Www.lancet.com/series/everynewborn #EveryNewborn EVERY NEWBORN “A healthy start is central to the...

www.lancet.com/series/everynewborn #EveryNewborn

EVERY NEWBORN

“A healthy start is central to the human life course, with birth holding the highest risk of death, disability and loss of development potential, leading to major societal effects.”

Overview of the Series

Mary Kinney, MScon behalf of the Lancet Study TeamNigeria Newborn Health Conference October 23, 2014

Building a movementStrategic use of key moments

xWHO World

Health Assembly

The end of MDGs brings new clarity about what is left behind on the agenda – newborns, adolescents

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Every Newborn Series1) Who has been caring for the baby?

2) Every Newborn: Progress, priorities,

and potential beyond survival

3) Can available interventions end

preventable deaths in mothers,

newborn babies, and stillbirths, and

at what cost?

4) Every Newborn: Health-systems

bottlenecks and strategies to

accelerate scale-up in countries

5) From evidence to action to deliver a

healthy start for the next generation5 articles, 6 comments, 55 authors from 18+ countries, 60+ partner organizations

www.lancet.com/series/everynewborn

http://www.everynewborn.org/

4


WITHIN REACH:ENDING PREVENTABLE CHILD AND MATERNAL DEATHS

Every Newborn Series key actions


We’ve made significant progress toward MDGs

4 & 5, but newborn survival is lagging behind

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, WHO MMR estimates 2014* Maternal mortality ratio annual rate reduction 1990-2013

Average annual rate reduction 1990-2012

Maternal mortality ratio* 2.6%

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

The Every Newborn Action Plan sets new and achievable targets for ending preventable deaths: Newborn deaths,

stillbirths and maternal deaths

http://www.childinfo.org/


How many? Where?

12

Countries with highest neonatal mortality rates

Cen African Rep (40.9)Mali (41.5)DR Congo (43.5)Lesotho (45.3)Angola (45.4)Guinea Bissau (45.7)Somalia (45.7)Sierra Leone (49.5)

Countries with highest numbers of neonatal deaths

1. India (779,000) 2. Nigeria (267,000) 3. Pakistan (202,400) 4. China (157,400) 5. DR Congo (118,100) 6. Ethiopia (87,800) 7. Bangladesh (75,900) 8. Indonesia (72,400) 9. Angola (41,200) 10. Kenya (40,000)

Source: Lancet Every Newborn series, paper 2

The countries with highest neonatal mortality rates

Every year: 2·9 million newborns die2·6 million babies are stillborn287,000 women die from complications in pregnancy and childbirth


12


Countries in dark red are making slowest progress for newborn survival, 29 countries need to at least double progress to meet post 2015 targets

BUT in every region there are countries with rapid progress

Which countries are progressing?

www.everynewborn.org #EveryNewborn

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

8

3 main killers to address: 1. Preterm birth

2. Birth complications

3. Neonatal infections

80% of newborns deaths are in

small babies of which

2/3rds are preterm

Causes of under five deaths 44% are from neonatal causes

http://www.who.int/gho/child_health/en/index.html




Preterm birth

• Antenatal corticosteroids*, preterm labor management• Care including essential newborn care + Kangaroo mother

care

Birth complications

(and intrapartum stillbirths)

• Prevention by skilled attendance and obstetrics*• Care including essential newborn care + resuscitation*

Neonatal infections

• Prevention, essential newborn care especially breastfeeding, Chlorhexidine where appropriate*

• Case management of neonatal sepsis with antibiotics *

1

2

* Prioritised by the UN Commission on Life Saving Commodities for Women and Children

71% of newborn deaths preventable actionable now without intensive care

3

The three main causes of newborn deaths all have effective and feasible interventions = 3 by 2

10


PRIORITIZE DAY OF BIRTH



Source: Lancet Every Newborn series Lawn et al

When?For women, stillbirths, newborns, the time of highest risk is the same

Birth is the time of greatest risk of death and disability Triple return on investment – quadruple if count development outcomes

1.2 million intrapartum stillbirths

>1 million neonatal deaths

~113,000 maternal deaths

75% neonatal deaths

Birth day


Lawn et al http://www.nature.com/pr/journal/

In low income countries the major challenge is still survivalBUT in middle income countries higher disability

Must track and minimise disability as we scale up more complex neonatal care

Beyond newborn survivalThe world you are born into determines your survival and your risk of disability

13


INVEST IN CARE AT BIRTH AND REAP A TRIPLE RETURN


Lives that could be saved per year with universal coverage

Source: The Lancet Every Newborn series, paper 3370,000 lives could be saved in Nigeria each year29,000 women, 250,000 newborns and 97,000 stillborns



CARE AT BIRTH, TRIPLE RETURNHighest impact, Highly cost effectiveBenefits women, stillbirths, newborns

3 MILLION LIVES SAVED PER YEAR Running cost $1.15 per person

Packages for integrated care for women and children

16


TARGET SPECIFIC HEALTH SYSTEM BOTTLENECKS


Health System bottleneck assessment for care around birth and care of small and sick newborns


Major bottlenecks in care of small and sick newborns

Green 1-3 countries, orange 4-5 countries, red 6-8 countries

18


What works in fast progressing countries?

Lessons from countries that have reduced neonatal deaths

Malawi

Workforce planning increases numbers and specific skills

Peru

Financial protection measures including expansion of health insurance

Nepal

Dynamic leadership, innovation and community empowerment

Strategies to systematically scale-up care


High mortality countries → Improve supply, demand, equity and quality

Low mortality countries → Focus on quality and equity, and beyond survival

19


WE KNOW WHAT SHOULD CHANGE?

22%

Adoption curves for global health innovations


22%

Official development assistance for MNCH as tracked by Countdown to 2015

2003 2004 2005 2006 2007 2008 2009 20100.00

1,000.00

2,000.00

3,000.00

4,000.00

5,000.00

6,000.00

7,000.00

Mill

ion

s U

SD

(c

on

sta

nt

20

10

)

ODA for Child Health

ODA for Maternal Health

Value of ODA for MNCH men-tioning newborn search terms: 10%

2003: 67 projects ($51.6 M) mentioning newborn

2010: 1,573 projects ($612.9 M) mentioning newborn

“Stillbirth” or “fetal” missing in donor funding databases


22


COUNT EVERY MOTHER EVERY NEWBORN



Count every newborn

One third of babies have no birth certificate in their first year

The majority of neonatal deaths and almost all stillbirths have no death certificate

Counting programme coverage and quality• Most high impact neonatal care interventions

lack coverage data

www.lancet.com/Series/EveryNewborn

5.5 million babies enter and leave the world without certificates Urgent need to improve birth and death registration

Opportunities with facility-based minimum perinatal dataset and perinatal audit

24


UNPRECEDENTED OPPORTUNITY FOR PROGRESS IS NOW

Every Newborn Action Plan

Get involved! www.everynewborn.org

www.Healthynewborn.org

Will we act on the call?

The time is now!

http://www.everynewborn.org/

http://www.healthynewborn.org/

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