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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
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Photo: The Bill & Melinda Gates Foundation. This blog was originally published in Impatient Optimists. Written by Ane Adondiwo, Isaac Amenga-Etego, Ireneous Dasoberi, Ernest Kanyoke.
To mark the critical first 28 days of a newborn’s life–the neonatal period (when a baby is most at risk)– in the lead up to the Global Newborn Health Conference, Gary Darmstadt and others will be sharing, via Twitter, 28 days of “Did You Know?” facts about newborn health. Follow @gdarmsta, share the facts widely using #Newborn2013 and we can work towards saving newborn lives together.
Did you know that in many traditional cultures around the world, newborns are not allowed outdoors or around outsiders for weeks for fear of “evil spirits” and “evil people” doing them harm just by looking at them in a certain way or cursing them? Where do these beliefs come from? There are likely different reasons for these beliefs, depending upon the region, but in communities in which so many babies don’t survive the first month of life, people develop their own explanations for why bad things happen and what they must do to protect themselves and their families. To protect the health and lives of both women and babies, we must find ways to work with communities who hold these beliefs to provide care that we know will save lives.
For example, concern about the “evil eye” at birth, in some communities, makes it quite difficult for women to have a skilled attendant during delivery or to get early postnatal care, both of which can improve the health of mom and baby. How can this cultural norm be accommodated while promoting life-saving interventions?
Project Fives Alive! is trying to answer that question in northern Ghana. This project is a collaboration of the Institute for Healthcare Improvement, the National Catholic Health Service and the Ghana Health Service to accelerate the achievement of Millennium Development Goal Four to reduce child mortality in Ghana.
Communities and the health providers who serve them are working together to develop innovative approaches to adapt these cultural norms and change how mothers care for their newborns.
Here are a few examples from our work with promising results:
Babies born outside the community of the Boyelle community in Upper West Region of Ghana are considered “unclean” until elders perform special rituals to “cleanse” the child to accept them back into the community. The midwife in the sub-district, Jane Kuudamnuru, convinced them to do the same ritual for children born in a health facility. Because of this change, 100 percent of women from Boyelle community delivered in a health facility between December 2008 and October 2009, a drastic change from zero for most of 2008 before this new idea was introduced.
Midwife Theresa Kpinbo, in Douri (also in Upper West Region) converted one of the small rooms in her clinic exclusively for postnatal care so women would be assured that their babies would be attended to in private, away from the curious and potential “evil eyes” of other women. Now women come for postnatal care in the first week of life with their babies hidden under a shroud until they are alone with a health staff in the special room. Postnatal care visits went from zero to 88 percent within the first 48 hours after delivery and up to 80 percent for a follow-up care visit on day six or seven.
In Busunu, midwife Martina Naagmentoma decided to ask the families in the community if she could attend the naming ceremony for their babies, usually held seven days after delivery. They were happy to invite her as she was not a member of the indigenous community and thus was less likely to be one of the “ill-wishers.” Furthermore, being a health worker, she was held in high esteem by the community.
So Martina uses the naming ceremony as an opportunity to check-up on mothers and their newborns on the seventh day and provide health education messages about exclusive breastfeeding, hygienic care of the umbilical cord, and keeping the baby warm.
As of February 2013, an astounding 95 percent of women were provided a first postnatal care visit – and 90 percent, a second visit. Just as amazing – there were no newborn deaths recorded in the facility or the community during 2012.
And in Zorko, in Upper East Region, the midwife Janet Adongo and her team convinced families to let them enter their compounds through the back gate to provide postnatal care within the first week. This resolved the concern that visitors or strangers who use the front entrance during the first week after birth would bring the “evil eye” with them. Since these and other changes, the percentage of newborns provided postnatal care within 48 hours of birth increased from 32 percent to 100 percent, while those who received a follow up visit by the seventh day of birth increased from 1 percent to 87 percent.
Project Fives Alive! describes these ideas and many others in a detailed how-to guideline, called a “change package.” It has been promoted throughout northern Ghana for the past three years with modifications to suit different local contexts and, as we’ve noted, is clearly generating evidence of impact.
We know that different regions hold different cultural norms, but what’s ultimately important is improving the health of mothers and babies. We learn a lot from listening to communities and working with them to develop solutions that are both culturally-appropriate and clinically-safe.
Our goal is to adapt cultural norms to safer health practices and spread these types of practices across similar contexts in the country of Ghana, so more children are alive at five.
This column was originally published by IPS News
I nearly died on the day I was born. My mother laboured for 24 hours in a bush hospital in northern Uganda that had no running water and no electricity. Fortunately, the midwife found a doctor, who had witnessed a Caesarian section, who managed to operate, saving my life and my mother’s. Today, had I been born in one of the many places across the world without adequate maternal and reproductive health care, I may not have survived my own day of birth.
While many nations have made remarkable progress towards achieving maternal and child health goals – one of the greatest development successes of the last few decades – newborn death rates (in the first month of life) are declining one-third slower than progress for older children (after one month of age) and at half the rate of decline for maternal deaths.
Each year, three million newborns die, making up 43 percent of the world’s under-five child deaths. The moments before, during and immediately after labour are critical for the survival both mother and baby. Many brain injuries that cause long-term disability and rob the poorest countries of development and economic potential also occur around the time of birth.
Global health goals do not even account for the world’s 2.6 stillborn children, 1.2 million of whom die during labour and are totally preventable with better obstetric care.
Almost all these baby’s deaths stem from preventable causes: prematurity, birth complications and infections. Highly cost-effective solutions to these conditions have already been developed. For example, something as simple as “ Kangaroo mother care” can halve the death rate of preterm babies, preventing half a million deaths each year. This technique, which simply involves skin-to-skin contact between mother and child, provides warmth, promotes breastfeeding, and helps protect against infections.
Africa is now at a tipping point for saving lives, with half of births happening in hospitals. Yet, shockingly, essential equipment that could save newborns is often not available. Midwives and frontline workers are saving lives every day, but they would benefit greatly from access to basic tools and supplies.
Midwives seldom have the neonatal bag-and-mask device that helps resuscitate babies not breathing at birth. Many frontline workers are not trained to recognise common infections in newborns, and lack the 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, as many health workers are unaware that these would almost halve breathing problems in preterm babies.
Why is this care for newborns missing, even as we invest millions in healthcare for women and children? The single biggest reason is that newborn survival has only recently been recognised as a global health issue.
A decade ago we lacked data, and timely interventions were too complex. Now we have no excuse – the data are clear and the solutions are doable. Yet a recent study of 250,000 disbursements of aid from 2002 to 2010 showed that, before the year 2005, the word “newborn” barely occurred. While mention of newborns has since increased, only 0.01 percent of about six billion dollars in aid refers to newborn care interventions that would reduce infant mortality.
One thousand days before the deadline for the Millennium Development Goals, global and national leaders are waking up to the urgency and the opportunity of investing in newborns. If newborns survive, their families are more likely to choose to have fewer children. If they are healthy, the nation becomes stronger.
Meeting goals for preventable child deaths is more and more dependent on targeting newborns. Newborn health conditions, especially preterm births and stillbirths, affect all countries, rich and poor. Such deaths are a tragedy for women, families and communities, and rob nations of the development potential of future generations
In mid-April, many of the world’s leading newborn health experts will come together in Johannesburg, to focus on one of the world’s most solvable but neglected health issues, and lay the groundwork for a Global Newborn Action Plan, linked to national roadmaps.
Teams of experts and stakeholders from high-burden countries, led by their health ministries, will attend the conference, hosted by USAID’s Maternal and Child Health Integrated Program (MCHIP), Save the Children’s Saving Newborn Lives program (SNL), the Bill & Melinda Gates Foundation and the United Nations Children’s Fund (UNICEF), in collaboration with the World Health Organisation (WHO), UKAID and other partners.
Much of the discussion, which will be available to the entire global community via live stream through the Healthy Newborn Network, will focus on effective, low-cost and scalable interventions that already exist to address the leading causes of newborn deaths.
The development of a global action plan is proof that leaders are prepared to commit and hold themselves accountable to new targets to end preventable newborn deaths.
But leaders need support in the form of national data, reliable evidence and experienced advice to make context specific choices to accelerate change for their newborns and to build sustainable healthcare systems: in short, they require investments.
The main source of health funding in even the poorest countries comes from national governments, which must take up this call. Donor aid also has a role to play in helping governments achieve commitments they have set to reduce newborn mortality. Such donor aid has helped bring major changes to other urgent global health issues, including prevention and treatment of HIV/AIDS and the distribution of bed nets to prevent malaria.
The year 2013 has emerged as the moment to include the health and survival of newborn babies among the world’s priorities. As Melinda Gates recently said, “Next focus on the newborn”.
I survived my first day on this earth. Today, as you read this, nearly 8,000 newborns will be lost to grieving parents. We can – we must – do better. The voices of families and advocates all over the world are sparking a movement that no longer accepts that babies are born to die.
Photo: The Bill & Melinda Gates Foundation. This blog was originally published in Impatient Optimists. Written by Gary Darmstadt, Ellen Piwoz, Wendy Prosser.
To mark the critical first 28 days of a newborn’s life–the neonatal period (when a baby is most at risk)– in the lead up to the Global Newborn Health Conference, Gary Darmstadt and others will be sharing, via Twitter, 28 days of “Did You Know?” facts about newborn health. Follow @gdarmsta, share the facts widely using #Newborn2013 and we can work towards saving newborn lives together.
Eating for two. It’s a good excuse used by millions of pregnant women to have that second helping to make sure they are getting enough food for their baby to be healthy, well-nourished, and normal in birth weight.
What happens if a baby does not have a normal birth weight, if he or she is born with low birth weight (born weighing less than 2,500 grams, essentially less than a 5 pound bag of sugar)? Unfortunately, far too many babies are born too small, particularly in low-income countries. Prevalence of low birth weight is highest in South Asia, with sub-Saharan Africa a close second. And it’s not because of missing a second helping of lunch or dinner.
Many factors influence the likelihood of having a baby with low birth weight.
The consequences of being born "too small" are pretty severe, both for chances of survival and life-long risks, particularly in low-income countries:
• Low birth weight infants are more likely to die in the first month of life as well as in infancy and early childhood.
• Babies who are born with low birth weight and survive are more likely to continue to grow poorly after birth, remain underweight and stunted in early childhood, andface educational and neuro-developmental delays.
• Low birth weight babies grow into shorter adults, often with health problems such as higher blood pressure, heart disease, and other metabolic problems.
• Low birth weight girls tend to grow into women with short stature and an under-developed pelvis, leading to obstetric complications during childbirth.
So, what are those factors that can lead to devastating consequences like these?
Often this is an intergenerational phenomenon. It starts with a malnourished girl, who grows into a poorly nourished teen, who far too frequently becomes pregnant in her adolescent years, becoming ever more likely to give birth to a low birth weight infant. This child, born too small, will most likely have slow growth due the same poor nutritional environment faced by her mother, suffering from stunted physical and neuro-developmental growth throughout childhood, and thus the cycle begins again as she enters her reproductive years with poor nutritional status.
Of course a mom’s health status is also important. More than just a second helping of dinner is necessary for a healthy pregnancy.
Early and regular prenatal care is needed to identify, prevent, and appropriately manage the array of infections that are common in areas where low birth weight is also common. Conditions such as syphilis, malaria, HIV and other sexually transmitted infections, if left untreated, also increase the chances that a baby will be born too soon or too small. Iron and folic acid supplementation is also needed during pregnancy to prevent maternal anemia and neural tube defects in the baby.
Social factors also influence the chance of a baby being born with low birth weight. In certain cultures, child marriage is a common risk factor as girls and teenagers are married and expected to start bearing children before their bodies are developed enough to provide full nutrition to a baby or to accommodate the passage of a normal birth weight baby, resulting in birth complications.
Additionally, a woman’s status in the household is highly correlated with the nutritional status of her young children. And as a woman’s status goes up, the likelihood that her children will be malnourished goes down.
So when we are talking about newborn health at the upcoming Global Newborn Health Conference, we can’t simply talk about interventions at birth focusing on the newborn. The first 28 days of life is part of a much bigger and complex system with so many other influential factors, one of which is nutrition. And that is, in turn, influenced by education, social status, and even grandmothers’ nutrition.
Do you want to get involved? Join Gary’s team and support a project on Catapult.org raising money for community-based nutrition groups in Cambodia which work with women to increase their ability to grow their own food and improve the nutrition and health of their families.
To mark the critical first 28 days of a newborn’s life–the neonatal period (when a baby is most at risk)– in the lead up to the Global Newborn Health Conference, Gary Darmstadt and others will be sharing, via Twitter, 28 days of “Did You Know?” facts about newborn health. Follow @gdarmsta, share the facts widely using #Newborn2013 and we can work towards saving newborn lives together.
There is a well-known proverb which says, “If you want to go fast, go alone; if you want to go far, walk together.”
The story of childhood cancer in high-income countries is a case in point. Half a century ago, a diagnosis of childhood cancer often came with a grim prognosis. There was little in the armamentarium of health care providers to combat such cancers, and chances for survival from many forms of cancer were grim. Yet over the past 50 years, survival rates have risen from about 30 percent to over 80 percent.
Much of this rise can be attributed to the power of partnerships: stakeholders and organizations that are partnering closely together, researching, running trials, conducting close monitoring and follow-up of patients in a bid to combat these cancers. It’s the quintessential example of working together, recognizing the strengths and depth of partners.
The same thing is beginning to happen around preterm birth and has exciting potential to dramatically change the chances for survival for babies born too soon, especially those born in low income settings.
A number of partners have come together to find solutions to prevent preterm birth – when a baby is born before 37 weeks of gestation – and to identify best care practices for babies born preterm.
Despite great advances in maternal and child health care in recent years, the estimated number of preterm births has stayed the same, and in some countries has been reported to be on the increase.
Preterm birth occurs as frequently in high income as well as low- and middle-income countries, and an estimated 13 million babies are born too soon around the world each year. More than a million of these will die every year within their first month of life, mostly in low- and middle-income countries.
• Many partners have come together around this issue:UNICEF and WHO have taken leadership roles in combating preterm birth, the unanswered research questions, and exploring best practices to deal with preterm birth.
• The March of Dimes has been a long-standing leader in focusing research efforts on the problems that threaten the health of babies.
• And the National Institute of Child Health and Human Development (NICHD) has brought needed attention to research into human development in order to ensure that every person is born healthy and wanted, and gets a healthy start to life.
• The Global Alliance to Prevent Prematurity and Stillbirth (GAPPS) is dedicated to making every birth count. Numerous academic centers in the world are deeply engaged in this effort.
• The Grand Challenge to Reduce the Burden of Preterm Birth is built on a partnership between the Brazilian Ministry of Health and the Bill & Melinda Gates Foundation, drawing from the extensive Brazilian “Stork Network” to reduce infant and maternal mortality.
Many of these partners highlight the importance of this issue, often drawing on experiences from organizations on the ground such as Save the Children/Saving Newborn Lives.
These are just a few of the groups of researchers, program implementers, policy makers, and academics who are focused on prematurity. As broad as these partnership go, we could extend the partnerships even further, beyond the “preterm birth” box.
We can’t talk about the health of a newborn without including family planning partners, the maternal and child health community, and nutrition experts, among others.
The factors that influence newborn health and whether a baby will be born too soon or not go well beyond these strong partnerships. There are socio-economic factors that influence a mom’s health and care during pregnancy. There are community factors that shape a family’s response to pregnancy and delivery. Social media is another part of the partnership, making information more available, bringing people together into a closer-knit partnership.
The Global Newborn Health Conference will bring many partners together to address preterm birth and newborn health. It’s not possible for all partners to be there; but it is possible to recognize that partnerships extend beyond the conference room into each of our communities around the world.
To go far, as the proverb states, we absolutely need these partnerships.
Md. Mushifiqur Rahim visits a health facility in Bangladesh
This blog was originally published in The Everyone Campaign. Written by Taskin Rahman.
Md. Mushfiqur Rahim is not only Bangladesh’s star Cricket Team Captain –he’s also a Maternal and Newborn Health Brand Ambassador for USAID and has supported the Maternal and Child Health Integrated Program (MCHIP) in Bangladesh.
Last week, Mushfiqur visited the MaMoni Project at Habiganj District; a safe motherhood, newborn care and family planning project implemented by Save the Children. He also took time to visit the Union Health and Family Welfare Centre (UH&FWC) in Bangladesh.
Mushfiqur emphasized the importance of community health initiatives, prenatal care for pregnant women, and the use of health facilities for giving birth.
“For the first time I carried a one-day (old) baby,” he said after playing cricket with local budding cricketers to raise funds for poor mothers. He later took time to speak to new mothers at a remote union health facility.
A huge crowd gathered in the stadium, outside the health facility and the homes he visited, in solidarity with the belief that thousands of mothers and newborns in Bangladesh need not die from preventable causes.
“We should look after our mothers. If they remain healthy, the newborn will be healthy,” he told the thunderous crowds after hitting numerous boundaries in the three-a-side match at Habiganj district stadium.
The game’s commentator also gave out messages on maternal and newborn health, family planning and nutrition with each boundary the skipper hit.
Mushfiqur and Nazmul – national team pace bowler, played with community cricketers to raise BDT 100,000 to help mothers and newborns in a complicated delivery. The friendly match brought together the corporate sector, civil society and GO-NGO on the same platform to work towards achieving MDGs 4 & 5.