Presentation on theme: "Newborn Survival and Maternal Health: a key to child survival"— Presentation transcript:
1Newborn Survival and Maternal Health: a key to child survival Zulfiqar A. BhuttaHusein Lalji Dewraj Professor & ChairmanDepartment of Paediatrics & Child HealthAga Khan UniversityKarachi, 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
3Inequity in maternal and newborn health The health of the mother and newborn is inseparable
4Deaths among infants under 7 days are decreasing more slowly than among older infants 100Developing RegionsPost-neonatal mortality80Late neonatal mortalityEarly neonatal mortality6040Developed Regions201983200019832000Source: RHR/WHO, 2003
5Where do 4 million newborns die? 1.5 million (38% of all newborn deaths) occur in 4 countries of South Asia
635-40% 5-10% 50-60% Tertiary Secondary Primary University Hospital Referral HospitalSecondaryDistrict General HospitalSub-district Hospitals35-40%PrimaryRural Health Center5-10%Village Health Units50-60%
7When do they die? Up to 50% of neonatal deaths are in the first 24 hours75% of neonataldeaths are inthe first week –3 million deathsData 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.
8Spectrum of Asphyxia outcomes Neonatal encephalopathy (mild/ mod / severe)Neonatal death as a consequence of NENeurological disability as a complication of neonatal encephalopathy
9Intra-partum Stillbirths an extension of Asphyxia deaths?
10Newborn Deaths from Asphyxia: the tip of an iceberg 0.9 million asphyxia deaths1-2 million suffer medium to long–term impairmentStillbirths fromintrapartum hypoxia(~ 1 million deaths)
11Two thirds of all neonatal deaths are in LBW infants 4 million newborn deaths – Why? almost all are due to preventable conditionsTwo thirds of all neonatal deaths are in LBW infants
12Immediate causes Underlying causes Basic Determinants Maternal & Newborn illnessManifestationsImmediate causesMalnutritionDiseaseCare for womenBreastfeeding/Feeding;Psychosocial Care;Hygiene Practices;Home Health PracticesUnderlying causesInsufficientHouseholdFood SecurityInsufficient HealthServices & UnhealthyEnvironmentInadequate EducationResources & ControlHuman, Economic & OrganisationalBasicDeterminantsPolitical and Ideological SuperstructureEconomic StructurePolitical, social and economic structures
13Three dimensions of poverty Poverty of means and accessPoverty of Hope!Poverty of Imagination
16Effective 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)
17Effective 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)
18Clinical or Facility-based care TertiaryUniversity HospitalReferral HospitalSecondaryDistrict General HospitalTaluka HospitalClinical or Facility-based carePrimaryRural Health CenterOutreachFamily andCommunityPackagesBasic Health Units
19Intervention Packages Skilled obstetric and immediate newborn care including resuscitationEmergency obstetric care to manage complications such as obstructed labour and hemorrhageAntibiotics for preterm rupture of membranes#Corticosteroids for preterm labour#Emergency newborn care for illness, especially sepsis management and care of very low birth weight babiesClinicalcare%NMReffect4-visit antenatal package includingtetanus immunisation,detection & management of syphilis, other infections, pre-eclampsia, etcMalaria intermittent presumptive therapy*Detection and treatmentof bacteriuria#OutreachservicesPostnatal care to support healthy practicesEarly detection and referral of complicationsAdministering basic community-based intervention packages at full coverage can save ~ 37% of all newborn deaths!6 - 9%Folic acid #Counseling and preparation for newborn care and breastfeeding, emergency preparednessHealthy home care including breastfeeding promotion, hygienic cord/skin care, thermal care, promoting demand for quality careExtra care of low birth weight babiesCase management for pneumoniaFamily-communityClean home deliverySimple early newborn care%InfancyNeonatal periodPre- pregnancyPregnancyBirth
20How can these be scaled-up much faster? Coverage rates are low!How can these be scaled-up much faster?
22Analysis of systematic reviews for maternal and newborn health interventions Bhutta et al (Pediatrics & GFHR 2005)
2330% reduction in neonatal mortality! Major impact on maternal mortality!
24Shivgarh (India) Trial Community Mobilization and Behavior Change Communication Birth preparedness for essential newborn careClean delivery, cord and skin careImmediate wiping, drying and keeping the baby warmSkin-to-Skin CarePromotion of immediate and exclusive breastfeedingRecognition and management of hypothermia
25Shivgarh (India) Trial Community Mobilization and Behavior Change Communication Birth preparedness for essential newborn careClean delivery, cord and skin careImmediate wiping, drying and keeping the baby warmSkin-to-Skin CarePromotion of immediate and exclusive breastfeedingRecognition and management of hypothermia
268 clusters Hala Project Phase 2 Pilot (2003-2004) 317 villages 43000 households284,000 population
27Community organization & mobilizationImproved Referral Pathways & Clinical CareImproved Primary Maternal,Perinatal & Newborn Care(Common in all areas)(through Lady Health Workers)
30ConclusionsImproving newborn health and care is critical to attaining the MDG targets for child survivalTo do so would require concerted efforts to improve maternal care, outreach and provide innovative models of community support and educationEmerging data from demonstration projects in health system settings indicate that this is doable and can be scaled up using affordable models of careCommunity engagement and ownership is a critical element in successful intervention models for maternal and newborn care
31Participatory development Democratization of public health