neonatal care

NEONATAL PUBLIC HEALTH POLICYFossari, MarcioMolinari, SilvanaDos Santos, RobertaReiser, Karina

City of Itajaí - BRA

NEONATAL CAREExploring the Possibilities towards Better Healthcare

THE CITY- We have 205.271 habitants

- A average of 2.991 live births/year

- About 2.400 in the Public Maternity

- It´s a port town City

- It has a human development index of0,795 3rd in the province

- We have about 76% of the City totalArea cover by the Family HealthStrategy and divided in the micro-areas.

- The Family Health team has at leastone nurse, one medical doctor and acommunity health worker (variableabout the number of people)

http://cod.ibge.gov.br/232T9

http://dab.saúde.gov.br

http://cod.ibge.gov.br/232T9

CHILD < 1Y MORTALITY 2010-2013

dez-10 dez-11 dez-12 dez-13

Early Neonatal 18 19 22 22

Late Neonatal 3 13 7 11

After Neonatal 9 12 10 19

1819

22 22

0

5

10

15

20

25


18

1922

22

3

13

7

11

9 12 1019

Early Neonatal Late Neonatal After Neonatal

2011 2012 20132010

30

44

39

52

20

30

40

50

60

2700 2900 3100

Total live births

DEATHS

2011

2012

2013

2010


13,3

10,9

15,2

12,8

17,3

2009 2010 2011 2012 2013

Mortality Rate


CHILD MORTALITY < 1YEAR 2013

• The second highest rate of child mortality from theprovince

• One of the largest number of child death from theprovince

• A fickle line of child mortality

• The oscilatory curve demonstrates increase anddecrease in mortality rate by chance, and notassociated to an efficient Public Health Policy

• It`s a surprise ?

RESOURCERESULTS

We’ve been here in the past.

We have to care our children in their homes !!!

WHICH ARE THE PILLARS TOADEQUATE HEALTH CARE ?

SURVEILLANCE

• Public health surveillance is the continuous, systematic collection, analysis

and interpretation of health-related data needed for the planning,

implementation, and evaluation of public health practice. (WHO)

• We have a systematic collection of data (a lot of manual work), but We

were not efficient at analysis and interpretation.

• We were not anticipating the healthcare processes. (Very Important !!).

• http://www.who.int/topics/public_health_surveillance/en

CARE

• What kind of care Wewant ?

• Home visit based care

• The Mother care and baby care

• A Breastfeeding empowerment

• No more than 7 days to do the visit

• Better if the community health

worker don’t go alone have to

be with the nurse or the community

doctor or both.

WHO technical consultation on newborn health indicators: Every Newborn

Action Plan Metrics

SUPPORT

Primary Level

IntermediateLevel

AdvancedLevel

• We have to support our teams

• We must be prepared for theneeds that We have and supportthem

• We need to evaluate and thinkabout the strategy often

• We have to give conditons for theproperly work of our teams

Preventive Care in all Levels

• We began talk with the largest

working group in the public health,

the community health worker, and

the nurses, most of then are the

supervisors from the health facilities at

primary care.

• Total about 300 people.

• We talk with all comumunity medical

doctors about the numbers of

mortality.

Action

Re-evaluateAction

Evaluate

Where do We Start ?

ATTENTIVE CAREX

THERAPEUTIC CARE

Mother/Baby

Breastfeeding

Desnutrition

Jaundice

Screeningtests

We were worried about a attentive

care, more about the visit at home

for the mother and the baby and less

about a medical appointment.

We tried thinking about a integrative

care and more of it, a care with

responsability, like to care about the

mother and the baby.

25,14

23,2

1,2 1,1

26,7

28,2

2013 2014

Features

Mother Age Number of Children Weeks at Birth

• When We look for the verybrief profile from the mothersin 2013, We don’t found asocial determinant for thenumber of neonatal death.

• We need to measure andevaluate the expected results,We tried to antecipated them.

What to say ?

A CARE MOVEMENT

Prenatal Care

• BreastfeedingEmpowerment

• Diabetes

• Maternal Nutrition

• Maternal Hypertension

• Urinary tract Infection

• Syphilis

Intrapartum care

• Attendant skilledhealth staff

• The Golden hour

• The father togetheror someone from theFamily

• Newborn measuresand physicalexamination after 1 hour

Home care

• Start at the Hospital

• No more than 7 days

• Look for some riskfactor

• Child log book

• Nurse or Medical Visit (same of prenatalcare)

A CARE MOVEMENTIN THE CITY ??

• World breastfeeding week (40%)

• World Health day

• First walk of breastfeeding

• A municipal “law” for support breastfeedingactions

• Better information (computers in all healthfacility)

CHILD <1Y MORTALITY 2013-2014

22

19

11

2

19

12

0

5

10

15

20

25

som 52 som 33

NU

MB

ER

OF

DEA

TH

< 7 days 7- 27days 28 - 1year

2013 2014


dez-10 dez-11 dez-12 dez-13 dez-14

Early Neonatal 18 19 22 22 19

Late Neonatal 3 13 7 11 2

After Neonatal 9 12 10 19 12

1819

22 22

19

0

5

10

15

20

25

13,3

10,9

15,2

12,8

17,3

10,9

2009 2010 2011 2012 2013 2014

Mortality Rate


30

44

39

52

33

20

30

40

50

60

2700 2800 2900 3000 3100 3200 3300 3400

Total live births

DEATHS

2011

2012

2014

2013

2010


WE MUST CONTINUE !!

• We believe that the set of all actions and not just one or the other hasbeen essential for improved results.

• We need to get a better result for the neonatal early deaths

• We have to improved a lot our prenatal assistance

• We must to continue all the actions and have more patterns for help

• Invest in education for all !!

THE CITY HALL ANDOUR TEAM

neonatal care

Health & Medicine