Addressing Critical Knowledge Gaps in Newborn Health


By Meshack Ndolo on July 9, 2014

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

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.

By Katie Taylor on June 30, 2014

Photo: Isabel Pinto/PMNCH

This blog was originally published in the Huffington Post Global Motherhood. Written by Katie Taylor and Lily Kak

Each of us has a role to play in helping to save newborn lives. Here's why I believe it's important, what some of us are doing about it, and how each of us can help.

Neonatal deaths account for 44 percent of under-5 mortality. Although we have seen incredible success in bringing down under-5 deaths, neonatal mortality rates have declined at a slower pace. This is in part because the leading causes of newborn mortality are sometimes harder to diagnose and treat than leading causes of mortality in older children under age 5.

This week, USAID is joining a global movement to give newborns a fighting chance to survive and thrive during the most perilous period of life -- during delivery and the post-natal period when prematurity, asphyxia and infection pose grave threats to their survival. Action to prevent newborn deaths is a vital element in all we are doing to end preventable child and maternal deaths -- and helping to save newborns helps us to save moms, and can enable these fragile beings to become healthy children.

For more than a year, USAID and our partners have developed the Every Newborn Action Plan, which was endorsed at the World Health Assembly in May and will be launched today at the Partnership for Maternal, Newborn and Child Health Forum. This is the first plan to unite the global community around progress toward newborn health outcomes -- it is both a historic moment and opportunity. The plan outlines a practical strategy to address newborn mortality and identifies tactics and milestones for the global community to support national and local plans and action.

This is a very exciting next step in saving the 2.9 million babies that die every year during their first month of life, and helping to avoid 2.6 million stillbirths per year.

For the past decade, USAID has played a significant role in advancing development policies, practice and strategy for newborns through collaborative research and programming to address the major drivers of mortality. Let me tell you a little more about this, and about how partnerships with governments, private sector, and other actors are helping to drive transformational results.

Through research, USAID demonstrated the efficacy of training health professionals to manage asphyxia, a leading cause of newborn mortality. The World Health Organization (WHO) estimates that 700,000 newborn babies die each year from intrapartum complications, including birth asphyxia, the inability to breathe immediately after delivery. USAID, through a public-private partnership, is supporting the implementation of this approach in 24 partner countries by rolling out training and implementation research. Learn how Helping Babies Breathe and innovative equipment -- like the NeoNatalie training simulator, bag and mask resuscitator and "penguin" suction blub -- are driving down neonatal mortality in Malawi.

And the Agency supported scaling up of chlorhexidine (CHX) in Nepal. CHX, a very low-cost antiseptic, is used to prevent umbilical cord infections in newborns, a leading cause of newborn mortality. Cutting the birth cord with unsterilized instruments, and the application of substances such as ash, oil and cow dung by traditional birth attendants or family members, increased risk of cord infection and death.

USAID partnered with Nepal's Ministry of Health and Population to bring chlorhexidine to newborns in nearly all of Nepal's districts. At 23 cents per dose, the drug is a scientifically proven innovation that has been shown to reduce up to a third of newborn deaths. The recent World Health Assembly resolution reflects many years of work by USAID and others to advance global-level policy and inspire country-level action.

This is the second research product USAID has guided through a managed research-to-use process. The first product, oral rehydration solution and zinc, has been used as a treatment for diarrheal diseases in more than 20 USAID-supported countries. Working with the partner governments, the chlorhexidineworking group and other partners, product introduction for CHX is anticipated in at least 10 countries by 2016.

To complement the strong evidence available on the impact of facility-based Kangaroo Mother Care (KMC), USAID is currently evaluating the feasibility of implementing community-based Kangaroo KMC, as an extension of supervised facility-based KMC, to help babies born with low birth weight survive. Babies who are born small are around 20 times more likely to die compared to babies who have higher birth weights; and around one-third of low birth weight babies die within the first 12 hours of delivery. Since many deliveries take place at home in partner countries, community kangaroo mother care teaches mothers and other caretakers how to practice prolonged skin-to-skin contact and provide exclusive breastfeeding while they are in their home.

And USAID is advancing simple actions, such as hand-washing with soap, that can make a drastic difference in ending preventable newborn deaths. Together with Unilever, USAID has developed a communication package to promote hand-washing with soap among caretakers of newborns.

During the Acting on the Call forum, co-hosted by the Governments of Ethiopia and India in collaboration with UNICEF and the Bill & Melinda Gates Foundation, USAID and other partners announced several new commitments to improve newborn survival.

USAID, the American Academy of Pediatrics, and pediatric associations of Nigeria, India, and Ethiopia announced the Helping 100,000 Babies Survive and Thrive partnership, a new initiative aimed at saving at least 100,000 newborn lives each year in partnership with Laerdal Global Health, Johnson & Johnson, the Government of Norway, and the Bill & Melinda Gates Foundation. This is an expansion of the Survive and Thrive Global Development Alliance, which was announced at the 2012 Call to Action.

Tore Laerdal, managing director of Laerdal Global Health and executive director of Laerdal Foundation, announced a commitment of $55 million in support of USAID's public-private partnerships, including the new Helping 100,000 Babies Survive and Thrive, and other partners' efforts to end preventable newborn and maternal deaths.

It's thanks to the passion and commitment of all these organizations and people that we can aspire to end newborn and child deaths in a generation. Please help us by joining us with your voice and your action.

Editor's Note: Johnson & Johnson is a sponsor of The Huffington Post's Global Motherhood section.

By Carolyn Miles on June 27, 2014
Bangladesh, Ethiopia, India, Nepal
Africa, Asia

Photo: Andy Hall for The Observer

This blog was originally published in HuffPost Impact. Written by Carolyn Miles

Fifteen years have passed since a husband and wife team in western India challenged the notion that the deaths of thousands of mothers and millions of babies during pregnancy and childbirth are inevitable in poor and remote communities.

Drs. Abhay and Rani Bang trained a battalion of local women to deliver lifesaving care to mothers and newborns who had little access to doctors or hospitals. Their paper published in 1999 in the prestigious medical journal, The Lancet, recorded that the interventions delivered by these community-based health workers led to a 62 percent reduction in newborn mortality in only three years. Since then, more evidence has been generated suggesting that up to 75 percent of maternal and newborn deaths are preventable -- most without intensive care.

Today babies in some of the world's poorest, most remote communities are being saved through the use of low-tech interventions, such as a low-cost, hand-held device that can resuscitate babies who are not breathing at birth or an antiseptic gel that can prevent deadly infections when applied to the umbilical cord immediately after birth.

These interventions -- and a number of others -- have the potential of saving 1.9 million newborns and 158,000 mothers a year, while also averting 800,000 stillbirths, according to the latest estimates published in The Lancet last month. But the problem is this: So far no country in Africa or South Asia -- where 80 percent of maternal and newborn deaths take place -- has succeeded in delivering these high-impact, cost-effective interventions nationwide. Yet, based on the work of the Bangs and others, we know that these lives CAN be saved.

Without these interventions reaching every woman and every newborn, many deaths happen needlessly each year. But that may be about to change.

Last month, when the World Health Assembly met in Geneva, health ministers from around the world took the historic step of making maternal and newborn health and stillbirths a top global health priority. The health ministers approved the Every Newborn Action Plan (ENAP), a roadmap to help countries sharpen their plans to reduce stillbirths and maternal and newborn deaths.

Even more importantly, many countries, including India, Bangladesh, Nepal, Ethiopia, Uganda and Malawi have already taken steps to change health policies that will help ensure that proven newborn interventions are made more widely available. In Ethiopia and India, for example, trained personnel at community health posts are now allowed to use injectable antibiotics to treat severe newborn infections when a hospital referral is not possible. In both countries severe infections are among the leading killers of newborns.

Increasing access and use of such interventions, especially for those that have not been reached, will help ensure that the reductions in newborn mortality start to catch up with great global declines we've already seen in deaths to children after the first month of life. Currently, babies who die within the first month of life account for almost half (44 percent) of all deaths of children under age 5.

On Monday, ENAP will be launched with great fanfare in Johannesburg, with many notables and agencies including Save the Children joining in a global call to action.

Hopefully, this will mark the beginning of one of the world's greatest health crusades in history -- ending preventable deaths of mothers and newborns and stillbirths within our own lifetime.