Africas Newborns counting them and making them count

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Africas Newborns counting them and making
them count

• An overview of newborn deaths and lives that
  could be saved in Africa
• (Section I and V of the publication)

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Adapting this presentation

• Consider the audience and how technical or
  detailed you want to be and how much time you
  have select and adapt slides to fit
• Consider adding regional or your own country
  level data, or charts. Charts and graphs are
  based on best available data up to November 2006.
• Personalise with local photos or examples

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What does the book provide?
I

• I. Information on Africas newborns
• Where, when and why do they die?
• How many lives could be saved?
• II. An overview of the care needed for mothers,
  newborns and children
• III. The opportunities and practicalities of
  including newborn health in nine existing health
  programmes
• Reaching every mother and baby in Africa with
  essential care
• Examples of countries that are progressing
• Operationalising action and integration
• Data profiles for 46 African countries
• CD ROM with programme and action guides

V
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Questions

• Millennium Development Goal 4 Can Africa reach
  the goal?
• Every year 1.16 million Africas newborns die -
  where, when and why?
• How many newborn lives could be saved and what
  are the priority opportunities?

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Question 1

• Is there new hope for meeting MDG 4 in Africa?

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Meeting MDG 4 in Africa?
New hope for reducing under five deaths! Over the
last year several large African countries have
reported reductions of 25 or more in under five
deaths
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Not all countries are the same e.g. Eritrea
Steady progress for over 20 years with
4.1 average annual reduction under
five mortality Now 30 of under 5 deaths are
neonatal
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Tanzania
Limited progress in the 1990s now a 30 fall in
U5M and a 25 reduction in neonatal mortality Now
30 of under 5 deaths are neonatal
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MDG 4 cannot be met without more purposeful focus
on newborn deaths

• 25 of under 5 deaths in Africa are neonatal
  1.16 million a year
• Progress is slow and no measurable progress in
  reducing neonatal mortality rates especially
  early neonatal (first week) death rates
• As under five mortality is reduced then more and
  more child deaths are in the neonatal period
  (first month) for example in most Asian
  countries over two thirds of child deaths are
  neonatal

To reduce these deaths we need to know where,
when and why they occur
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Question 2

• Every year 1.16 million Africas newborns die -
  where, when and why?

Same number as ALL the babies born in South
Africa, Lesotho and Swaziland during 2006
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WHERE do newborns die?
Most die at home - unnamed and uncounted Tradition
al taboos prevent access to care and promote
acceptance of newborn deaths BUT new data used
well can make newborns count
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SOURCES of data on newborn deaths

• Only one sub Saharan Africa has high quality,
  full coverage data from vital registration
  (Mauritius)
• For most countries we rely on large,
  population-based surveys which ask women about
  their last pregnancy and any child deaths in the
  last 5 years
• For some countries (often affected by crisis)
  survey data is not available and instead WHO
  country estimates have been used

Neonatal death numbers are mainly from
retrospective surveys which are known to under
estimate newborn deaths, especially on the first
day of life
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WHERE? The 10 African countries where newborns
have the highest risk of dying
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WHERE? African countries with the highest
numbers of newborn deaths
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Within countries, where do babies die?
Often missed is the growing issue of urban and
peri-urban poverty in Africa
Mean NMR for rural and urban populations in 22
African DHS surveys 2000-2005
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Newborn deaths and poverty
On average newborn deaths are 67 higher for the
poorest families compared to the richest within
their own country
If all babies in Africa had the same neonatal
mortality rate as the richest in their own
countries then deaths would be reduced by at
least 20
Analysis of NMR by wealth quintiles for 25
African DHS surveys 1994-2005
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Poor families bear the burden

• User fees can be catastrophic, especially for
  obstetric emergencies
• Indirect costs (e.g. transport) also hit families
  hard

• Less than 20 percent of health spending comes
  from out-of-pocket costs in southern African
  countries
• In the poorest sub-region, west and central
  Africa, 40 to 80 percent of health expenditure
  comes directly from families.

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1.16 million newborn deaths in Africa - When?
Up to 50 of neonatal deaths are in the first
24 hours
Birth and first week is key when most babies
die yet when coverage of care is lowest for
mothers and babies
75 of neonatal deaths are in the first week
3 million deaths
Source Lawn JE, Kerber K Daily risk of death in
Africa during first month of life based on
analysis of 19 DHS datasets (2000 to 2004) with
5,476 neonatal deaths
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WHEN do newborns die?

• The first days of life are the riskiest
• Up to 50 of all newborn deaths are on the first
  day of life - 500,000 African babies die on
  their birth day
• 75 of newborn deaths are in the first week

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WHY do African newborns die?
Infections 39
Source Opportunities for Africas Newborns,
2006. Based on vital registration for one country
and updated modeling using the CHERG neonatal
methods for 45 African countries using 2004
birth cohort, deaths and predictor variables.
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WHY do newborns die?

• Three causes together account for 88 of newborn
  deaths in Africa
• Infections including tetanus
• Preterm birth complications
• Birth asphyxia

These causes are highly preventable, especially
tetanus and neonatal infections
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If the neonatal mortality rate is higher then
more deaths are rapidly preventable
When NMR is less than 15 per 1000 live births,
Infections account for lt 20 of neonatal deaths
and more complex solutions are required
At very high NMR (over 45 per 1000 live births)
infections cause 50 of neonatal deaths
Source Lawn JE, Cousens SN, Zupan J Lancet 2005.
based on cause specific mortality data and
estimates for 192 countries
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Question 3

• How many newborn lives could be saved and what
  are the priority opportunities?

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SOLUTIONS for neonatal tetanus

• Tetanus still kills up to 70,000 babies a year
  in Africa despite being one of the most cost
  effective, feasible conditions to prevent with
  two 20 cent injections during pregnancy

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SOLUTIONS for neonatal infectionssepsis,
meningitis and pneumonia
Prevention through identifying and treating
maternal infections (e.g. syphilis), and through
clean delivery and clean cord care

• Prevention through early and exclusive
  breastfeeding

Treating newborn babies who have infections
with antibiotics, including through IMCI
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SOLUTIONS for preterm babies
Prevention of preterm birth through addressing
malaria and other infections the mother has
during pregnancy
Extra care of preterm babies including clean,
safe delivery, support for breastfeeding and
keeping babies warm, e.g. with Kangaroo Mother
Care
Early treatment and care for complications such
as breathing problems, and infections
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SOLUTIONS for babies with complications from
birth asphyxia
Prevention through antenatal care including
management of pre eclampsia and multiple pregnancy

• Skilled attendance at childbirth and emergency
  obstetric care including neonatal resuscitation
  if needed

Supportive care (oxygen, intravenous fluids
etc) if the baby does continue to be severely
affected
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Lives could be saved now
If the essential interventions described in The
Lancet newborn survival series reached 90 of
women and babies then 67 of newborn deaths could
be prevented 800,000 babies could be saved
each year in Africa, one-third of these
through family behaviours and community care alone

Additional cost of 1.39 per capita per year
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Beyond survival...the health of the next
generation in Africa
0.9 million stillbirths
4 million LBW babies
1.16 million newborn deaths
Babies with major neonatal illness??
Children with poor development or disability due
to fetal and/or neonatal illness?? (birth
asphyxia, preterm birth, infections)
Inappropriate feeding and other missed
prevention opportunities (e.g. PMTCT) related to
care during the neonatal period
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Improving the information for action

• Add neonatal mortality rate to MDG 4 tracking
  U5M and IMR run parallel to each other unlike
  NMR. Tracking NMR is necessary for policy and
  programmes and promotes MNCH integration
• Improve future information
• Increase coverage of birth and death registration
• Improve the quality of surveys especially to
  track newborn deaths and stillbirths
• Harmonise data collection tools such as verbal
  autopsies so data are more comparable
• 4. Use existing information more for action and
  involve civil society in tracking and
  accountability for maternal, newborn and child
  deaths

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Need country level data for decision-makingMNCH
with a focus on newborn health
Rate of Progress
Coverage along the Continuum of Care
Missed Opportunities
Source Opportunities for Africas Newborns 2006.
Eds Lawn JE, Kerber KJ. Data from SOWC, CHERG, DHS
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Why focus on newborns?

• Huge numbers of deaths yet neglected
• Solutions are possible now
• up to 800,000 newborn lives could be saved each
  year in Africa with known interventions, many
  possible at home
• African countries are succeeding
• 3. Improving newborn health is a catalyst for
  saving mothers and children, reducing HIV burden,
  and improving health systems

A healthy newborn changes the future!
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Moving into action

• Operationalising opportunities within existing
  programmes
• Section II Continuum of care
• Section III Practical steps to advance
  opportunities in nine existing programmes
• Many guidelines and manuals exist and can be
  used/adapted
• CD ROM has a resource library of over 100 useful
  documents
• Data for decision making at country level..
• Country profiles
• Country PowerPoints for adaptation

Count every newborn and make every newborn count!
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Thank you !