OAN overview

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Opportunities to save 1.16 million African
babies who die each year

• Dr Joy Lawn MB BS MRCP (Paeds) MPH
• Saving Newborn Lives / Save the Children-USA
• For The Opportunities for Africas Newborns Team
• WHO Geneva
• December 14th 2006

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Each year in Africa at least 30 million women
become pregnant
around 250,000 women die of pregnancy-related
causes approximately 1 million babies are
stillborn of which at least 300,000 die during
labour at least 1.16 million babies die in
their first month of life 4 million low birth
weight babies and others with neonatal
complications may live but not reach their full
potential 600,000 babies are infected with HIV
through mother to child transmission
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Why focus on newborns within the context of
Maternal, newborn and child health (MNCH) ?

• Huge numbers of deaths relatively neglected
• Solutions exist now to prevent two-thirds of
  these deaths and some African countries are
  progressing
• MNCH is the backbone of a healthy health system -
  systematically strengthening newborn care builds
  the MNCH continuum of care
• Countries are requesting support

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Opportunities for Africas Newborns

• 60 authors and over 40 reviewers drawn from
  policy makers and program leaders for MNCH in
  Africa
• 9 organisations, under the Partnership

• UN agencies
• UNICEF
• UNFPA
• WHO
• World Bank
• USAID and projects
• ACCESS
• BASICS
• LINKAGES
• MAQ

• Saving Newborn Lives/
• Save the Children
• Academy for Educational Development
• Population Council
• Professional organizations
• International Paediatric Association
• FIGO

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What does the book provide?

• I. Information on Africas newborns
• Where, when and why do they die?
• How many lives could be saved?
• II. An overview of the care needed for mothers,
  newborns and children
• III. The opportunities and practicalities of
  including newborn health in nine existing health
  programmes
• Reaching every mother and baby in Africa with
  essential care
• Examples of countries that are progressing
• Operationalising action and integration
• Data profiles for 46 African countries
• CD ROM with programme and action guides

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Questions

• Every year 1.16 million African newborns die
  where, when and why?
• How many newborns could be saved and what are the
  opportunities now?
• Are African countries progressing in saving
  newborn lives and what can we learn?

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Question 1
Every year 1.16 million African newborns die
where, when and why?
Same number as ALL the babies born in South
Africa, Lesotho, Namibia and Swaziland during
2006
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WHERE do newborns die?
Most die at home - unnamed and uncounted BUT

new data used well can make them
count
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WHERE? African countries with the highest
numbers of newborn deaths
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WHERE? The 10 African countries where newborns
have the highest risk of dying
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WHEN do newborns die?

• The first days of life are the riskiest
• Up to 50 of all newborn deaths are on the first
  day of life - 500,000 African babies dying on
  their birth day
• 75 of newborn deaths are in the first week
• Also the time of highest risk of maternal death

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WHY do African newborns die?
Infections 39
Source Opportunities for Africas Newborns,
2006. Based on vital registration for one country
and updated modeling using the CHERG neonatal
methods for 45 African countries using 2004
birth cohort, deaths and predictor variables.
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Question 2
How many African newborns could be saved and what
are the opportunities now?
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Question 2
How many African newborns could be saved and what
are the opportunities now?
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Policy Opportunities for newborns in African
countries
Millennium Development Goals MDG 4 Child
survival MDG 5 Maternal health MDG 6
HIV/AIDS, malaria MDG 8 Partnership
Directly linked to newborns
African Union Maternal and Newborn Survival Road
Map Since 2004 35 of 46 countries have started a
national Road Map to accelerate progress to
reduce Maternal and Newborn deaths
WHO, UNICEF and World Bank Framework for Child
Survival under development, linking to the
African Union
Source Opportunities for Africas Newborns based
on data from WHO AFRO
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Examples of solutions to save newborn lives now
Avoiding adolescent pregnancy and spacing
pregnancies by at least 24 months

• Focused antenatal care including
• Tetanus immunisation,
• Malaria control
• Prevention of mother-to-child transmission of HIV

Clean and safe childbirth care with a skilled
attendant, ensuring that midwives can care for
mothers and babies
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Examples of solutions to save newborn lives now
Breastfeeding promotion and support

• Keeping babies warm, especially preterm babies
  Kangaroo mother care

Treating newborn infections with antibiotics
for example through IMCI
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Lives can be saved now
If the essential interventions in The Lancet
Newborn Survival series reached 90 of African
women and babies then 67 of newborn deaths could
be prevented 800,000 babies could be saved
per year in Africa alone, one-third
through family behaviours and community care

Additional cost of 1.39 per capita per year
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BUT coverage along the continuum of care in
sub-Saharan Africa is low
The days of highest risk have the lowest
coverage of care
63 of African women give birth at home.
Postnatal care is only measured for home births
in most Demographic and Health Surveys. Source
Opportunities for Africas Newborns, inputs from
28 African DHS from 1998-2005
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Integrated packages that reduce newborn deaths in
Africa
26- 51 NMR reduction
10 - 30 NMR reduction
14 - 32 NMR reduction
Childhood
Newborn/postnatal
Pre-pregnancy
Pregnancy
Birth
For health systems with higher coverage and
capacity
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Health system reality
Sick baby and child care in hospital
Childbirth
Postnatal and newborn care
Antenatal
Routine Postnatal care package
PMTCT of HIV
Family planning
IMCI
Behaviour Change and community mobilisation,
community IMCI
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Missed opportunities in Antenatal care in sub
Saharan Africa
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Progress for essential MNCH packages in sub
Saharan Africa 1990 to 2000
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Question 3
Are African countries progressing in saving
newborn lives and what can we learn?
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Meeting MDG 4 in Africa?
MDG 4 target for 2015
New hope for reducing under five deaths! Over the
last year several large African countries have
reported reductions of 25 or more in under five
deaths
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Not all countries are the same e.g. Eritrea
MDG 4 target for 2015
Steady progress for over 20 years with 4
average annual reduction in under five
mortality Now 30 of under 5 deaths are neonatal
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Not all countries are the same e.g. Tanzania
MDG 4 target for 2015
Limited progress in the 80s and 90s but
recently have seen a 30 decline in under 5
mortality and 25 decline in neonatal
mortality Now 30 of under 5 deaths are neonatal
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Not there yet - but progressing to lower newborn
deaths despite poverty
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400
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What can we learn?

• Eritrea Strong commitment to MNCH, elimination
  of neonatal tetanus, Road Map developed
• Malawi Health sector reform, national consensus
  on health package priorities and costing with
  harmonized investment by donors including human
  resource planning
• Burkina Faso High level advocacy using REDUCE
  model, removed user fees for obstetric emergency

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What can we learn?

• Tanzania Decentralized decision making and
  funding to district level, matching investment
  with local scale up
• Uganda Newborn health detailed in the Health
  sector plan, district health results published in
  national newspapers
• Madagascar Consistent scaling up of community
  programs, promotion of MNCH integration

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Countries that are progressing A,B,C,D
A ccountable leadership, champions for MNCH B
ridging the gap between national policy and
district action C ommunity and family
empowerment D emonstrated commitment to Making
focus on high coverage of essential
interventions Mobilising resources, pro- poor
financing Maximising human resource
potential Measuring progress, using data for
decision making, equity
assessment
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Steps to save newborn lives

• Implement phased plans
• Strengthen existing MNCH packages especially
  intrapartum care
• Identify and address missed opportunities for
  saving newborn lives through existing programmes
• Integrate with other programmes (HIV, malaria,
  immunisation)
• Address key gaps either in packages of care
  (postnatal) or for certain underserved
  populations
• Use of existing data and improve future data for
  decision making

A healthy newborn changes the future! Count every
newborn and make every newborn count!
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Thank you !