Addressing Critical Knowledge Gaps in Newborn Health

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By Melinda Gates on September 16, 2013

This post was originally published on Impatient Optimiists

Two of my passions are child health and statistics. So I look forward to mid-September every year, to the day when UNICEF reports how many fewer children died the previous year.

Every single year—for at least the last 50 years—the number has gone down. Every. Single. Year.

I challenge you to name something else that gets better on that kind of schedule. The stock market goes up and down. Sprinters keep getting faster, but they don’t set new records every year. The 100 meter record set in 1968 didn’t get broken until 1983.

Meanwhile, the child mortality record set in 1968 got broken in 1969. And 1970. And 1971. And so on.

Keep in mind that we’re talking about the most important statistic in the world—who is alive.

This year, the number is 6.6 million. That’s 300,000 fewer children dying than last year. To give a longer view, that’s 6 million fewer than 1990.

The report is very important from a policy perspective. It tells us which children are still dying and what they’re dying from. For example, the report shows that adolescent mothers are more likely to give birth to premature babies (and are also at a greater risk of experiencing life-threatening complications). It also indicates we still have work to do delivering two relatively new vaccines for diarrhea and pneumonia, because they’re still the leading causes of death among children. And it proves we have to pay more attention to newborn health, because as we get better at saving older children a greater proportion of mortality happens in the first month of a baby’s life.

The report will lead to important conversations about how to make sure health systems deliver all this lifesaving care in a single, integrated package that reaches all families at all stages of life.

But before we move on to the detailed conversations about how to get the number even lower next year, let’s celebrate the beautiful, simple fact that it’s lower again this year. Let’s celebrate this new world record in the most important category there is.

By Tunde Segun on September 12, 2013
Africa
This blog was originally published on MamaYe
 

This week, the African Union Commission is holding the inaugural International Conference on Maternal, Newborn and Child Health in Africa, which is taking place in Johannesburg, South Africa. I will be attending the conference, along with several members of the MamaYe teams from across Africa. At the conference, CARMMA, with the support of MamaYe, is launching a new prize for excellence in maternal, newborn and child health: the Mama Afrika Award.

The Mama Afrika Award honours remarkable efforts by individuals or organisations in Africa that ensure Africa’s mothers, newborns and children survive and thrive into the future.

The Mama Afrika Award is named after Miriam Makeba, the famous singer, who was made a citizen of 10 African countries in recognition of her opposition to apartheid; and whose daughter died from complications related to pregnancy.

MamaYe has worked with CARMMA, an African Union campaign to reduce maternal, newborn and child mortality, to develop this award. The award will hail real-life heroes and heroines, including organisations, from around the African continent.

All around Africa, people from all walks of life, including health-workers, decision-makers, community leaders and campaigners, are working for the health of women, babies and children in their communities. Their efforts have saved lives and helped ensure healthy and happy future generations for Africa. MamaYe has collaborated with the African Union Commission to acknowledge these people and organisations through a prestigious, continent-wide prize for excellence in the field of maternal, newborn and child health.

 

It will reward those who, for example:

  • make a major breakthrough in care for mothers and newborns
  • demonstrate long-term service dedicated to maternal, newborn and child survival
  • ensure women and newborns survive and thrive in particularly adverse conditions
  • raise standards, quality and resources for MNCH in a significant way at governmental level
  • Individuals, organisations, communities, companies and governments are all eligible for the award.

The award will focus on 6 categories

  • Innovation in Finance
  • Access to Services
  • Community Mobilisation and Participation
  • Vulnerable Groups and Disadvantaged Population
  • Conflict and Unstable Situations
  • Capacity Building

The Awards committee of the African Union Commission will examine evidence of the commitment, dedication and achievements of the nominees in maternal, newborn and child health - before making the Award.

Nominations will open shortly, and will close on 1 February 2014, with the award being given at a ceremony in August/September 2014. The prize will consist of a Medal and a document confirming the award.

 

By Steve Davis on September 10, 2013


Photo: Monika Gutestam/Save the Children

This blog was originally published in the Skoll World Forum

Life-changing innovation sometimes comes in a plain-vanilla package.

Chlorhexidine is a workhorse antiseptic that’s been around since the 1950s. It’s used in more than 60 medical products widely available in drugstores and hospitals across the United States and Europe, from mouthwash to skin products to surgical washes. It’s inexpensive, effective, and safe.

In low-resource countries, it could be a powerful solution to an unacceptable tragedy: the preventable deaths of hundreds of thousands of newborns every year from infection. For about 30 cents a dose, a new formulation of chlorhexidine developed for low-resource settings could be used to prevent infection of newly cut umbilical cords and help save the lives of an estimated 422,000 babies over the next five years.

So what’s stopping us? On the road from development to delivery, innovation can lose its way. Market failures, regulatory and policy roadblocks, and gaps in supply and demand can choke off the flow of ideas and technologies through the development pipeline and put lifesaving solutions out of reach. This is one of our most urgent challenges for the next 850 days and beyond in achieving the Millennium Development Goals: breaking the logjam of innovation.

The pipeline is piled high with game-changing solutions such as chlorhexidine that have gotten stuck in the middle part of the pipeline where new discoveries or new applications of existing interventions can stall and die. Chlorhexidine has a long shelf life, requires no cold chain, and is easy to apply with minimal training and no equipment. Few other interventions have shown such promise for saving newborn lives in so many settings for such a low cost.

Yet chlorhexidine is an overlooked lifesaver. Regulatory hurdles, supply issues, misconceptions about guidelines for umbilical cord care, and a nascent market for the new product formulation all contribute to the product’s limited availability and adoption in developing countries.

Dismantling these barriers requires patient and persistent work. PATH, as secretariat of the Chlorhexidine Working Group, leads an international collaboration of organizations that’s been working since 2007 to promote the use of chlorhexidine for umbilical cord care through advocacy and technical assistance. That work helped lead to a recent decision by the World Health Organization (WHO) to add 7.1% chlorhexidine digluconate to its Model List of Essential Medicines for Children. This is a key step in encouraging its introduction in low-resource settings. PATH is also working to establish manufacturing in African countries to increase the product’s availability at an affordable price.

Global health has too many wallflowers like this, lifesaving solutions that have been sidelined in the development pipeline. Another example is magnesium sulfate. For about $1 a dose, this medicine could save an estimated 55,000 mothers over the next five years from preeclampsia and eclampsia, pregnancy-related conditions that are leading causes of maternal deaths. Confusion among health workers about dosing requirements inhibits routine use. WHO, Merck, PATH, and others are investigating a simplified dosing regimen to make it easier for health workers to administer.

Innovation is more than the act of invention. Truly transformative innovation also must include the everyday business of pushing solutions forward through the barriers that can keep them from achieving impact at scale. The hard work of identifying and developing health solutions, while not complete, has already delivered proven results. The next step will be at least as hard—shattering the walls that stand between these breakthroughs and the people who need them.

This can be painstaking, even tedious work, with payoffs that may not be as tangible as the creation of a new vaccine or the invention of a lifesaving device. It’s fair to say that market development, supply chain improvements, health system strengthening, and demand generation may never be hailed as global health’s “next big thing.”

Yet it is every bit as critical to the goal of saving the lives of women and children. We must cut through the bottlenecks to take innovation to scale, paving the way for the most promising ideas to reach the most vulnerable and disrupt the status quo of poor health and poverty.

By Lanre Olagunju on September 9, 2013
Breastfeeding
Africa

For infants to survive, grow and develop properly they require the right proportion of nutrients. Breast milk is rich in nutrients and anti-bodies and contains the right quantities of fat, sugar, water and protein. These nutrients are major pre-requisites to the health and survival of the baby. When a child is exclusively breast fed, their immune system is strengthened, enabling it to life threatening illnesses like pneumonia and diarrhoea amongst other infections. In fact, reports indicate that babies who are not breast fed for the first six months of life are 15 times more likely to die from Pneumonia compared to newborns that are breast fed exclusively for six months after birth.

The World Health Organization estimates that around 220,000 children could be saved every year with exclusive breastfeeding. It recommends that colostrum, the yellowish sticky breast milk that is produced at the end of pregnancy as the ideal food for newborns; to be given within the first hour of birth, a process referred to as early initiation. Infants breast fed within the first hour of birth are three times more likely to survive than those who have their first breast milk after a day. Exclusive breastfeeding should be given from birth up to 6 months and continued breastfeeding is recommended with appropriate complementary food until the child celebrates his/her second year birth day without water, food or drink. The only exceptions are rehydration salts and syrups that contain medicine.

It becomes essential that we counsel, encourage and support mothers to initiate exclusive breastfeeding. Governments, family members and community health workers all have a role to play in the survival of newborns through the uptake of exclusive breast feeding.

****Lanre Olagunju is a hydrologist turned freelance journalist. An alumnus of the American College of Journalism, Lanre advocates on several international platforms for the prosperity and absolute well-being of the African continent. He is @Lanre_Olagunju on Twitter.

 

By Joy Lawn on September 6, 2013
Kenya, Malawi, Pakistan
Africa, Asia

Photo: Ayesha Vellani/Save the Children

This blog was originally published in The Huffington Post

Today in Northern Ireland, over 200 babies will be born, about 20 preterm, but only about three newborns die each week. In Belfast, newborns dying of infection recently precipitated a major media storm. Yet we do not expect birth to be a time for death and so we name our babies, often on the first day. But around the world in many countries, parents take days, even weeks, before they name their babies because surviving birth and the first weeks of life is so uncertain. Most of these deaths are preventable, yet the world still accepts them with little comment.

In Belfast on Friday, at the 8th International Neonatal Nursing Conference, we honour nurses from Pakistan, Kenya and Malawi who are committed to saving newborns and supporting families despite enormous challenges.

Each year three million newborns die during the first month of life, including one million who do not survive their birth day. Another 2.6million babies are stillborn, nearly half of whom die during labour, closely linked to around 250,000 maternal deaths. The moments before, during labour and the first few days are critical for the survival of both mother and baby.

These babies die from treatable conditions - being born too soon (preterm), affected by birth complications or by infections. Most of these deaths can be prevented without intensive care, with simple, cost-effective solutions, such as injection antibiotics, breastfeeding, or "Kangaroo Mother Care (KMC)" which involves continuous skin-to-skin contact between a mother and her baby and could halve the death rate of preterm babies.

Nurses and midwives with the skills to look after women - especially to care for preterm newborns who can die within minutes - are in short supply in Sub-Saharan Africa and South Asia, where 80% of all newborn deaths take place. That is why this week's awards are so important and these three nurses have come to Belfast to be honoured by COINN and Save the Children for excellence against the odds.

In rural Kenya, nursing officer Christine Sammy leads a neonatal care unit at Kitui District Hospital. She has saved lives by training nurses to use newborn resuscitation equipment and to care for newborns as a matter of emergency. Her work has helped her unit reduce infections among newborns and also improve record keeping, which is critical to further improving care.

In Karachi, Pakistan, Anila Ali Bardai as the head of Aga Khan University Hospital's neonatal intensive care unit, also uses evidence to improve newborn care and survival. She supports mothers of sick babies, counseling them on breastfeeding and teaching them how use KMC to keep their babies warm. Her over 10 years of service at the hospital have resulted in reducing newborn infection rates, which in turn have reduced mortality rates and lessened the lengthy of stays of patients. Her work has also resulted in better policies and coordination both in the intensive care unit and well-baby nursery.

In Blantyre, Malawi, nurse Netsayi Gowero has become a role model and mentor to the other newborn nurses and midwives at Queen Elizabeth Central Hospital. The young registered nurse midwife brings an energetic approach to her work. In one particular case, a sick preterm baby orphaned at a health center was brought under her care. She worked tirelessly to monitor and ensure the sick newborn was properly fed, treated and received appropriate warmth. After three months of treatment that baby was healthy enough to go home. Her peers have recognized her enthusiasm and passion and have cited that as a reason for the newborn nursery's improved outcomes.

While these skilled health workers are saving lives every day against the odds, they could save even more with access to basic medicines and supplies. Many frontline workers have not been trained to resuscitate babies at birth or to recognize common newborn infections, or may even lack the simple antibiotics that would save hundreds of thousands of lives. Antenatal steroid injections, costing less than a dollar, are not administered to women in preterm labor, yet many health workers are not aware that these could half deaths from severe breathing problems in preterm babies.

Why is this care missing for so many newborns? The single biggest reason is that newborn survival is only now being recognized as a global health priority. A decade ago newborn deaths were invisible, data lacking. Now the large burden is clear and the solutions are recognized as doable. Yet a recent study donor aid from 2002 to 2010 led by London School of Hygiene & Tropical Medicine showed that, before the year 2005, the word "newborn" barely occurred. While mention of newborns has since increased, only 0.01% of about US$6 billion aid mentions interventions that would reduce newborn mortality.

With less than 1,000 days before the deadline for the Millennium Development Goals, global and national leaders are recognizing the urgency and the opportunity of investing in newborn care. This is increasingly especially important since newborn deaths account for 43% of all deaths of children under five. If newborns survive, their families are more likely to choose to have fewer children. If they are healthy, the nation becomes stronger. Momentum is building to focus on one of the world's most solvable but neglected health issues and more attention to nursing skills for newborn babies in low income countries is critical.

There are important actions we can all take, whether in Belfast, or Blantyre to save children's lives and help by calling on governments, civil society and the private sector, to invest in high quality health services, including nursing skills especially in the world's poorest countries. You or your organization can join "Every Newborn" country-based action plans to end preventable newborn deaths.

Today alone nearly 8,000 newborns and almost as many stillbirths will be lost to grieving parents. We can - we must - do better. The voices of families and leaders all over the world are sparking a movement that no longer accepts that babies are born to die and makes it possible for parents to name every newborn on the day they are born.

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