By the time you finish reading this blog, at least one newborn child will die in Bangladesh due to prematurity. The United Nations (UN)[1] reported an estimated 2.4 million deaths in 2019, within the first four weeks after birth, or the neonatal period. Globally, 6,700 newborns die every day; in Bangladesh, there are 250 deaths. Half of premature babies die within 24 hours after they are born¹. Additionally, 25% of newborn deaths occur within the first week¹. This global estimate is disproportionately distributed among developed and developing countries. The majority of newborn deaths occur in developing countries due to low access to quality health care. Among ten countries with the highest rate of preterm births, Bangladesh is fourth on the list. This warrants a concerted effort by all stakeholders to adopt an integrated approach to reduce under-five mortality.
Bangladesh achieved the under-five mortality target of the UN’s Millennium Development Goals (MDGs); however, we will have to adopt effective measures to reduce under-five mortality from 30 to 12 deaths per 1,000 live births to achieve the UN’s Sustainable Development Goals (SDGs) target by 2030. From 1994 to 2017, there was a sharp decline in the under-five mortality rate, from 133 to 45 per 1,000 live births. However, within the same timeframe, neonatal mortality only declined from 52 to 30 per 1,000 live births[2]. This slower reduction of neonatal mortality led to a higher percentage of neonatal deaths in overall under-five deaths, from 40% (in 1993-1994) to 67% (in 2010-2017)².
The global burden of death due to prematurity is very high. Fifteen million babies are born prematurely every year. As short and long-term complications occur due to premature birth, babies die unnecessarily and pose a burden to the health system. In Bangladesh, 17.2% of newborn deaths are due to complications of premature births[3].
Newborn mortality rate varies by wealth quintile, mother’s educational status, and geographic location. A poor family or a family with an uneducated mother is at a higher risk of newborn mortality compared to a rich family and/or a family with an educated mother[4]. The lack of quality care during birth, and post-birth management are two significant factors responsible for neonatal deaths². Skilled birth attendants, either in the facility or at home, and quality care are essential to avert these deaths. The World Health Organization has identified some proven interventions to follow during pregnancy and the immediate neonatal period that resulted in improved newborn survival outcomes. Bangladesh is implementing suggested evidence-based interventions as it aspires to reduce neonatal mortality to 12 deaths per 1,000 live births, and under-five mortality to 25 deaths, to achieve SDG target #3.2.
Bangladesh is currently implementing its fourth health sector program (2017-2022). Maternal and child health is one of its priority areas, with an emphasis on 24/7 availability of quality care at public health facilities. Save the Children has been supporting the Ministry of Health and Family Welfare (MOHFW) in Bangladesh to scale-up evidence-based practices to improve the quality of maternal and newborn care services. Over the years, Save the Children implemented quality care for maternal, newborn, and child health interventions in several districts of Bangladesh through the MaMoni Maternal and Newborn Care Strengthening Project (MaMoni MNCSP; 2018-2023) and its predecessor projects with funding from the United States Agency for International Development (USAID). USAID’s MaMoni contributes to the Government of Bangladesh’s vision of “A Bangladesh where there are no preventable deaths of newborns or stillbirths, where every pregnancy is wanted, every birth celebrated, and women, babies, and children survive, thrive, and reach their full potential.”
Save the Children’s longer-term ambition is that all children survive, learn, and are protected. USAID’s MaMoni project aims to address critical health system challenges in Bangladesh through increased equitable utilization of quality maternal and newborn care services. The project works closely with local government authorities and nongovernmental organizations to improve delivery of health services, and strategically partner at the national level to build consensus on policies and standards that positively drive evidence-based interventions at all levels. MaMoni, in collaboration with the government, developed and implements life-saving care packages including essential newborn care (ENC) and Kangaroo Mother Care (KMC) to improve the survival of preterm babies. The project also supports service providers to use antenatal corticosteroids (ACS) as part of the care provided for pregnant women at imminent risk of preterm delivery to improve preterm survival.
Last year, 66,066 newborns were resuscitated using a bag and mask. MaMoni supported functioning of six Special Care Newborn Units (SCANUs) that offered services to 6,729 newborns. The project rolled out KMC in 41 hospitals, and trained doctors and nurses to support families in learning the KMC technique. In 2021, MaMoni will reach out to more families and women, especially in under-served and hard-to-reach areas, and strengthen health services to improve pregnancy and delivery care to reduce preterm births. Under the leadership of the MOHFW, Save the Children will continue working with key development partners to reduce under-five mortality through ensuring high-quality services for preterm babies in Bangladesh.
[1] UN Inter-agency Group for Child Mortality Estimation report 2020.
[2] Bangladesh Demographic and Health Survey (BDHS), 2014.
[3] Bangladesh Demographic and Health Survey, 2017-2018.
[4] WHO. Newborns: reducing mortality [Internet]. [cited 2018 Aug 13]. Available from: http://www.who.int/en/news-room/fact-sheets/detail/newborns-reducing-mortality
