Download - Neonatal Mortality Worldwide
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Neonatal Neonatal Mortality Mortality
WorldwideWorldwideFebruary 2, 2012
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Reduce child mortality
Target: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
Millennium Development Goal 4:
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Key facts
• Over 130 mln. babies born every year
• In 2010: 7.6 mln. children under 5 years of age died: more than 40% die within the first month:
75% of which occur in the first week of life:between 25% to 45% occur within the first
24 hrs
• Up to two thirds of newborn deaths can be prevented if known, effective health measures are provided at birth and during the first week of life.
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Neonatal Mortality Rate by MDG region, 1990 and 2010 (deaths per 1,000 live births)
Source: 2011 Report: Levels and Trends in Child Mortality - Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation.
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Daily risk of death during the first month of life
Source: Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365:891–900. (Based on 47 DHS surveys conducted from 1995–2003).
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Major Causes of Neonatal Deaths
Source: World Health Organization. The Global Burden of Disease: 2004 update. WHO, Geneva, 2008.
1-3 causes
~80%
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I. Interventions Prior to or During Pregnancy
II. Interventions During Delivery
III. Interventions After Delivery
The lifecycle continuum of care
Interventions
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I. Interventions Prior to or During Pregnancy
• Antenatal care
• Assess the pregnant woman for pre-eclampsia, anemia, syphilis, HIV status, TB
• Nutritional Interventions (iron and folic acid, vitamin A)
• Malaria Prophylaxis
• Immunizations -tetanus toxoid
• Detection and treatment of bacteriuria
• Birth plan – HF delivery or SBA
• Family planning
• Using bednets
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Impact of Antenatal Interventions
Intervention Reduction in Neonatal Mortality
Global Sub-Saharan
Africa
South Asia
Routine ANC 4-7% 7-12% 3-5%
ALL ANTENATAL CARE SERVICES
5-10% 7-14% 4-9%
Source: Darmstadt et al., 2008
ANC has a larger impact on maternal mortality than neonatal mortality
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II. Interventions During Delivery
• Skilled birth attendant
• Prevention and management of hypothermia
• Clean cord care – clean delivery kit
• Asphyxia management:
Stimulation by quickly drying & wrapping
Gentle flicking
Open & maintain the airway
• Antibiotics for PPROM
• Prevention and management of delivery complications
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Impact of Interventions During DeliveryAsphyxia/Sepsis management led to reduction of relative risk of mortality
Source: Darmstadt et al., 2008
Intervention Reduction in Neonatal Mortality
Global Sub-Saharan
Africa
South Asia
Clean delivery 5-8% 6-9% 6-9%
Skilled birth attendance 11-18% 12-20% 12-19%
Emergency obstetric care 3-11% 4-11% 4-11%
ALL INTRAPARTUM CARE 19-34% 19-34% 20-36%
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III. Interventions After Delivery
• Breastfeeding and Nutritional Support:
- Early and exclusive breastfeeding (within a 30 min of birth)
• Prevention and Management of Infections
• Early identification and timely treatment of neonatal problems
• Special care for sick newborns, those who are preterm and/or low birth weight
• Home visits for the newborn
• Community-based pneumonia casemanagement
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Impact of Post-natal interventions
Source: Darmstadt et al., 2008
Intervention Reduction in Neonatal Mortality
Global Sub-Saharan
Africa
South Asia
Clean home childbirth, clean cord care & Community-based care of low birth weight babies
6-19% 5-18% 7-21%
Community-based pneumonia management
4-12% 5-13% 4-12%
Emergency neonatal care 9-24% 8-23% 10-26%
ALL POSTNATAL CARE 17-39% 16-38% 18-42%
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Impact of Post-natal Interventions
• Mortality in those who received a post-natal visit on first day of life was 67% lower
• The home visits have improved coverage of key newborn care practices such as early initiation of breastfeeding, exclusive breastfeeding, skin-to-skin contact, delayed bathing and attention to hygiene, such as hand washing with soap and water, and clean umbilical cord care.
Source: Siddhartha Gogia et al., 2008
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1. 2011 Report: Levels and Trends in Child Mortality - Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation.
2. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365:891–900. (Based on 47 DHS surveys conducted from 1995–2003).
3. World Health Organization. The Global Burden of Disease: 2004 update. WHO, Geneva, 2008.
4. Gary L Darmstadt, Neff Walker, Joy Saving et al. Newborn lives in Asia and Africa: Cost and impact of phased scale-up of interventions within the continuum of care. Health Policy and Planning 2008; 23:101-117
5. Siddhartha Gogia, Siddarth Ramji, Piyush Gupta et al. Community Based Newborn Care: A Systematic Review and Meta-analysis of Evidence: UNICEF-PHFI Series on Newborn and Child Health, India. Indian Pediatrics 2011; 48: 537-546
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