Continuum of Care The Links That Save Mothers and Newborns

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Continuum of Care The Links That Save Mothers
and Newborns
O. Massee Bateman, MD, DTMH Save the Children/
Saving Newborn Lives
Core Group Fall Meeting Community Health
Person-Centered Care October 7, 2009
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Outline

• Continuum of Care
• Newborn Mortality
• Maternal Mortality
• Intervention Strategies
• Summary

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Continuum of Care
Childhood
Newborn/postnatal
Pre-pregnancy
Pregnancy
Birth
Source Lawn JE DCP chapter adapted for Lancet
neonatal series executive summary
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Household to Hospital Continuum of Care
Enabling Environment
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4 million neonatal deaths
Why? When?
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4 million newborn deaths Why?
60 to 90 of neonatal deaths are in low birth
weight babies, mostly preterm
Source Lawn JE, Cousens SN, Zupan J Lancet 2005.
for 192 countries based on cause specific
mortality data and multi cause modeled estimates.
As used in World Health Report 2005
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4 million newborn deaths - When?The riskiest day
of life
Up to 50 of neonatal deaths are in the first
24 hours
Birth and first week is key yet coverage of
care is lowest for mothers and babies Over 50
million women deliver at home every year
75 of neonatal deaths are in the first week
3 million deaths
Source Lawn JE et al Lancet 2005, Based on
analysis of 47 DHS datasets (1995-2003), 10,048
neonatal deaths)
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Over 500,000 maternal deaths
Why? When?
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536,000 Maternal Deaths annually Main
Causes Hemorrhage Obstructed
Labor Sepsis Unsafe Abortion Hypertensive
disorders 75 occur during delivery and
immediate postpartum period
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Where?Countries with the highest numbers of
neonatal deaths are similar to those with high
maternal deaths
2.5 million neonatal deaths Approx 66 of
global total
325,000 maternal deaths Approx 61 of
global total
Estimates of neonatal deaths for the year 2005
(GBD 2004/5). WHO/UNICEF/UNFPA estimates of
maternal mortality for 2000
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Intervention Strategies
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Coverage along the continuum of care
Innovation for an integrated routine postnatal
care package, and access to case management
The days of highest risk and lowest coverage
Immediate postnatal care is based on the DHS
assumption that all facility births get PNC
before discharge. Early postnatal care (within 2
days) at home was only measured for home births
only in previous DHS Source Opportunities for
Africas Newborns, inputs from 28 African DHS
from 1998-2005
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Proliferating interventions and proliferating
Lancet series..
Over 190 single interventions listed
Need to package the interventions and strengthen
existing programmatic platforms to reach
families. A paradigm shift to MNCH continuum of
care
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Delivery of interventions
Childhood
Newborn/postnatal
Pre-pregnancy
Pregnancy
Birth
Source Lawn JE DCP chapter adapted for Lancet
neonatal series executive summary
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Integrated MNCH packages in the continuum of care
Childbirth care
Antenatal care
Postnatal care
Adol-escent health
Child health care

• POSTNATAL CARE
• Promotion of healthy behaviours
• Early detection and referral of complications
• Extra care of LBW babies
• PMTCT for HIV

• ANTENATAL CARE
• - 4-visit focused package
• - IPTp and ITN for malaria
• - PMTCT for HIV/AIDS

• REPRODUCTIVE HEALTH CARE
• - Family planning
• - Prevention management of STI HIV
• - Folic acid

• PREVENTIVE CHILD CARE
• Immunisations
• Malaria ITN
• Nutrition
• Care of children with HIV including cotrimoxazole

Childhood
Newborn/postnatal
Pre-pregnancy
Pregnancy
Birth
Source Kerber KJ, Lawn JE et al Lancet in press
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Reality for the delivery of integrated care
Childbirth care
Postnatal care
Antenatal care
Adol-escent health
Child health care
Sick baby and child care in hospital
Skilled Attendance
PMTCT of HIV
Routine Postnatal care
Routine postnatal care

• POSTNATAL CARE
• Promotion of healthy behaviours
• Early detection and referral of complications
• Extra care of LBW babies
• PMTCT for HIV

• ANTENATAL CARE
• - 4-visit focused package
• - IPTp and ITN for malaria
• - PMTCT for HIV/AIDS

• REPRODUCTIVE HEALTH CARE
• - Family planning
• - Prevention management of STI HIV
• - Folic acid

• PREVENTIVE CHILD CARE
• Immunisations
• Malaria ITN
• Nutrition
• Care of children with HIV including cotrimoxazole

IMCI
Malaria programmes
Nutrition programmes
Behaviour Change and community mobilisation,
community IMCI
Childhood
Newborn/postnatal
Pre-pregnancy
Pregnancy
Birth
Source Lawn JE DCP chapter adapted for Lancet
neonatal series executive summary
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Integrated Intervention Strategies

• Care at Delivery
• 1.02 million babies are stillborn having died
  during labor
• 904,000 babies die soon after birth due to birth
  complications
• 42 of maternal deaths are directly related to
  delivery
• Care in the immediate postnatal period
• After delivery, the highest risk of death of
  mothers and babies is in early days in the
  postnatal period

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In Summary
Maternal and Neonatal deaths are highest in the
same places, in the same lifecycle periods and
may best be addressed by integrated program
strategies
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Thank you!