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Newborn Survival and Maternal Health: a key to child survival Zulfiqar A. Bhutta Husein Lalji Dewraj Professor & Chairman Department of Paediatrics & Child.

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Presentation on theme: "Newborn Survival and Maternal Health: a key to child survival Zulfiqar A. Bhutta Husein Lalji Dewraj Professor & Chairman Department of Paediatrics & Child."— Presentation transcript:

1 Newborn Survival and Maternal Health: a key to child survival Zulfiqar A. Bhutta Husein Lalji Dewraj Professor & Chairman Department of Paediatrics & Child Health Aga Khan University Karachi, Pakistan

2 “ Fate has allowed humanity such a pitifully meagre coverlet that in pulling it over one part of the world, another has to be left bare … ” Rabindranath Tagore

3 Inequity in maternal and newborn health The health of the mother and newborn is inseparable

4 Post-neonatal mortality Late neonatal mortality Early neonatal mortality Developing Regions Developed Regions Source: RHR/WHO, 2003 Deaths among infants under 7 days are decreasing more slowly than among older infants

5 Where do 4 million newborns die? 1.5 million (38% of all newborn deaths) occur in 4 countries of South Asia

6 Referral Hospital Tertiary University Hospital Secondary District General Hospital Sub-district Hospitals Primary Rural Health Center Village Health Units 50-60% 35-40% 5-10%

7 When do they die? Up to 50% of neonatal deaths are in the first 24 hours 75% of neonatal deaths are in the first week – 3 million deaths

8 Spectrum of Asphyxia outcomes Neonatal encephalopathy (mild/ mod / severe) Neonatal death as a consequence of NE Neurological disability as a complication of neonatal encephalopathy

9 Intra-partum Stillbirths an extension of Asphyxia deaths?

10 Newborn Deaths from Asphyxia: the tip of an iceberg 0.9 million asphyxia deaths 1-2 million suffer medium to long–term impairment Stillbirths from intrapartum hypoxia (~ 1 million deaths)

11 4 million newborn deaths – Why? almost all are due to preventable conditions Two thirds of all neonatal deaths are in LBW infants

12 Insufficient Health Services & Unhealthy Environment Maternal & Newborn illness Insufficient Household Food Security Resources & Control Human, Economic & Organisational Political, social and economic structures MalnutritionDisease Basic Determinants Immediate causes Underlying causes Inadequate Education Political and Ideological Superstructure Economic Structure Manifestations Care for women Breastfeeding/Feeding; Psychosocial Care; Hygiene Practices; Home Health Practices

13 Three dimensions of poverty Poverty of means and access Poverty of Hope! Poverty of Imagination

14 39% Fatalism Past experience 30% Empowerment Support structures

15 What can be done?

16 Effective interventions for Newborn Care Lancet Series on Newborn Survival Paper 2 (2005) 16 interventions identified with adequate evidence of effect on neonatal deaths ( e.g., tetanus toxoid immunization, clean delivery, obstetric care, breastfeeding, antibiotics for infections) All are highly cost-effective especially if packaged and delivered within other programmes (e.g., maternal and child health)

17 Effective interventions for Newborn Care Lancet Series on Newborn Survival Paper 2 (2005) 16 interventions identified with adequate evidence of effect on neonatal deaths ( e.g., tetanus toxoid immunization, clean delivery, obstetric care, breastfeeding, antibiotics for infections) All are highly cost-effective especially if packaged and delivered within other programmes (e.g., maternal and child health)

18 Referral Hospital Tertiary University Hospital Secondary District General Hospital Taluka Hospital Primary Rural Health Center Basic Health Units Clinical or Facility-based care Outreach Family and Community Packages

19 Intervention Packages Skilled obstetric and immediate newborn care including 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 Clinical care Folic acid # 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 home delivery Simple early newborn care % 4-visit antenatal package including tetanus immunisation, detection & management of syphilis, other infections, pre- eclampsia, etc Malaria intermittent presumptive therapy* Detection and treatment of bacteriuria # Outreach services Postnatal care to support healthy practices Early detection and referral of complications 6 - 9% % NMR effect Infancy Neonatal period Pre- pregnancy Pregnancy Birth Administering basic community-based intervention packages at full coverage can save ~ 37% of all newborn deaths!

20 Coverage rates are low! How can these be scaled-up much faster?

21 Know ….Do gap Don’t know….Don’t do gap

22 Analysis of systematic reviews for maternal and newborn health interventions Bhutta et al (Pediatrics & GFHR 2005)

23 30% reduction in neonatal mortality! Major impact on maternal mortality!

24 Shivgarh (India) Trial Community Mobilization and Behavior Change Communication 1.Birth preparedness for essential newborn care 2.Clean delivery, cord and skin care 3.Immediate wiping, drying and keeping the baby warm 4.Skin-to-Skin Care 5.Promotion of immediate and exclusive breastfeeding 6.Recognition and management of hypothermia

25 Shivgarh (India) Trial Community Mobilization and Behavior Change Communication 1.Birth preparedness for essential newborn care 2.Clean delivery, cord and skin care 3.Immediate wiping, drying and keeping the baby warm 4.Skin-to-Skin Care 5.Promotion of immediate and exclusive breastfeeding 6.Recognition and management of hypothermia

26 Hala Project Phase 2 Pilot ( ) 8 clusters 317 villages households 284,000 population

27 Community organization & mobilization Improved Primary Maternal, Perinatal & Newborn Care Improved Referral Pathways & Clinical Care (Common in all areas) (through Lady Health Workers)

28 Perinatal mortality trends (Hala, Pakistan)

29

30 Conclusions Improving newborn health and care is critical to attaining the MDG targets for child survival To do so would require concerted efforts to improve maternal care, outreach and provide innovative models of community support and education Emerging data from demonstration projects in health system settings indicate that this is doable and can be scaled up using affordable models of care Community engagement and ownership is a critical element in successful intervention models for maternal and newborn care

31 Participatory development Democratization of public health


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