kmc accelleration convening | istanbul, 21 - 22 october 2013 1 | dr. elizabeth mason, director...

KMC Accelleration Convening | Istanbul, 21 - 22 October 20131 |

Dr. Elizabeth Mason, Director Maternal, Newborn, Child and

Adolescent HealthWorld Health Organization

on behalf of the Steering Committee

World Prematurity Day 2013

Version Nov 2013


Born too Soon: Global Action Report on Preterm birth

• First estimates of preterm birth by country.• Key points:

– 15 million babies are born preterm annually; > 1 in 10 live births.

– Preterm birth leading cause of newborn deaths

– > 1 million babies die annually due to preterm complications. 75% could be saved with current, cost-effective interventions — even without intensive care.

– Boys are more likely to be born preterm than girls but more likely to survive their first month


2000-2011: improved understanding of newborn mortality and importance of preterm birth

GLOBAL OVERVIEW

20112000

Diarrhoea12%

Other29%

ARI20%

Measles5%

Malaria8%HIV/AIDS

4%

Perinatalcauses22%

43%

3 million

Malnutrition contributes to 60% of newborn deaths


Who is a preterm birth baby?

Late and moderate preterm 32 to <37 weeks84%

Very preterm28 to <32 weeks10%

Extremely preterm < 28 weeks5%

Baby born alive before 37 completed weeks of pregnancy


What is the burden of preterm birth?

• 15 million preterm births/year• > 50% neonatal deaths occur

among preterms• Direct cause of 35% of all

neonatal deaths• Significant disability risk:

• Visual impairment• Hearing loss• Chronic lung disease• Developmental delay• NCDs


135 million newborns and 15 million premature babies- health system needs and human capital outcomes

Every Newborn: Outline

Why are 3 million newborns dying? Can we change?

Where do we want to be in 2035?[Target setting and other analyses discussion]

How can we change outcomes for Every Newborn in every country? [Strategic objectives]

What is the Every Newborn Action Plan?

What is the process for building a Movement and a Plan? Who needs to be involved? [Discussion]

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https://savenet2.savechildren.org/op/ip/ipl/pr3/DHN%20Pictures%20Library/StoryCentral%20ID%2040691.jpg

No baby

stillborn

Our delivery goal

No newborn is born

to die

2.9 million die~ 280,000 die 2.6 million die

No child

stunted or dying

3 million die

3.5 million within a few days of birth

10 million deaths

We can reduce the main causes of deathNewborn Survival Solutions – 3 by 2

Preterm birth1. Preterm labor management including antenatal corticosteroids*2. Care including Kangaroo mother care, essential newborn care

Birth complications (and intrapartum stillbirths)3. Prevention with obstetric care *4. Essential newborn care, resuscitation*

Neonatal infections5. Prevention, essential newborn care, breastfeeding,

Chlorhexidine*6. Case management of neonatal sepsis *

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3

* Prioritised by the UN Commission on Life Saving Commodities for Women and Children

Over two-thirds of newborn deaths preventable – actionable now without intensive care

MDG 4 MDG 5 Neonatal mortality rateAv annual change 2000-2010

Rwanda Progressing 6.2%

Bangladesh 4.0%

Nepal 3.6%

Malawi Progressing 3.5%

We have proof of change at scaleSome Li countries are “bending the curve” for newborn survival

Source: Newborn survival decade of change analysis: Health Policy and Planning. 27(Suppl. 3) papers 3 to 7

Over the last decade 77 countries reduced NMR by >25%

including at least 13 low income countries

Bangladesh, Bolivia, Eritrea, Guatemala, Indonesia, Nepal, Madagascar, Malawi, Morocco, Senegal,

Rwanda, Tanzania, Vietnam

Outline

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19902000

20102012

20142016

20182020

20222024

20262028

20302032

20340

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50

60

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A PROMISE RENEWED TARGET• Global av U5MR of 15/1000 with

every country below 20/1000• Global av NMR 7/1000 with every

country below 10/1000

MDG 4

6.9 m child deaths in 20113m are neonatal (43%)

U5M current trajectory: AAR 2.5%

Child survival target by 2035 in A Promise Renewed

Under 5 mortality = 20/1000

Source: UNICEF State of the World’s Children 2012; The UN Inter-agency Group for Child Mortality Estimation, Levels and Trends in Child Mortality: Report 2011, 2011; Team analysis from 2035 onward based on straight-line ARR reduction from UNICEF numbers 1990-2035

NMR current trajectory: AAR 2.2%

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Mor

talit

y ra

te (p

er 1

,000

live

birt

hs)

9.6 m deaths in 2000

Unless we achieve major acceleration for newborn survival, we cannot reach our goal for ending preventable child deaths by 2035

Outline

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Strategic objectives1. Invest in care during labour, childbirth and the first days of life.

2. Improve the quality of maternal and newborn care. This requires investment, especially for effective care at birth. Skilled

workers are the key to change

3. Reach every woman and every newborn and reduce inequalities achieve universal coverage and equity.

4. Harness the power of parents, families and communities to mobilise change.

5. Count every newborn - measurement, oversight and accountability improve and use the data.

Source: Pattinson R, Kerber K, Buchmann E, et al, for The Lancet’s Stillbirths Series steering committee. Stillbirths: how can health systems deliver for mothers and babies? Lancet 2011; published online April 14. DOI:10.1016/S0140-6736(10)62306-9.

Deaths prevented: Stillbirths 1.1 million (45%) Newborn deaths 1.4 million (43%) Maternal deaths 201,000 (54%)

TRIPLE RETURN ON INVESTMENT

Basic antenatal

Advanced antenatal

Childbirth care Care at birth, analysis from The Lancet Stillbirth series

Quality of care is essential The quality gap is a contributor to

slow progress towards MDG 4 and 5 and leads to significant morbidity as well as mortality.

Increased coverage of facility care at birth is an opportunity to ensure that all women and babies receive effective, safe respectful care

Programmatic change is possible and will also require better data to drive change.

Outline

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• Country demand for guidance and action, country driven

• Large problem but huge potential for rapid change since we know what to do and can develop clear context specific guidance on HOW

• Harmonize global response which so far has been slow and needs to link to many existing initiatives for reproductive, maternal, child and adolescent health care, scaling up global attention and action

Why Every Newborn?

Health Sector Strategic & Investment Plan

Sharpened and Integrated National RMNCH Plan

Increased access and use of FP

Ending preventable newborn deaths

Ending preventable child deaths for A Promise Renewed

Ending preventable maternal deathsCOMMODITIES, HUMAN RESOURCES etc.

How it fits together in countries for sharpened RMNCH plans

Building a movement

• Building on Born Too Soon, A Promise Renewed for Child Survival

• Outreach: Senior policymakers, parliamentarians, civil society, media

• Reaching across communities: reproductive, maternal + newborn and child

• Advocacy and communications through all partners: National, regional, global – 500+ PMNCH partners

Every Newborn consultations – Countries • Countries events:

– 17 country consultations between July – September 2013

– Other countries have undergone high level meetings e.g. Ghana, South Africa, Zambia

• Regional consultations:– West Africa (UNICEF Dakar office) 9th-12th July– Asia (Kathmandu UNICEF office) 30th August – 1st September

• Upcoming consultations– Cameroon, Niger– Regional consultation in East and Southern Africa

Country consultations1. India2. Nigeria3. Pakistan 4. China5. DRC6. Bangladesh7. Afghanistan8. Uganda9. Kenya10. Senegal11. Malawi12. Nepal13. Thailand14. Sierra Leone15. Myanmar16. Philippines17. Vietnam

Learn more about these events at EveryNewborn.org

May – September 2013• Global and regional events• National and regional consultations

October 2013 – May 2014• Present to the WHO Executive Board• Finalize Every Newborn including production and

translations

May 2014 • Launch linked to 67th World Health Assembly• Lancet series (update from 2005 and giving the

analyses which are the basis for the Every Newborn)

Online: www.everynewborn.org

The way forward

Send your inputs! Join the action!

http://www.globalnewbornaction.org/

Be part of the action for newborns#EveryNewborn

kmc accelleration convening | istanbul, 21 - 22 october 2013 1 | dr. elizabeth mason, director...

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