Home based newborn care:

the Bangladesh experience

Professor Mohammad ShahidullahPresident

National Technical Working Committee on Newborn Health

President Bangladesh Neonatal Forum

Pro-vice Chancellor, and Chairman Neonatology, BSMMU

EVERY NEWBORN AN ACTION PLAN TO END PREVENTABLE DEATHS

Outline Background National Strategy and

Program directives Evidences on PNC

home visit PNC status in

Bangladesh Status of newborn

care in home Recent Initiatives on

Newborn Health in Bangladesh

WHERE? Neonatal deaths

Countries

Ranking for Numbers of Neonatal Deaths

India 1

Nigeria 2

Pakistan 3

China 4

DR Congo 5

Ethiopia 6

Bangladesh 7

Indonesia 8

Afghanistan 9

Tanzania 10

Ref: Lawn JE et al BJOG Sept 2009. Data sources: Estimates of neonatal (2008) deaths from WHO. Updated June 2010

Global 3.1 Million newborn

deaths in 2010 28% decline in 2

decades Sources: UNICEF. Levels and Trends in Child Mortality: 2011 Report. NY: UNICEF; 2011.

Bangladesh 80000 newborn deaths

in 2011 (CHERG) 49% decline in 2

decades Sources: State of the World’s Mother 2013/SC

2.4%Annual rate of reduction

3.3%Annual rate of

reduction

39% 60

%

Bangladesh Demographic and Health Surveys

Bangladesh on track to achieve MDG4 targets well before 2015

Bangladesh is one of 23 countries on track to

achieve MDG4 &has the 4th most rapid rate of decline in child

mortality

Data Source: Bangladesh Demographic and Health Survey 2011

Neonatal Deaths

Causes of neonatal deaths in Bangladesh

Annual number of deaths:

Neonatal (60% of all child deaths)Neonatal infections

38,500Birth asphyxia

21,500Preterm

12,000(+17,500)

Facility Delivery Has Increased But Not Home Delivery By Skilled Attendants

4% 3% 4% 3%

6% 7%10% 12%

3%8%

13%17%

13%

18%

28%32%

2004 2007 2010 2011

Facility-Private/ NGOFacility-PublicHome (Skilled)

Increases in skilled attendance at deliveries has been entirely due to increases in facility deliveries, particularly in private facilities

BMMS BDHSBDHSBDHS

PNC Home Visit

7

NATIONAL NEONATAL HEALTH STRATEGY AND GUIDELINES FOR BANGLADESH

Approved in March 2009

STANDARD OPERATION PROCEDURE (SOP) FOR NEWBORN CARE SERVICESApproved in 2011

HEALTH POPULATION NUTRITION SECTOR DEVELOPMENT PROGRAM2011 -2016

Prioritized Postnatal Home Visit by Trained Community Health Workers

National Neonatal Health Strategy

Page 7

Page 9

Health, Population, and Nutrition Sector Development Program 2011-2016

The national average of CHWs – 13.5 per 10000, 34% of them are trained in ENC ( 5 per 10000) . There is geographical inequity among the distribution of CHWs

Distribution of Community Health Worker and ENC trained Community Health Workers

Save the Children Study 2011

Distribution of Community Health Workers (all)

Distribution of ENC Trained CHWs

Community based PNC OR in Bangladesh (April 2009 to March 2010)

31

51

74

0

10

20

30

40

50

60

70

80

Any PNC visit at home within

24 hours

Any PNC visit at home within

2 days

Any PNC visit at home within

7 days

Madhukhali (intervention)

%

Early PNC home visit by existing government field workers is feasible.

Birth notification within 24 hours of birth is closely associated with early PNC visit at home and it should be a program priority to ensure early PNC.

Use of multiple field workers is challenging.

Timing of 1st postnatal home visit may be extended up to 2 days instead of 24 hours.Community based PNC OR End-line Report -NIPORT

In large scale community based MNCH projects trained community volunteers were able to make a home visit to 45% to 85% of home births within 2 days of delivery

These programs covered half of the country

MNHDHSSMaMoni

MNCH

SMPP

KOICAMNCS

Community Based MNCH programs for Scale-up Community Based ENC with partners support

Essential Newborn Care Practices in Home

Trends in essential newborn care

0

20

40

60

6 2

17

435651

33 28

5059

BDHS 2007 BDHS 2011

Newborn care practices – Drying and Wrapping

0-4 minutes 5-9 minutes 10+ minutes

Not Dried Don’t Know0

10

20

30

40

50

60

51.4

25.9

15

6.21.4

32.936.2

25.1

4.41.4

Dried Wrapped

Source: Bangladesh Demographic Health Survey 2011

Application of material after the umbilical cord was cut

Antibiotics10%

Antiseptic8%

Mustard oil with garlic11%

Boric powder

4%Other9%, Don’t

know, 1%

Nothing applied ,

59%

Other includes spirits/alcohol, chewed rice, turmeric juice/powder, ginger juice, shidur, gentian violet and talcum powder

The recommended practice of applying nothing to the umbilical cord increased slightly, from 56 % in 2007 to 59% in 2011

Source: Bangladesh Demographic Health Survey 2011

Newborn care practices: Timing of first bath

0

5

10

15

20

25

30

35

40 37.6

4.72.4

24.928.4

1.40.70000000000

0001

Source: Bangladesh Demographic Health Survey 2011

Trend of PNC for newborn from a medically trained provider within two days of delivery

BDHS 2004 BDHS 2007 BDHS 20110

5

10

15

20

25

30

35

13

20

30

Proportion of Newborn received PNC

Source: Bangladesh Demographic Health Survey 2011

Postnatal Care Practices of Newborn

Source: Bangladesh Demographic Health Survey 2011

Coverage by District

Data Source- BMMS 2010

Postnatal care visit in Bangladesh

6 District- <20% 14 District –20%-30% 19 District- 30%-40% 25 District - >40%

Recent Initiatives on Newborn Health in Bangladesh

Plan for national scale-up of

KMC for preterm babies

Antenatal corticosteroid for preterm labor

Use of 7.1% CHX in newborn umbilicus

Sepsis management in lower level facilities

National Scaling-up of HBB initiatives

17000 SBA trained

Challenge

Improving knowledge and practices regarding PNC and ENC in geographically remote and hard to reach are

Health workforce shortage

Training of huge numbers of CHWs and quality monitoring of training

Supportive Supervision, monitoring and mentoring for ENC care and PNC

Real time tracking of data through MIS for PNC and ENC

Thank You