Neonatal Neonatal Mortality Mortality

WorldwideWorldwideFebruary 2, 2012

Reduce child mortality

Target: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

Millennium Development Goal 4:

Key facts

• Over 130 mln. babies born every year

• In 2010: 7.6 mln. children under 5 years of age died: more than 40% die within the first month:

75% of which occur in the first week of life:between 25% to 45% occur within the first

24 hrs

• Up to two thirds of newborn deaths can be prevented if known, effective health measures are provided at birth and during the first week of life.

Neonatal Mortality Rate by MDG region, 1990 and 2010 (deaths per 1,000 live births)

Source: 2011 Report: Levels and Trends in Child Mortality - Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation.

Daily risk of death during the first month of life

Source: Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365:891–900. (Based on 47 DHS surveys conducted from 1995–2003).

Major Causes of Neonatal Deaths

Source: World Health Organization. The Global Burden of Disease: 2004 update. WHO, Geneva, 2008.

1-3 causes

~80%

I. Interventions Prior to or During Pregnancy

II. Interventions During Delivery

III. Interventions After Delivery

The lifecycle continuum of care

Interventions

I. Interventions Prior to or During Pregnancy

• Antenatal care

• Assess the pregnant woman for pre-eclampsia, anemia, syphilis, HIV status, TB

• Nutritional Interventions (iron and folic acid, vitamin A)

• Malaria Prophylaxis

• Immunizations -tetanus toxoid

• Detection and treatment of bacteriuria

• Birth plan – HF delivery or SBA

• Family planning

• Using bednets

Impact of Antenatal Interventions

Intervention Reduction in Neonatal Mortality

Global Sub-Saharan

Africa

South Asia

Routine ANC 4-7% 7-12% 3-5%

ALL ANTENATAL CARE SERVICES

5-10% 7-14% 4-9%

Source: Darmstadt et al., 2008

ANC has a larger impact on maternal mortality than neonatal mortality

II. Interventions During Delivery

• Skilled birth attendant

• Prevention and management of hypothermia

• Clean cord care – clean delivery kit

• Asphyxia management:

Stimulation by quickly drying & wrapping

Gentle flicking

Open & maintain the airway

• Antibiotics for PPROM

• Prevention and management of delivery complications

Impact of Interventions During DeliveryAsphyxia/Sepsis management led to reduction of relative risk of mortality

Source: Darmstadt et al., 2008

Intervention Reduction in Neonatal Mortality

Global Sub-Saharan

Africa

South Asia

Clean delivery 5-8% 6-9% 6-9%

Skilled birth attendance 11-18% 12-20% 12-19%

Emergency obstetric care 3-11% 4-11% 4-11%

ALL INTRAPARTUM CARE 19-34% 19-34% 20-36%

III. Interventions After Delivery

• Breastfeeding and Nutritional Support:

- Early and exclusive breastfeeding (within a 30 min of birth)

• Prevention and Management of Infections

• Early identification and timely treatment of neonatal problems

• Special care for sick newborns, those who are preterm and/or low birth weight

• Home visits for the newborn

• Community-based pneumonia casemanagement

Impact of Post-natal interventions

Source: Darmstadt et al., 2008

Intervention Reduction in Neonatal Mortality

Global Sub-Saharan

Africa

South Asia

Clean home childbirth, clean cord care & Community-based care of low birth weight babies

6-19% 5-18% 7-21%

Community-based pneumonia management

4-12% 5-13% 4-12%

Emergency neonatal care 9-24% 8-23% 10-26%

ALL POSTNATAL CARE 17-39% 16-38% 18-42%

Impact of Post-natal Interventions

• Mortality in those who received a post-natal visit on first day of life was 67% lower

• The home visits have improved coverage of key newborn care practices such as early initiation of breastfeeding, exclusive breastfeeding, skin-to-skin contact, delayed bathing and attention to hygiene, such as hand washing with soap and water, and clean umbilical cord care.

Source: Siddhartha Gogia et al., 2008

1. 2011 Report: Levels and Trends in Child Mortality - Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation.

2. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365:891–900. (Based on 47 DHS surveys conducted from 1995–2003).

3. World Health Organization. The Global Burden of Disease: 2004 update. WHO, Geneva, 2008.

4. Gary L Darmstadt, Neff Walker, Joy Saving et al. Newborn lives in Asia and Africa: Cost and impact of phased scale-up of interventions within the continuum of care. Health Policy and Planning 2008; 23:101-117

5. Siddhartha Gogia, Siddarth Ramji, Piyush Gupta et al. Community Based Newborn Care: A Systematic Review and Meta-analysis of Evidence: UNICEF-PHFI Series on Newborn and Child Health, India. Indian Pediatrics 2011; 48: 537-546

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