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Steve Wall Save the Children Global Newborn Health Conference Johannesburg April 15, 2013
Outline
I. Global shift in care seeking toward facilities I. Quality of facility-based MNH care I. Linkages to community/household care
2010
One in 4 newborns is African
Source: SOWC 2013, UNICEF global databases 2012, from MICS, DHS and other nationally representative sources. http://www.childinfo.org/delivery_care.html Note: Global estimates are based on a subset of 110 countries, covering 82% of births in the developing world. Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate the regional average for CEE/CIS.
40
30 20 10 0 Bangladesh
12 27
36
39
39
18 11
Nepal
Pakistan
Malawi
Uganda
Source: Newborn survival decade of change analysis: Health Policy and Planning. 27(Suppl. 3) papers 3 to 7
90
80 70 Coverage (%) 60 50 40 30 20 10 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 55
73
Assam
Bihar Chattisgarh Jharkhand Madhya Pradesh
55.5
47.7 34.9 37.6 76.1
Odisha
Rajasthan Uttar Pradesh Uttarkhand
71.3
70.2 45.6 50.5
Babies born in facilities with trained staff and equipment for neonatal resuscitation
100%
70%
60%
% of all babies born in facilities with equipment for newborn respiratory support
Percentage
50%
49%
40%
47% 41%
30%
20%
10%
40% Missed Opportunities Quality Gap in Facilities Only 1 of 5 babies born in 22% hospitals have 19% access to 17% Neonatal Resuscitation 12% 8% 7%
28%
15% 10% 2% 6% 8% 8%
0%
Egypt
Ghana
Kenya
Rwanda
Tanzania
Uganda
Original data source: National Service Provision Assessment Surveys, years ranging 2002-2006 Source: Wall S et al, IJGO 2009
Facility Birth quality MN care . . . unless there is Respectful care Skilled staff 24/7 Functional equipment Essential medicines in stock Newborn routine and emergency care signal functions with B/EmOC Standard protocols used Quality control in place
Data Action Measurement
Infection
Prevention: clean delivery, cord care, handwashing, breastfeeding; chlorhexidine Detection and treatment: antibiotics (including at health centers/posts)
Antenatal corticosteroids identification of PTL and1st dose ACS at peripheral facility, referral
KMC provide space, support to mothers/families Chlorhexidine ? high mortality settings, poor hygiene, early discharge Safe birth checklist ? Increase newborn health components Treatment of routine sepsis/pneumonia at health centers/posts (pending evidence from simplified antibiotic trials (2013-14)
- Oxytocin augmentation of labor (without monitoring) risk of uterine rupture, intrapartum stillbirth, birth asphyxia
- Routine suctioning of all newborns potential to depress breathing and heart rate needlessly; use only when necessary, as indicated - Routine or frequent separation of mothers and newborns immediately after birth (all too common with newborn corner, stabilization units, etc)
- Elective c-section prior to 39 weeks major contributor to high preterm rates, increased newborn morbidity and mortality
Referrals
Community referral systems
Community awareness and leadership Birth/emergency preparedness, Transport Community funds Trained CHWs to accompany mothers/newborns
Many/most mothers & newborns are discharged (or leave facility) within hours of delivery
Need to ensure pre-discharge examination of mother & baby (including breastfeeding); counseling to mother re: home care practices, danger signs; contact CHW for home visit Need to ensure early postnatal home visits (ie, within 1- 2 days) by trained health worker - check on mother and baby, refer for danger signs, counsel on home care practices
Integrated Family Health Initiative (Bihar, India). Facility Assessment Direct Observation: Baseline 2012
Integrated Family Health Initiative (Bihar, India). Facility Assessment Direct Observation: Baseline 2012
Pre-discharge checklist
Breastfeeding assessment Assess mother & baby Provide counseling (eg, danger signs)
M-health
SMS to link facility discharge to early CHW home visit
We can make it happen: High coverage, high quality, and high demand for facility-based maternal-newborn care
Changing expectations
(From the SNL evaluation team visit to Nysamba Hospital, Uganda)
SNL supported training of midwives, nurses, clinical officers, and physicians in management of labor & delivery and essential newborn care.
Much to do
- Together we can make it happen. - Thanks