West and Central Africa Regional Consultation on Global ‘Every Newborn’ Action Plan, 09-11 July 2013 – Dakar,
Senegal.
Status of Newborn Health in the
African Region
Presentation outline
• Why are 3 million newborns dying? Causes of death Risk factors
• Needed change: which interventions and at what level?
• Opportunities
Status of newborn survival
• Neonatal deaths account for 40% of the global 6.9 million under-five deaths
• Of the 3 million newborns who die every year 1.1 million (38%) are from the Sub-Saharan region
• These deaths contribute heavily to the under-five mortality rates disengaging the Region from reaching the targets for MDG4.
Major causes of deaths in neonates and under-five in the African Region, 2010
• Prematurity is a complication to be dealt with starting in pregnancy
• Birth asphyxia needs to be dealt with in the first minutes of life
Why the deaths: Factors that increase risk of death.
• Undernutrition, increases the risk of death and ill-health for both mother and baby, during pregnancy, childbirth and the postnatal period through to early childhood.
• The 24 hours around childbirth and the first day of a baby’s life carry the greatest risk
• Skilled care can make a difference.• Yet only 50% of births are attended to by a skilled health worker
in the African Region
• Inequities in coverage for skilled attendant at birth and other interventions that require a strong health system are much wider in regions with the highest mortality rates, especially sub-Saharan Africa.
World Health Report, 2006
Critical shortage of health service providers (doctors, nurses and midwives)
Focus for improvement for newborn survival
1. Solutions exist now to prevent two-thirds of these deaths and some African countries are progressing
2. Addressing newborn deaths cannot be in isolation but has to be within the backbone of a healthy health system for MNCH
Framework for action: Continuum of care
COMMUNITYHEALTH
FACILITIES SERVICES
Essential newborn care
Identify and treat asphyxia and sepsis
Refer if necessary
Home based maternal, newborn care
Identify danger signs and refer
Seek appropriate care or refer
Facility 1-2 days
Maternal and Newborn
essential post partum care
& emergency first aid or
BEmOC and IMNCI
Facility
Skilled Attendant
Essential Maternal and
Newborn Care Package
Ob-Newborn Emergency First
Aid or BeMOC
Facility Complete ANC
Package
TT Iron folicBlood pressureTreatment of infections IPT if indicatedPMTCT if indicatedManagement or referral of OB complications
Health Facility Model
ANC DELIVERY POST - PARTUM
Emergency Obstetric and Neonatal Care
(Referral if needed)
In Community during 1st week
1. Pregnancy Home Visits
Home based maternal and newborn careCommunity model
Pregnancy - 2 Home Visits
Community Health Worker
registers all pregnant women refer to ANC
Key interventions
health/nutrition education birth preparedness danger sign awareness breastfeeding preparedness provide insecticide treated bednet (where appropriate)
FOCUSED ANC
Tetanus Toxoid
Iron and Folic Tablets
BP and urine test for protein
Foetal Lie
Syphilis (and other STI)detection and treatment
IPT if indicated
PMTCT if indicated
Management or referral of obstetric complications
(EmOC)
2. Delivery
Delivery under skilled care Temperature management Dry, wrap and skin to skin Resuscitation if required Immediate and exclusive breastfeeding
Cord Care Temperature of newborn Birthweight Refer if necessary
3. Post Delivery Care – 2-3 home visits during first week
Home based maternal and newborn careCommunity model
Care of Newborn using checklist: Assess newborn
weight temperature feeding cord care
Assess for sepsis - refer if required Counsel parents on thermal control, exclusive BF, danger signs Refer for vaccination Birth registration
If Low Birth Weight:
give extra care with 2 additional home visits
Kangaroo mother care Keep warm Assist with feeding if needed Attention to hygiene Review danger signs
Care of Mother using checklist: Assess mother
check bleeding check temperature breast problems
Discuss danger signs Nutrition counseling and family planning Refer if necessary
Essential interventions linked to cause of mortality
Asphyxia (27%)
Resuscitation of newborn baby can reduce neonatal mortality by 5-20%
Serious Infections (sepsis) 26% Hygienic cord care, thermal care,
breastfeeding can reduce up to 50% of newborn deaths
Malaria IPT can reduce 10-30% of newborn deaths
Case management pneumonia/sepsis can reduce deaths due to pneumonia by 20-55%
Prematurity and low
birth weight (29%)Extra care for low birth
weight infants including
extra warmth, hygiene,
feeding, can reduce deaths
due to prematurity 20-50 %
Tetanus 7 % Tetanus toxoid can eliminate tetanus
deaths Hygienic cord care can reduce tetanus
deaths by 75-85%
Programmatic progress in the implementation of the outlined packages
By 2012
• 30 out of the 46 WHO African Region countries were implementing the Essential Newborn Care package.
• 22 countries had adopted the community newborn package.
Opportunities: Regional initiatives
The African Union championed advocacy at the highest level through:• Recommendations of the special session on the RMNCH during the
2010 AU meeting held in Kampala Uganda
• The adoption of the Campaign for Acceleration of Reduction of Maternal and Newborn Mortality in Africa (CARMMA) - 2009
Governments have shown committed through increasing of MNCH funding and addressing financial barriers through various strategies like fee waiver, voucher system.
Governments are individually committing to:
• Addressing human resources challenges• Increased efforts to implement the MNCH Roadmaps• Increased efforts to scale up the Child survival Strategies.
Opportunities
Global ‘Every Newborn’ Action Plan
• Opportunity to re-align country orientations for newborn health based on the identified needs.
• Opportunity to rally all towards a common purpose and common deliverables.
• Opportunity to contribute to the Global ‘Every Newborn’ Action Plan.
•T
hank you•
Merci B
eaucoup