By Sarah Boseley for The Guardian
An increasing proportion of child deaths in poor countries – now 41% – are among neonates (babies less than four weeks old). Photograph: Dan Chung for the Guardian
Children under the age of five are increasingly likely to survive in poor countries, as efforts to reach millennium development goal 4 (reducing child deaths by two-thirds) pay off. But newborns are still at high risk – and a new study shows that the slower progress in cutting death rates among babies in the first weeks of life is putting the goal in jeopardy.
More than 8 million children die before they reach the age of five, but as more older children survive an increasing proportion of those deaths – now 41% – are among neonates (babies less than four weeks old).
Tiny babies are very vulnerable. They die because they are small and frail after premature delivery (29%), from asphyxia during birth, or from severe infections such as blood poisoning and pneumonia. Many would survive if they were delivered by a trained midwife, but these are in short supply.
"The global health worker crisis is the biggest factor in the deaths of mothers and children, and particularly the 3.3 million newborns dying needlessly each year. Training more midwives and more community health workers will allow many more lives to be saved," says Dr Joy Lawn of Save the Children's Saving Newborn Lives programme, a co-author of the report that SCF has produced with the World Health Organisation and the London School of Hygiene and Tropical Medicine.
The report, published on the open access website PLoS Medicine, is the most comprehensive estimate yet of the death toll among newborns worldwide over a 20 year period, from 1990 to 2009. The researchers find that newborn mortality dropped by 28% – but that was much slower than the drop in maternal mortality (34%) and the deaths of older children under five (37%).
"Newborn survival is being left behind despite well-documented, cost-effective solutions to prevent these deaths," says Dr Flavia Bustreo, WHO assistant director general for family, women's and children's health. "With four years to achieve the millennium development goals, more attention and action for newborns is critical.
"We know that solutions as simple as keeping newborns warm, clean and properly breastfed can keep them alive, but many countries are in desperate need of more and better-trained frontline health workers to teach these basic lifesaving practices."
The study authors urge more focus on newborn survival. "National governments, international organisations, non-governmental organisations, and other international health bodies must increase investment in care at birth and the first few weeks of life within existing health programmes, adding targeted interventions especially at the time of birth. The majority of neonatal deaths could be prevented with existing interventions, including some that can be delivered at community level with potential to reduce neonatal deaths by one-third, such as improved hygiene at birth, breastfeeding, and simple approaches to keeping babies warm," they write.
"Maternal health programmes and child health programmes are beginning to place greater emphasis on newborn survival, but major missed opportunities remain even in existing programmes – for example, midwives who are not trained and equipped for simple newborn care and neonatal resuscitation. Many of the 79 million babies who died in the neonatal period since 1990 were born with little or no access to health services and in settings with little health information to drive health system improvement.
"If MDG 4 is to be achieved, and this needless loss of life prevented, it is essential that national governments, international agencies and civil society increase attention to systematically preventing and tracking neonatal deaths."