This number of newborn deaths is due to three main causes:

• preterm birth complications (1.0 million),
• childbirth-related conditions (0.7 million)
• and infections (0.6 million) .

Many of these deaths could be prevented through improved care during and immediately after childbirth.

We at the IDEAS project, based at the London School of Hygiene & Tropical Medicine, hope our work will contribute to the global movement, highlighted by this new Lancet series and the forthcoming launch of the Every Newborn Action Plan, to improve the health and survival rates of newborns globally.

Few women and babies get the care they need

IDEAS is a project evaluating the Billl & Melinda Gates Foundation funding strategy for maternal and newborn health. The foundation is funding innovations to improve the health of mothers and newborns (babies 0-28 days old) in Ethiopia, northeast Nigeria and Uttar Pradesh State, India, three settings with high levels of maternal and newborn deaths. Indeed, the Every Newborn Lancet series shows that “half of the newborn deaths worldwide occur in just five countries”, with India (779,000 deaths per year) and Nigeria (276,000 deaths per year) at the top.

In 2012 we carried out surveys to get a snapshot of maternal and newborn health care in each of these settings. Sadly, our findings echo the Every Newborn series’, showing few women and babies get the quality of care they need during childbirth.

In 2012, although 15% women gave birth with a skilled birth attendant (such as a midwife, doctor or nurse) in Ethiopia, 22% in Gombe State, Nigeria and 76% in Uttar Pradesh State, India, many of them didn’t receive the quality of care needed to help prevent unnecessary deaths. And even among these babies who were delivered by a skilled attendant, not all of them had the essential care practices needed to prevent newborn deaths:

• In Ethiopia, only 6% of newborns had both a skilled attendant at birth and were dried within 30 minutes after birth. Drying the baby straight after birth helps it to stay warm.
• In Gombe State, Nigeria, only 9% of newborns had both a skilled attendant at birth and were breastfed less than an hour after birth. Immediate and exclusive breastfeeding of the baby improves its health and survival status.
• In Uttar Pradesh, India, only 14% of newborns had both a skilled attendant at birth and their bathing delayed for at least 6 hours after birth. Delayed bathing means the baby can regulate its body temperature more easily and it won’t get cold.

Our second set of surveys in 2015 will show how the foundation’s investments have made a difference and how mothers and their newborns can get the postnatal care they need.

READ OUR 2012 BASELINE SURVEY REPORTS FOR MORE DATA

Government-led community based newborn care

Governments are at the heart of work to tackle the problem of preventable newborn deaths. In Ethiopia, the Ministry of Health is rolling out Community Based Newborn Care (CBNC) to reach over 11 million people across 7 zones in 4 regions (Amhara, Tigray, Oromia and SNNP) by the end of 2013. A second phase of scale-up will see the intervention rolled out to all zones in the 4 regions.

CBNC includes a newborn care package along the continuum of care from pregnancy to post-birth through training community frontline workers called Health Extension Workers and Health Development Army volunteers. In Ethiopia, where approximately 90% of births still take place at home [4], this intervention is needed to bring newborn care to the place of birth.

IDEAS has been asked by the Ethiopian government to evaluate CBNC and our baseline study findings are due out very soon (watch this space!)

READ MORE ABOUT OUR EVALUATION OF CBNC

Worldwide movement for change

The Every Newborn Lancet series is the start of a movement to get newborn survival high on the global agenda. The series lists 5 shifts needed to accelerate progress, including “evaluation, tracking coverage of priority interventions and packages of care with clear accountability to accelerate progress and reach the poorest groups” [5].

The IDEAS project team is contributing to this movement: our work will help the foundation and Ethiopian government invest in innovations to improve newborn survival.

References