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Hearing the Unheard Cry: Pillars To Improve Newborn Survival Stephen Wall, MD MS MSW  Saving Newborn Lives  Save the Children/USA April 28, 2010
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neonatal deaths and the Millennium Development Goals   Almost 40% of under 5 deaths are neonatal   – almost 4 million a year MDG- 4 can only be achieved if neonatal deaths – especially early neonatal deaths – are addressed Source: Lawn JE et al Lancet 2005 0 50 100 150 Mortality per 1000 births (global av) 1960 1980 2000 2020 Year Under-5 mortality rate Late neonatal mortality Early neonatal mortality Target  for  MDG-4
Where are babies born and where do newborns die? ,[object Object],[object Object]
When do neonatal deaths occur? Up to 50% of neonatal deaths are in  the first 24 hours 75% of neonatal  deaths are in  the first week –  approximately 3 million deaths Source: Lawn JE et al Lancet 2005, Based on analysis of 47 DHS datasets (1995-2003), 10,048 neonatal deaths)
Risk of stillbirth, newborn, maternal mortality: WHEN? Sources: Maternal deaths: from WHO/UNICEF/UNFPA 2000 estimates. Child deaths from UNICEF estimates for 2000, Neonatal deaths from WHO RHR estimates 2004. Stillbirths from WHO in SOWC 2001. Denominator used is the number of live births from UNICEF, adjusted to all births by adding the 4 million stillbirths. Timing of maternal deaths is based on Li XF et al, 1996 after subtraction of 13% estimated to be related to unsafe abortion, assuming these are prior to the last trimester (WHO 1997). Percent of stillbirths that are intrapartum from Lawn JE et al (WHO Bull June 2005)). Child deaths, percentage early neonatal, neonatal, months 2-12 and years 2-4.99 based on WHO and UNICEF estimated rates for 2000. Percentage of deaths on day 1 based on 2 inputs; DHS data (34 most recent surveys, 10,041 NNDs, median year 2000). Study input of 28 studies (NNDs 7369, median year 1991)
Direct causes of 3.72 million neonatal deaths -  almost all are due to preventable conditions Source: Lawn JE, Cousens SN, Zupan J Lancet 2005. 60 to 90% of neonatal deaths are in low birth weight babies, mostly preterm
Evidence-based interventions to reduce neonatal deaths Childhood  Neonatal period Pre- pregnancy Pregnancy Birth Source: Lawn et al. DCP chapter adapted for Lancet neonatal series executive summary, plus impact by level and time period based on Darmstadt et al 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Outreach/Outpatient Postnatal care to support healthy practices Early detection and referral of complications Folic acid  # Family Plann-ing Skilled obstetric and immediate newborn care (hygiene, warmth, breastfeeding) & resuscitation Emergency obstetric care to manage complications such as obstructed labour and hemorrhage Antibiotics for preterm rupture of membranes # Corticosteroids for preterm labour # Emergency newborn care for illness, especially sepsis management and care of very low birth weight babies including Kangaroo Mother Care Clinical  care  Counseling and preparation for newborn care and breastfeeding, emergency preparedness Healthy home care including breastfeeding promotion,   hygienic cord/skin care, thermal care, promoting demand for quality care Extra care of low birth weight babies  Case management for pneumonia Family-community Clean delivery by traditional birth attendant  (if no skilled attendant is available) Simple early newborn care
GAP 1 GAP 2 Where are actions needed?  Covering the gaps Source: Lancet Countdown Coverage writing group, Lancet Countdown special issue, 2008
Evidence for newborn care  ‘ packages ’  with CHW home visits
India ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bangladesh ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
India ,[object Object],[object Object],[object Object],[object Object]
Pakistan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Content and timing of home visits:  A summary of the evidence 30% ,[object Object],[object Object],Prenatal, Days 1, 3, 7, 14 and 28 Lady Health Worker (government paid) Hala (Pakistan) Source: Bhutta. Bull World Health Organ 2008 54% ,[object Object],[object Object],Prenatal, Days 1 and 3  Community health worker (paid), changed to community volunteers Shivgarh (India) Source: Kumar et al. Lancet 2008 34% ,[object Object],[object Object],[object Object],Prenatal, Days 1, 3, and 7  Community health worker (paid) Projahnmo (Bangladesh) Source: Baqui et al. Lancet 2008 51% ,[object Object],[object Object],[object Object],[object Object],[object Object],Prenatal, Delivery, Days 1, 2, 3, 5, 7, 14, 21 and 28 Community health worker (paid, plus performance incentives) ANKUR (India) Source: Bang et al. Unpublished 61% ,[object Object],[object Object],[object Object],[object Object],[object Object],Prenatal, Delivery, Days 1, 2, 3, 5, 7, 14, 21 and 28 Community health worker (paid. Plus performance incentives) SEARCH (India) Source: Bang et al. Lancet 1999 ↓ NMR Content of home visits Home visits for newborn  care on Provider Study
Evidence to Policy
UN Joint Statement key messages ,[object Object],[object Object]
UN Joint Statement key messages ,[object Object],[object Object]
Thank you!
Healthy Newborn Network What can I do? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Hearing the Unheard Cry: Pillars To Improve Newborn Survival

  • 1. Hearing the Unheard Cry: Pillars To Improve Newborn Survival Stephen Wall, MD MS MSW Saving Newborn Lives Save the Children/USA April 28, 2010
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  • 3. Neonatal deaths and the Millennium Development Goals Almost 40% of under 5 deaths are neonatal – almost 4 million a year MDG- 4 can only be achieved if neonatal deaths – especially early neonatal deaths – are addressed Source: Lawn JE et al Lancet 2005 0 50 100 150 Mortality per 1000 births (global av) 1960 1980 2000 2020 Year Under-5 mortality rate Late neonatal mortality Early neonatal mortality Target for MDG-4
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  • 5. When do neonatal deaths occur? Up to 50% of neonatal deaths are in the first 24 hours 75% of neonatal deaths are in the first week – approximately 3 million deaths Source: Lawn JE et al Lancet 2005, Based on analysis of 47 DHS datasets (1995-2003), 10,048 neonatal deaths)
  • 6. Risk of stillbirth, newborn, maternal mortality: WHEN? Sources: Maternal deaths: from WHO/UNICEF/UNFPA 2000 estimates. Child deaths from UNICEF estimates for 2000, Neonatal deaths from WHO RHR estimates 2004. Stillbirths from WHO in SOWC 2001. Denominator used is the number of live births from UNICEF, adjusted to all births by adding the 4 million stillbirths. Timing of maternal deaths is based on Li XF et al, 1996 after subtraction of 13% estimated to be related to unsafe abortion, assuming these are prior to the last trimester (WHO 1997). Percent of stillbirths that are intrapartum from Lawn JE et al (WHO Bull June 2005)). Child deaths, percentage early neonatal, neonatal, months 2-12 and years 2-4.99 based on WHO and UNICEF estimated rates for 2000. Percentage of deaths on day 1 based on 2 inputs; DHS data (34 most recent surveys, 10,041 NNDs, median year 2000). Study input of 28 studies (NNDs 7369, median year 1991)
  • 7. Direct causes of 3.72 million neonatal deaths - almost all are due to preventable conditions Source: Lawn JE, Cousens SN, Zupan J Lancet 2005. 60 to 90% of neonatal deaths are in low birth weight babies, mostly preterm
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  • 9. GAP 1 GAP 2 Where are actions needed? Covering the gaps Source: Lancet Countdown Coverage writing group, Lancet Countdown special issue, 2008
  • 10. Evidence for newborn care ‘ packages ’ with CHW home visits
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Notas do Editor

  1. Data from DHS surveys in 47 countries, 10,048 neonatal deaths. A very high proportion of deaths occur in the first hours and days after birth. Prevention of these early neonatal deaths will require improvements in care at the time of birth and improvements in care in the early neonatal period.