3.6 million neonatal deaths: What is progressing and what is not?

Dr. Joy Lawn MB BS, MRCP (Paeds), MPH, PhD

Director Evidence and PolicySaving Newborn Lives/ Save the Children-USFunded by the Bill & Melinda Gates Foundation

Overview from Seminars in Perinatology paper

December 2010

Outline1. Progress for newborn survival

• Numbers, where and when

2. Progress by the main causes of neonatal death

3. Priorities from the data

Source: Lawn JE, Kerber KJ, Enweronu-Laryea C, Cousens S. 3.6 Million Neonatal Deaths – What is Progressing and What is Not? Semin Perinatol; 2010, 34:371-386.

Click for free access online at the Healthy Newborn NetworkData are for 2008 unless otherwise stated

You are welcome to use these slides Please credit the source for data or images

www.healthynewbornnetwork.org

3.6 million neonatal deaths, 41% of under 5 deathsLinked closely with maternal health and MDG 5

Source: Lawn et al. 3.6 Million Neonatal Deaths – What is Progressing and What is Not? Semin Perinatol; 2010 34:371-386.

Global progress to MDG 4

3.6 million neonatal deaths:

Where?

Save the Children

Where? The 20 countries with highest neonatal mortality rates1

Somalia (61)2 DRC (56)3 Pakistan (53)4 Mali (52)5

Afghanistan (50)6 Nigeria (49)7 Myanmar (48)8 Central African Republic (47)9 Angola (47)10 Guinea-Bissau (45)

11 Mauritania (45)12 Sierra Leone (45)13 Chad (44)

14 Liberia (44)

15 Guinea (44)16 Timor-Leste (43)17 Mozambique (43)18 Burundi (42)19 Comoros (42)20 Cote d'Ivoire (41)

80% are African

countries

Manyhave

recent conflict

The neonatal mortality rate in UK is 3

“All lives have equal value ...” Bill & Melinda Gates

Source: Lawn et al. 3.6 Million Neonatal Deaths – What is Progressing and What is Not? Semin Perinatol; 2010, 34:371-386.

Where?Countries with the highest numbers of neonatal deaths are similar to

those with high maternal deaths

Ranking for numbers of neonatal deaths

Ranking for numbers of maternal deaths

India 1 1

Nigeria 2 2

Pakistan 3 8

China 4 13

DR Congo 5 3

Ethiopia 6 5

Bangladesh 7 6

Indonesia 8 7

Afghanistan 9 4

Tanzania 10 9

2.4 million neonatal deaths

Approx 67% of global total

340,000 maternal deaths

Approx 65% of global total

Source: Lawn et al. 3.6 Million Neonatal Deaths – What is Progressing and What is Not? Semin Perinatol; 2010, 34:371-386.

The rich – poor gap for neonatal mortality in India

Income quintile

Poorest (Lowest income quintile)

Richest(Highest income quintile)

Neonatal mortality rate (per 1000 live births)

56 26

If all the families in India received the same care as the richest then each year

300,000 fewer newborns would dieSource: Lawn et al. 3.6 Million Neonatal Deaths – What is Progressing and What is Not? Semin Perinatol; 2010, 34:371-386.

3.6 million neonatal deaths:

When?

The first week is the riskiest week of lifeMortality risk by week of life for the first 5 years:

Lawn based on global ENMR, NMR estimates by WHO, and IMR and U5M by UN child mortality group around the year 2008

The riskiest week of life

Sept 2009 – WHO & UNICEF

Joint statement on early postnatal care

Birth and first week is key yet coverage of care is low for

mothers and babies

When do maternal deaths, stillbirths, and neonatal deaths occur?

Source: Lawn et al. 3.6 Million Neonatal Deaths – What is Progressing and What is Not? Semin Perinatol; 2010, 34:371-386.

3.6 million neonatal deaths:

Progress and innovations for addressing major causes of

neonatal death

Save the Children

8.8 million child deaths Proportion of under five child deaths that are neonatal

according to the six WHO regions (2008)

Source CHERG/WHO 2010. Estimates for 193 countries for 2008. Black R et al Lancet 2010

In ALL regions deaths in the neonatal period are a major contributor to mortality - 27% to 54% of under five deaths

Data sources for neonatal cause of death (2008)

Source CHERG/WHO 2010. Estimates for 193 countries for 2008. Black R et al Lancet 2010Detailed methods for neonatal estimates – Lawn JE et al Int J of Epi, 2006

DATA ADVANCES 2000 to 20081. More countries with Vital Registration data (72 up from 46)2. India and China national data input (~30% of deaths)3. Increased quantity and quality of verbal autopsy data

Causes of child deaths in 2008almost all due to preventable conditions

These causes

account for 81% of all neonatal deaths

Source CHERG/WHO 2010. Estimates for 193 countries for 2008. Black R et al Lancet 2010

Causes of death in the neonatal period for 193 countries (2000-2008)

Source: Lawn JE, Cousens SN, Adler A, Ozi S , Oestergen M, Mather C for the CHERG neonatal group. Based on CHERG/WHO estimates

Source: Lawn et al. 3.6 Million Neonatal Deaths – What is Progressing and What is Not? Semin Perinatol; 2010, 34:371-386

Updated from Blencowe H et al, IJE March 2010

Tetanus immunisation coverage and estimated neonatal tetanus deaths, 1980-2005

From over 1 million deaths in 1980 to ~ 60,000 deaths per year in 2008Since 2000, elimination status in 34 countries and 15 Indian States

New investment AND use of data and targeted district based action plans

Variation of cause-specific neonatal mortality across 193 countries according to 5 levels of neonatal mortality

Source: Lawn et al. 2 million Intrapartum stillbirths and neonatal deaths: where, why, and what can be done? IJGO, 2009, 107:S5-S20.

Annual national estimates for neonatal cause of death used widely

Nigeria – subnational profiles

Countdown national profiles 2008 and 2010

Annual global United Nations reports

National and subnational data profiles

World statistics report by WHO

State of the World’s Children by UNICEF

3.6 million neonatal deaths:

Priorities based on the data

4 Priorities for actionLINKING

NEWBORN & MOTHER

Save the Children

© Copyright 2006 SASI Group (University of Sheffield) and Mark Newman (University of Michigan).

Stillbirths Neonatal deaths

Maternal deaths

Women’s health is closely linked to neonatal mortality and stillbirth

Particular gap for maternal and newborn care in humanitarian emergencies and conflict

Africa and South Asia – the highest burden

Priority 1WHERE

PEOPLE GAP… how to deliver solutions

Physician density in Countries

© Copyright 2006 SASI Group (University of Sheffield) and Mark Newman (University of Michigan).

Need urgent scale up of skilled workers but also innovation and task shifting to reach the poorest families now

CARE AT BIRTH IS CRITICALMaternal deaths, stillbirths and neonatal deaths

related to care at birth

Source: Lawn et al. 2 million IP stillbirths and neonatal deaths: where, why, and what can be done? IJGO, 2009, 107:S5-S20 Data sources for update: Stillbirths Stanton et al 2006, IP SBs Lawn et al 2005. Neonatal deaths WHO/CHERG Black R et al 2010, Maternal UN estimates 2008, Hogan et al 2010, % IP from Xhu et al,

2 million deaths at the time of birth

Priority 2WHEN

Source: Lawn et al. 3.6 Million Neonatal Deaths – What is Progressing and What is Not? Semin Perinatol; 2010, 34:371-386Data from CHERG/WHO 2010. Black R et al Lancet 2010 Estimates for 193 countries for 2008

Focus on the three main causes of neonatal death

Priority 3WHAT

Opportunities in existing programs to add high impact newborn interventions (e.g. Resuscitation, antenatal steroids)

or gaps to address (e.g. postnatal care)

Counting better and making the data count in programs

Priority 4DATA

MORTALITY DATA:

Counting - Retrospective surveys provide 75% of the data and undercount newborn deaths but none of the current estimates correct for this

Cause of death data – further advances in consistency, quantity and quality

STILLBIRTHS: major data gap and a missed opportunity to track progress

MORBIDITY DATA: major gaps especially for cohort studies of impairment

COVERAGE DATA: critical gaps for high impact intervention coverage data