World Health Organization 15 April, 2017 Essential Newborn Care Dr P. Mongi African Regional Meeting on Interventions for Impact for Essential Obstetric and Newborn Care: 21-23 February 2011, Addis Ababa, Ethiopia

Presentation outline Some Facts and Figures on Newborn health Essential Newborn Care Definition of Essential Newborn Care Key components of Essential Newborn Care WHO Essential Newborn Care Course- ENCC & Resuscitation

Progress towards MDG 4 Total number of deaths of children < 5 dropped from 12.4 million in 1990 to 8.8 million in 2008 (30%) Neonatal mortality represents about 40% (3·575 million), most in the first week

3·6 Neonatal Deaths: Where ? Disclaimer: The designation employed and the presentation of material on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dashed lines represent approximate border lines for which there may not yet be full agreement. In Japan, 1 in 1000 babies die within 28 days of birth. In India, 37 in 1000 babies die within 28 days of birth. In Sierra Leone, 45 in 1000 babies die within 28 days of birth. 1 dot = 1'000 neonatal deaths

3·6 Neonatal Deaths: Why ? Under-nutrition contributes to one-third of child deaths Prematurity is a complication to be dealt with starting in pregnancy Birth asphyxia needs to be dealt with in the first minutes of life CHERG Lancet 2010; 375: 1969–87

In Africa 1·2 Neonatal Deaths: Why? Lower contribution to overall child mortality Prematurity and birth asphyxia contribute equally Neonatal deaths likely to increase as child deaths fall CHERG Lancet 2010; 375: 1969–87

Causes of Newborn deaths in SS-Africa Newborn deaths constitute 29% of under five mortality The main causes for almost 90% of Newborn deaths are: Infections- 32% Prematurity and Low birth weight- 29% Birth Asphyxia and birth trauma- 27% ALL are preventable and treatable MDG- 4 can only be achieved if neonatal deaths are addressed and this necessitates both maternal and child health interventions

When are the 1.2 million African newborn deaths occurring? World Health Organization When are the 1.2 million African newborn deaths occurring? 15 April, 2017 About a quarter of neonatal deaths are on the day of birth Birth and first week is key: when most babies die yet when coverage of care is lowest for mothers and babies More than 70% of neonatal deaths are in the first week 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. Source: Lawn JE, Kerber K -Daily numbers of death in 20 African countries during first month of life - based on 20 DHS datasets (2000 to 2004) with 5,763 neonatal deaths

World Health Organization Coverage of key Maternal and Child Survival Interventions, in WHO/AFRO 2008 15 April, 2017 The hours and days of highest risk have the lowest coverage of care Source: WHO World Health Statistics 2010, UNICEF State of the World’s Children, 2010 10

Definition of Essential Newborn Care- ENC WHO Working Group Meeting in 1994 in Trieste, Italy- ENC was defined as consisting of eight components These elements remain, even if some have slightly changed in content, since. The concept of ENC was further divided into Basic Care and Special Care Basic Care -includes interventions for all infants to meet their physiological needs. Special Care -required for a small group of newborns because of diseases acquired before, during or after birth and/or because they are born too soon/small This was the basis for developing the essential practice guide of the Integrated Management of Pregnancy and Childbirth (IMPAC) series as well as the guide for doctors, nurses and midwives Managing Newborn Problems. The WHO Essential Newborn Care Course is part of these IMPAC series

Essential Newborn Care-Components World Health Organization 15 April, 2017 Cleanliness Thermal protection Early and exclusive breastfeeding Initiation of breathing, resuscitation Eye care Immunization Management of newborn illness Care of the preterm and/or low birth weight newborn The WHO definition stemms from a WHO Working Group Meeting in 1994 in Trieste, Italy. ENC was defined as consisting of eight components: Cleanliness: clean delivery and clean cord care for the prevention of newborn infections Thermal protection: prevention and/or management of neonatal hypothermia and hyperthermia Early and exclusive breastfeeding: Breasfeeding should be started within an hour of birth. Feeding should be as frequent as the baby demands, without prelacteal feeds or other fluids and food. Knowledge about importance of breastfeedin should be disseminated among families and communities as well as health workers and managers (10 steps) Initiation of breathing, resuscitation: "Helping Babies Breathe" … These elements remain, even if some of these elements have slightly changed in content, sine. The concept of ENC was further divided into Basic Care and Special Care. Basic Care includes interventions for all infants to meet their physiological needs. Special Care is required for a small group of newborns because of diseases acquired before, during or after birth and/or because they are born too soon or too small. This was the basis for developing the essential practice guide of the Integrated Management of Pregnancy and Childbirth (IMPAC) series as well as the guide for doctors, nurses and midwives Managing Newborn Problems.

Integrated Management of Pregnancy and Childbirth (IMPAC) World Health Organization Integrated Management of Pregnancy and Childbirth (IMPAC) 15 April, 2017 Clinical guidelines Programme guides Education modules Advocacy material Tools for monitoring and evaluation

Essential Newborn Care Course New layout French version in print

The 5 modules in the ENCC 1. Care of the baby at the time of birth Introduction to the PCPNC guide Universal precaution Care of the baby at birth Keeping baby warm 2. Examination of the newborn baby Breasting a newborn baby- ensuring a good start Communication skills Examination of the newborn 3. Care of the newborn baby until discharge Resuscitation of the newborn baby Routine care of the newborn baby 4. Special situations Overcoming difficulties in breastfeeding The small baby Alternative methods of feeding a baby 5. Optional module Giving an injection Kangaroo mother care

The WHO Essential Newborn Care Course World Health Organization The WHO Essential Newborn Care Course 15 April, 2017 Five days course on essential and emergency newborn care Any health facility dealing with mothers and newborns For doctors, midwives and nurses

ENCC: State of Implementation World Health Organization ENCC: State of Implementation 15 April, 2017 Mali Kenya No WHO AFRO Trained trainers available (8 countries) Al least one core national ENC training conducted (7 countries) 4 districts Training started in periphery (3 countries) 7 or more district/provincial courses (2 countries) By 2010 ENCC training has been introduced in 40 countries globally AFRO-20 EMRO SEARO WPRO Yoy will receive an updated slide

Effective Perinatal Care Package (EPCP) Total 15 countries

Asphyxia &Resuscitation of the newborn baby Asphyxia is failure to breath within one minute after delivery. Good labour could prevent most birth asphyxia This is treatable if births are attended by health worker skilled in neonatal resuscitation One in 20 (5%) babies need help with breathing- resuscitation Resuscitation must be anticipated at each delivery Resuscitation skills are essential to the survival of babies

Training Newborn Resuscitation in the Context of Essential Newborn Care-1 Newborn resuscitation is a critical component of ENC, but one out of the eight components The WHO ENCC training package contains a module on basic newborn resuscitation based on the 1998 guidelines currently updated Countries may chose to replace that module by Helping Babies Breath (HBB) The introduction of ENCC should trigger the review of the national neonatal resuscitation guidelines including by level of care

Training Newborn Resuscitation in the Context of Essential Newborn Care-2 Efforts to improving ENC should go hand in hand with efforts to improving good quality obstetric care to prevent adverse neonatal outcomes including reduced need for resuscitation National Ministries of Health and professional bodies (e.g. midwife associations, paediatric societies should take ownership of these training initiatives, partners should align and coordinate their support The impact of any training (ENCC and/or HBB) on change of practice in all eight ENCC components in maternity services should be documented or evaluated, including in the context of other efforts such as the Baby Friendly Hospital Initiative (BFHI)

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