West and Central Africa Regional Consultation on Global ‘Every Newborn’ Action Plan, 09-11 July 2013 – Dakar,

Senegal.

Status of Newborn Health in the

African Region

Presentation outline

• Why are 3 million newborns dying? Causes of death Risk factors

• Needed change: which interventions and at what level?

• Opportunities

Status of newborn survival

• Neonatal deaths account for 40% of the global 6.9 million under-five deaths

• Of the 3 million newborns who die every year 1.1 million (38%) are from the Sub-Saharan region

• These deaths contribute heavily to the under-five mortality rates disengaging the Region from reaching the targets for MDG4.

Major causes of deaths in neonates and under-five in the African Region, 2010

• Prematurity is a complication to be dealt with starting in pregnancy

• Birth asphyxia needs to be dealt with in the first minutes of life

Why the deaths: Factors that increase risk of death.

• Undernutrition, increases the risk of death and ill-health for both mother and baby, during pregnancy, childbirth and the postnatal period through to early childhood.

• The 24 hours around childbirth and the first day of a baby’s life carry the greatest risk

• Skilled care can make a difference.• Yet only 50% of births are attended to by a skilled health worker

in the African Region

• Inequities in coverage for skilled attendant at birth and other interventions that require a strong health system are much wider in regions with the highest mortality rates, especially sub-Saharan Africa.

World Health Report, 2006

Critical shortage of health service providers (doctors, nurses and midwives)

Focus for improvement for newborn survival

1. Solutions exist now to prevent two-thirds of these deaths and some African countries are progressing

2. Addressing newborn deaths cannot be in isolation but has to be within the backbone of a healthy health system for MNCH

Framework for action: Continuum of care

COMMUNITYHEALTH

FACILITIES SERVICES

Essential newborn care

Identify and treat asphyxia and sepsis

Refer if necessary

Home based maternal, newborn care

Identify danger signs and refer

Seek appropriate care or refer

Facility 1-2 days

Maternal and Newborn

essential post partum care

& emergency first aid or

BEmOC and IMNCI

Facility

Skilled Attendant

Essential Maternal and

Newborn Care Package

Ob-Newborn Emergency First

Aid or BeMOC

Facility Complete ANC

Package

TT Iron folicBlood pressureTreatment of infections IPT if indicatedPMTCT if indicatedManagement or referral of OB complications

Health Facility Model

ANC DELIVERY POST - PARTUM

Emergency Obstetric and Neonatal Care

(Referral if needed)

In Community during 1st week

1. Pregnancy Home Visits

Home based maternal and newborn careCommunity model

Pregnancy - 2 Home Visits

Community Health Worker

registers all pregnant women refer to ANC

Key interventions

health/nutrition education birth preparedness danger sign awareness breastfeeding preparedness provide insecticide treated bednet (where appropriate)

FOCUSED ANC

Tetanus Toxoid

Iron and Folic Tablets

BP and urine test for protein

Foetal Lie

Syphilis (and other STI)detection and treatment

IPT if indicated

PMTCT if indicated

Management or referral of obstetric complications

(EmOC)

2. Delivery

Delivery under skilled care Temperature management Dry, wrap and skin to skin Resuscitation if required Immediate and exclusive breastfeeding

Cord Care Temperature of newborn Birthweight Refer if necessary

3. Post Delivery Care – 2-3 home visits during first week

Home based maternal and newborn careCommunity model

Care of Newborn using checklist: Assess newborn

weight temperature feeding cord care

Assess for sepsis - refer if required Counsel parents on thermal control, exclusive BF, danger signs Refer for vaccination Birth registration

If Low Birth Weight:

give extra care with 2 additional home visits

Kangaroo mother care Keep warm Assist with feeding if needed Attention to hygiene Review danger signs

Care of Mother using checklist: Assess mother

check bleeding check temperature breast problems

Discuss danger signs Nutrition counseling and family planning Refer if necessary

Essential interventions linked to cause of mortality

Asphyxia (27%)

Resuscitation of newborn baby can reduce neonatal mortality by 5-20%

Serious Infections (sepsis) 26% Hygienic cord care, thermal care,

breastfeeding can reduce up to 50% of newborn deaths

Malaria IPT can reduce 10-30% of newborn deaths

Case management pneumonia/sepsis can reduce deaths due to pneumonia by 20-55%

Prematurity and low

birth weight (29%)Extra care for low birth

weight infants including

extra warmth, hygiene,

feeding, can reduce deaths

due to prematurity 20-50 %

Tetanus 7 % Tetanus toxoid can eliminate tetanus

deaths Hygienic cord care can reduce tetanus

deaths by 75-85%

Programmatic progress in the implementation of the outlined packages

By 2012

• 30 out of the 46 WHO African Region countries were implementing the Essential Newborn Care package.

• 22 countries had adopted the community newborn package.

Opportunities: Regional initiatives

The African Union championed advocacy at the highest level through:• Recommendations of the special session on the RMNCH during the

2010 AU meeting held in Kampala Uganda

• The adoption of the Campaign for Acceleration of Reduction of Maternal and Newborn Mortality in Africa (CARMMA) - 2009

Governments have shown committed through increasing of MNCH funding and addressing financial barriers through various strategies like fee waiver, voucher system.

Governments are individually committing to:

• Addressing human resources challenges• Increased efforts to implement the MNCH Roadmaps• Increased efforts to scale up the Child survival Strategies.

Opportunities

Global ‘Every Newborn’ Action Plan

• Opportunity to re-align country orientations for newborn health based on the identified needs.

• Opportunity to rally all towards a common purpose and common deliverables.

• Opportunity to contribute to the Global ‘Every Newborn’ Action Plan.

•T

hank you•

Merci B

eaucoup