Transcript Diapositive 1 - Healthy Newborn Network

Version Jan 2013
Why Every Newborn?
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.
Photo credit: Save the Children
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)
At least 40% slower for
newborn survival and
slower still for stillbirths
1.0%
(1995-2009)
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
3
We know the causes of newborn deaths
Pneumonia
5%
Pneumonia
13%
3 main killers to address:
1. Preterm birth
2. Birth complications
3. Neonatal infections
Prematurity
14%
Neonatal
44%
Other conditions
13%
Birth asphysia and
birth trauma
10%
Non-communicable
diseases
8%
Neonatal sepsis
5%
Injuries
4%
HIV/AIDS
2%
Two-thirds of neonatal
deaths
are preventable
Congenital anomolies
4%
Malaria
7%
Measles
2%
Diarrhoea
9%
Diarrhoea
1%
Neonatal tetanus
Other conditions 1%
3%
Data source: Cause of death - WHO. Global
Health Observatory
http://www.who.int/gho/child_health/en/in
dex.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
We have the knowledge and tools to reduce the
main causes of death
• Preterm labor management including antenatal
corticosteroids*
• Care including Kangaroo mother care, essential
newborn care
1
Preterm birth
2
Birth
complications
(and intrapartum
stillbirths)
3
Neonatal
infections
• Prevention with obstetric care *
• Essential newborn care, and resuscitation*
• Prevention, essential newborn care especially
breastfeeding, Chlorhexidine where appropriate*
• Case management of neonatal sepsis *
* 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
Clinical
obstetric and childbirth care
including essential newborn care
emergency
newborn care
emergency child
care
reproductive
health care
antenatal care
postnatal care
child health care
early postnatal
home visits for
mother and
newborn
ongoing care for
the child at home
Family/community
reproductive
health care
Outreach/out
patient
There are proven interventions within RMNCH
continuum of care
adolescent
health at
home and
school
intersectoral
Pre-pregnancy
pregnancy
home visits
cleaner,
safer birth
Improved living and working conditions including housing, water and sanitation, and nutrition
Education and empowerment
Pregnancy
Birth
Birth
Newborn/postnatal
Childhood
Time around birth is critical window of opportunity
to prevent and manage complications
Care during labour, childbirth and the
days following birth
Labour and childbirth care
Reproductive
health care
Treatment for
pregnancy
complications
Preconception
care
• Labour monitoring; childbirth care
• Not breathing at birth: Resuscitation
• Obstruction/Fetal distress: caesarean section,
vacuum
• Preterm labour: corticosteroids, antibiotics for
PPROM
Care during
pregnancy
Essential newborn 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
Care at birth gives a triple return on investments by also
reducing stillbirths and maternal deaths
Stillbirths
Maternal deaths
Neonatal deaths
Deaths averted
2500000
2000000
1500000
1000000
500000
0
Basic antenatal
care
Advanced
antenatal care
Quality care at
birth
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%)
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.
Mortality rate (per 1,000 live births)
NEW NEONATAL MORTALITY TARGET
Unless we greatly accelerate newborn survival efforts, goal to end
preventable child deaths by 2035 unreachable
100
APR target:
90
National U5MR of 20 or less
Global U5MR of 15
80
70
2000-2012
AAR = 3.8%
Global U5MR
Proposed NMR target:
National NMR of 10 or less
Global NMR of 7
Business as
usual: U5MR
60
50
40
Business as
usual: NMR
30
20
Global NMR
2000-2012
AAR = 2.7%
10
0
1990
AAR = 4.3%
1995
2000
Scenario
2005
2010
2015
2020
2025
2030
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
2035
NEW target for stillbirths and
a maternal mortality target is in process
25
Business as
usual: SBR
Proposed SBR target:
National SBR of 10 or less
Global SBR of 8
Global average stillbirth rate
(per 1,000 total births)
20
2000-2009
ARR = 1.3%
15
ARR = 3.5%
10
5
0
1995
2000
2005
Scenario
2010
2015
2020
2025
2030
2035 global SBR
2035 stillbirths
If current trends are unchanged
15.9
2.2 million
Every country reaches SBR of 10 per 1000
8.0
1.1 million
Also similar to ≥2/3 reduction in SBR for every country
2035
We can bend the curve: proof of impact at scale
even in low income countries
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
MDG 4
MDG 5
Neonatal mortality rate
Av annual change 2000-2010
Progressing
6.2%
Rwanda

Bangladesh


4.0%
Nepal


3.6%
Malawi

Progressing
Source: Newborn survival decade of change analysis: Health Policy and Planning. 27(Suppl. 3) papers 3 to 7
3.5%
The Every Newborn Action Plan:
building a movement
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
Photo credit: Save the Children
Every Newborn’s strategic framework
Every Newborn’s guiding principles
Country leadership
Integration
Equity
Good governance,
community participation,
partner alignment
Integrated service delivery,
continuum of care,
programme coordination
Universal coverage, closing
the equity gap
Accountability
Innovation
Transparency,
oversight
Interventions, 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
Every Newborn supports
the Global Strategy
Country leadership & Implementation
Key catalytic initiatives in support of Every Woman Every Child
Family Planning
2020
UN Commission on Life
Saving Commodities
A Promise
Renewed
Global action plans: Every Newborn, scaling up nutrition,
global action plan for pneumonia & diarrhea, vaccines,
WASH for all, and others
Who? Global mechanisms for coordinated action and advocacy
Some examples:
Commission on Information and Accountability and independent Expert
Review Group
Visit www.everywomaneverychild.org
Every Newborn prioritizes focus on birth within existing
national strategies and plans; not a new stand alone plan
Health Sector Strategic & Investment Plan
Integrated National RMNCH Plan
Increasing
access and
use of FP
Ending
preventable
maternal deaths
Ending
preventable
newborn deaths
Ending preventable
deaths from pneumonia
and diarrhoea (GAPPD)
All stakeholders have a role to play
 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
Photo credit: Save the Children
Every Newborn Process
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
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_adoles
cent/topics/newborn/enap_consultation/en
or email [email protected]
For more information
visit www.everynewborn.org