version jan 2013. 44 percent of all under five deaths (2.9 million) are newborns, and another 2.6...
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Version Jan 2013
44 percent of all under five deaths (2.9 million) are
newborns, and another 2.6 million babies are stillborn, yet huge potential for rapid change
with high impact, avoidable, feasible interventions
Country demand for guidance and action to accelerate progress towards MDGs 4 and 5, universal
health coverage, and towards ending preventable deaths among
women and children
For greater effectiveness we must accelerate and harmonize global
response and link to existing initiatives for reproductive,
maternal, child and adolescent health care.
Why Every Newborn?
Photo credit: Save the Children
Source: Adapted from Lawn J,E. et al. 2012. Newborn survival: a multi-country analysis of a decade of change. Health Policy and Planning. 27(Suppl. 3): iii6-ii28. Data sources: UNICEF 2012 www.childinfo.org , UN MMR estimates 2012* Maternal mortality ratio annual rate reduction 190-2010
We’ve made significant progress toward MDGs 4 & 5, but newborn survival is lagging behind
Average annual rate reduction 1990-2012
Maternal mortality ratio* 4.2%
Children aged 1- 59 months 3.4%
Neonatal mortality (newborn, first 4 weeks after birth)
2.1%
Stillbirths (last 3 months of pregnancy)
1.0%(1995-2009)
At least 40% slower for newborn survival and
slower still for stillbirths
3
We know the causes of newborn deaths
Data source: Cause of death - WHO. Global Health Observatory http://www.who.int/gho/child_health/en/index.html); Child deaths - UN Inter-agency Group for Child Mortality Estimates. Levels and Trends in Child Mortality. Report 2013; Stillbirths - Lawn et al The Lancet stillbirth series 2011. 377 (9775) p1448 – 1463
4
3 main killers to address: 1. Preterm birth 2. Birth complications 3. Neonatal infections
Pneumonia5%
Prematurity14%
Birth asphysia and birth trauma
10%
Neonatal sepsis5%
Congenital anomolies4%
Neonatal tetanus1%
Other conditions3%Diarrhoea
1%
Diarrhoea9%
Measles2%
Malaria7%HIV/AIDS
2%
Injuries4%
Non-communicable diseases
8%
Other conditions13%
Pneumonia13%
Neonatal44%
Two-thirds of neonatal deaths
are preventable
We have the knowledge and tools to reduce the main causes of death
Preterm birth
• Preterm labor management including antenatal corticosteroids*
• Care including Kangaroo mother care, essential newborn care
Birth complications
(and intrapartum stillbirths)
• Prevention with obstetric care *• Essential newborn care, and resuscitation*
Neonatal infections
• Prevention, essential newborn care especially breastfeeding, Chlorhexidine where appropriate*
• Case management of neonatal sepsis *
1
2
* Prioritised by the UN Commission on Life Saving Commodities for Women and Children
Over two-thirds of newborn deaths preventable – actionable now without intensive care
3
Fam
ily/c
omm
unity
Out
reac
h/ou
t pa
tient
Clin
ical
antenatal care postnatal care
early postnatal home visits for
mother and newborn
cleaner, safer birth
adolescent health at
home and school
child health care
obstetric and childbirth care including essential newborn care
emergency newborn care
reproductive health care
reproductive health care
intersectoral Improved living and working conditions including housing, water and sanitation, and nutrition Education and empowerment
emergency child care
ongoing care for the child at home
pregnancy home visits
There are proven interventions within RMNCH continuum of care
ChildhoodNewborn/postnatalBirthPregnancyPre-pregnancy Birth
Time around birth is critical window of opportunity to prevent and manage complications
Reproductive health care
Treatment for pregnancy
complications
Pre-conception
care
Care during pregnancy
• Labour monitoring; childbirth care• Not breathing at birth: Resuscitation• Obstruction/Fetal distress: caesarean section,
vacuum• Preterm labour: corticosteroids, antibiotics for
PPROM
Labour and childbirth care
• Birth: drying, skin-to-skin; first week: early and exclusive breastfeeding, warmth, cord care, hygiene
• Suspected sepsis: Early antibiotic treatment• Preterm/LBW: Kangaroo Mother Care,
breastfeeding support, immediate treatment of suspected infection
Essential newborn care
Care during labour, childbirth and the days following birth
Source: Pattinson R, Kerber K, Buchmann E, et al, for The Lancet’s Stillbirths Series steering committee. Stillbirths: how can health systems deliver for mothers and babies? Lancet 2011; published online April 14. DOI:10.1016/S0140-6736(10)62306-9.
If intervention in pregnancy and at birth reached all families by 2015: 1.4 million newborn
deaths averted (43%)
1.1 million stillbirths prevented (45%)
201,000 maternal deaths averted (54%)
Care at birth gives a triple return on investments by also reducing stillbirths and maternal deaths
0
500000
1000000
1500000
2000000
2500000
Stillbirths Maternal deaths Neonatal deaths
Dea
ths
ave
rted
NEW NEONATAL MORTALITY TARGETUnless we greatly accelerate newborn survival efforts, goal to end
preventable child deaths by 2035 unreachable
19901992
19941996
19982000
20022004
20062008
20102012
20142016
20182020
20222024
20262028
20302032
20340
10
20
30
40
50
60
70
80
90
100
Mor
talit
y ra
te (p
er 1
,000
live
birt
hs)
2000-2012AAR = 2.7%
Proposed NMR target: National NMR of 10 or lessGlobal NMR of 7
2000-2012 AAR = 3.8%Global U5MR
Global NMR
APR target: National U5MR of 20 or lessGlobal U5MR of 15
Business asusual: U5MR
AAR = 4.3%
Business asusual: NMR
Scenario 2035 global NMR 2035 neonatal deaths
If current trends are unchanged 13 1.8 million
Every country to NMR of 10 per 1000 7 0.9 million
Similar to 2/3 reduction in NMR as if a continuation of MDG4
0
5
10
15
20
25
Glo
bal a
vera
ge sti
llbirt
h ra
te
(per
1,0
00 to
tal b
irths
) 2000-2009ARR = 1.3%
ARR = 3.5%
Scenario 2035 global SBR 2035 stillbirths
If current trends are unchanged 15.9 2.2 millionEvery country reaches SBR of 10 per 1000 8.0 1.1 million
Also similar to ≥2/3 reduction in SBR for every country
Business asusual: SBR Proposed SBR target:
National SBR of 10 or lessGlobal SBR of 8
NEW target for stillbirths and a maternal mortality target is in process
We can bend the curve: proof of impact at scale even in low income countries
MDG 4 MDG 5 Neonatal mortality rateAv annual change 2000-2010
Rwanda Progressing 6.2%
Bangladesh 4.0%
Nepal 3.6%
Malawi Progressing 3.5%
Source: Newborn survival decade of change analysis: Health Policy and Planning. 27(Suppl. 3) papers 3 to 7
Over the last decade, 77 countries reduced NMR by >25%, including at least 13 low income countries:
Bangladesh, Bolivia, Eritrea, Guatemala, Indonesia, Nepal, Madagascar, Malawi, Morocco, Senegal, Rwanda, Tanzania, Vietnam
A global roadmap for change…
A movement for greater action and accountability…
A platform for harmonized action by all partners…
Sets out a clear vision with mortality target, strategic directions, and innovative actions within the continuum of care
Supported by new evidence to be published in The Lancet in May 2014
The Every Newborn Action Plan: building a movement
Photo credit: Save the Children
Every Newborn’s strategic framework
Every Newborn’s guiding principles
Country leadershipGood governance, community
participation, partner alignment
IntegrationIntegrated service delivery, continuum
of care, programme coordination
EquityUniversal coverage, closing the equity
gap
InnovationInterventions, delivery approaches,
technologies
Every Newborn’s strategic objectives
Strengthen and invest in care during labour, child birth and the first day and week of life
Improve the quality of maternal and newborn care
Reach every woman and every newborn; reduce inequities
Harness the power of parents, families and communities
Count every newborn – measurement, tracking and accountability
Family Planning 2020
A Promise Renewed
Country leadership & Implementation
Global action plans: Every Newborn, scaling up nutrition, global action plan for pneumonia & diarrhea, vaccines,
WASH for all, and others
Visit www.everywomaneverychild.org
Key catalytic initiatives in support of Every Woman Every Child
Commission on Information and Accountability and independent Expert Review Group
Every Newborn supports the Global Strategy
Who? Global mechanisms for coordinated action and advocacy Some examples:
UN Commission on Life Saving Commodities
Health Sector Strategic & Investment Plan
Integrated National RMNCH Plan
Increasing access and use of FP
Ending preventable
newborn deaths
Ending preventable deaths from pneumonia and
diarrhoea (GAPPD)
Ending preventable
maternal deaths
Every Newborn prioritizes focus on birth within existing national strategies and plans; not a new stand alone plan
Countries, donors, civil society groups, professionals, and businesses are leading this effort in support of Every Woman Every Child. Every Newborn builds on key platforms like FP2020, A Promise Renewed, the Commodities Commission, and Commission on Information and Accountability.
A comprehensive consultation process whereby all stakeholders are given an opportunity to feed into the plan and countries identify specific bottlenecks and solutions
All stakeholders have a role to play
Photo credit: Save the Children
April 2013 – June 2014 National and regional consultation and technical
inputs to the development of the plan
20-25 January 2014 Discussed at the WHO Executive Board
February 2014 Open consultation on draft Every Newborn by
stakeholders and inputs incorporated into final draft
May 2014 Lancet series (update from 2005 and giving the
analyses which are the basis for the Every Newborn)
Draft plan presented to the 67th World Health Assembly
June 2014 Action Plan launched at PMNCH Partners’ Forum,
Johannesburg
Every Newborn Process
Photo credit: Save the Children
We are building a movement…
All stakeholders have a role to play…
Get involved!Join the online consultation
now at: http://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en
or email [email protected]
For more informationvisit www.everynewborn.org