maneesh batra md, mph
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Newborn health and survival Overview & Case Study Kiwoko , Uganda GH/HSERV 544 MCH in Developing Countries. Maneesh Batra MD, MPH. Jan 12, 2012. Goals. Provide an overview of the current status of Newborn Survival in the world - PowerPoint PPT PresentationTRANSCRIPT
NEWBORN HEALTH AND SURVIVAL
OVERVIEW & CASE STUDY
KIWOKO, UGANDAGH/HSERV 544MCH IN DEVELOPING COUNTRIES
Maneesh Batra MD, MPHJan 12, 2012
Goals Provide an overview of the current
status of Newborn Survival in the world
Place Newborn Survival within the context of Childhood Survival in the world
Provide an in-country example Highlight potential areas for
intervention to improve Newborn Survival
The Newborn Period is Risky - Pop Quiz
Each year _ million children (<5 yrs old) die~8.8 million
Each year _ million infants (<1 yr old) die~5.9 million
Each year _ million newborns (<1 mo old) die~3.6 million = 10,000 per day!
How many die within the first 24 hrs of life ?~1.8 million
Black, 2010
Millennium Development Goals
2000 UN Millennium Declaration:1. Eradicate extreme poverty and hunger2. Achieve universal primary education3. Promote gender equality and empower women4. Reduce child mortality5. Improve maternal health6. Combat HIV/AIDS, malaria and other diseases7. Ensure environmental sustainability8. Develop a global partnership for development
MDG-4 “Reduce Child Mortality by 2/3 between 1990 and 2015”
Lawn Sem Peri 2010
Is It Possible to Change This Trend?
Childhood Deaths…Where?
Black, Lancet 2010
Childhood Deaths…Why?
Black, Lancet 2010
Lawn, IJGO 2010
Half of neonatal deaths occur on day 1
Neonatal Deaths – Why?
• Physiologic adjustments and adaptation to extrauterine life:• Establish breathing• Change fetal circulation to newborn• Body temperature regulation• Feeding and digestion• Immune system development
• Recognizing illness is a challenge
• Majority of births occur at home
Neonatal Deaths – Where?
66% in 10 countries 99% in low/middle income countries Majority of deaths occur in-home, not in a
health facility
Causes of Neonatal Deaths
Lawn, Sem Peri 2010
Lawn, Sem Peri 2011
Neonatal Deaths – Why?
60-80% of neonatal deaths occur in babies with birth weight <2500g
Risk of early death: 1500-2499g, 6 times greater <1500g, 100 times greater
~3 million newborn deaths can be prevented with low-cost, low-tech interventions ~$1 per inhabitant per year! Marginal cost of adding neonatal resuscitation training and
equipment for midwives: <$0.02 per capita per year Most deaths could be prevented with simple interventions such
as: Thermoregulation Breast feeding, Kangaroo care Early treatment of infections A very small minority of patients require costly intensive care
How…
Lawn, IJGO 2010
Risk of Mortality Peaks Around Childbirth
ChildhoodNewborn/postnatalPre-pregnancy Pregnancy Birth
Maternal deaths
StillbirthsNewborn deaths
Child Deaths
Courtesy of ZA Bhutta
Kiwoko, Uganda
Case Study
Setting - Uganda
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Population: 27 million 84% rural
Languages: English, Luganda, Swahili
Literacy Rate: 69% (male), 59% (female)
Per capita GNP: $270 Fertility rate: 7.1 (5th in world) Malnourished Children: 26% Life expectancy: 42 years
Setting - Uganda
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Per Capita Govt healthcare spending: $5
NMR: 29/1000 live births Annual Neonatal Deaths 40,900
IMR: 88.3/1000 live births
U5MR: 137/1000 live births
MMR: 435/100,000 live births Annual Maternal Deaths: 6,100
Stillbirths: 31/1000 deliveries
Setting - Uganda
25Opportunities for Africa’s Newborns, 2006
21% of childhood deaths are newborns
Setting – Luwero District
Area: 5773.53 sq. km Population: 492,184 (proj. 2000)
91.1% rural Population within 5 km of a health
services unit: 53%. Doctors to Population Ratio
1:23,438 16 doctors in the district
IMR: 112/1000 live births U5MR: 150/1000 live births
Setting – Luwero District
Immunization Coverage: 46% Stunting Rate: 36% Acute Malnutrition: 7% Antenatal Care
ANC attendance rate: 75 % Delivery by trained staff: 36 %
Access to Safe Water: 42% Latrine Coverage: 54%
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Kiwoko Hospital
Kiwoko Hospital Early 1990s - Abandoned
school into a health clinic by Dr. Ian Clarke
One of 3 hospitals in the district
4 full time doctors Serves population of 500,000 Treats 25,000 people per year 1000 deliveries per year 1500 operations per year Most patients arrive by foot or
bicycle30
Kiwoko Hospital 150-250 beds 8 wards (Peds, Malnutrition, Male, Female, Surgical, TB,
Maternity, NICU) Outreach/Education
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Kiwoko Hospital - Resources
Majority of care by family members
Sporadic electricity Rain + well water Limited vaccine supply
BCG, DTP, Td, Measles, OPV Limited laboratory Limited medication supply Limited blood supply
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Kiwoko Hospital - NICU35
Built by ISIS, opened in 1999
Kiwoko Hospital - NICU36
Primary Diagnoses: LBW, Sepsis, Tetanus, Malaria, Meningitis, Asphyxia, Meconium
Aspiration, Respiratory Distress
Kiwoko Hospital - NICU
20 beds, 3 functioning incubators ½ of admissions inborn Overall Mortality 20-30% Tetanus Mortality 80-90%
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Why do babies die in Luwero?
At Home
Largely unknown magnitude and scope of problem
Barriers to seeking care Knowledge $$$$$$$$$ Impact on family unit What if the baby dies?
Critical point of intervention!39
Why do babies die in Luwero?
In the Hospital In-born
LBW Sepsis Asphyxia
Out-born Delayed presentation LBW Sepsis, Meningitis, Skin infections Tetanus ? Etiology
Majority present with non-specific signs
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World Bank 2003
Improving Newborn Outcomes
Framework Antenatal
Antenatal care Immunization Malaria treatment Maternal nutrition
Birth spacing Breast feeding
counselling
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Improving Newborn OutcomesFramework
Peripartum Skilled birth attendant Immediate newborn care Obstetric emergencies
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Improving Newborn Outcomes
Framework Postpartum
Recognition of illness Appropriate initial stabilization
Prevent hypoglycemia Maintain temperature Eye care Prevent/treat infections
Nutritional management of LBW
Availability of referral care Birth spacing
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Thanks!45