately after birth, delaying a baby’s first bath, and hygienic care of the baby’s umbilical cord among the poorest households with lowest access to care.

Joy Lawn Director of the MARCH Centre at the London School of Hygiene, and her co-authors of the editorial to the special issue identify four key learnings from Uganda:

  1. Scalability depends on recognition of community care as a part of the health system with consistent funding and supervision. The home visit package was well received by the community with 100% retention of the volunteer village health workers during implementation. The package was also pro-poor, with more women from the poorest families, who are most at risk, visited during pregnancy and after delivery compared to wealthier families.
  2. Quality care at facilities is crucial for ending preventable deaths amongst mothers and their babies. The Uganda Newborn Study worked with both public and private sector facilities to improve care. More women are giving birth in health facilities yet persistent staff shortages and supply chain failures for essential drugs and equipment continue to place lives at risk.
     
  3. Innovations can address key challenges: novel solutions for how address the realities of operating in a low resource setting were tested. Innovative solutions included a foot length card that village health workers can use, in the absence of a scale, to identify and refer small babies to the health facility for extra care.
  4. Local leadership is key and requires intentional strategies. More local leaders are needed, to champion the cause of improving care at birth and ending these preventable deaths. This was the first study of its kind to be led and carried out by local researchers in Uganda. We need more program implementation studies of this kind that helps us identify and remove the barriers to scale up of known maternal and newborn among the communities that would benefit the most.

To learn more, read the special issue in Global Health Action