Version Jan 2013 Why Every Newborn ? 44 percent of all under five - - PowerPoint PPT Presentation

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

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We know the causes of newborn deaths

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

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3 main killers to address: 1. Preterm birth 2. Birth complications 3. Neonatal infections

Pneumonia 5% Prematurity 14% Birth asphysia and birth trauma 10% Neonatal sepsis 5% Congenital anomolies 4% Neonatal tetanus 1% Other conditions 3% Diarrhoea 1% Diarrhoea 9% Measles 2% Malaria 7% HIV/AIDS 2% Injuries 4% Non-communicable diseases 8% Other conditions 13% Pneumonia 13%

Neonatal 44%

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

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Family/community Outreach/out patient Clinical

antenatal care postnatal care early postnatal home visits for mother and newborn cleaner, safer birth adolescent health at home and school child health care

• bstetric 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

• ngoing care for

the child at home pregnancy home visits

There are proven interventions within RMNCH continuum of care

Childhood Newborn/postnatal Birth Pregnancy Pre-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

• f 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

500000 1000000 1500000 2000000 2500000

Basic antenatal care Advanced antenatal care Quality care at birth

Deaths averted

Stillbirths Maternal deaths Neonatal deaths

NEW NEONATAL MORTALITY TARGET Unless we greatly accelerate newborn survival efforts, goal to end preventable child deaths by 2035 unreachable

10 20 30 40 50 60 70 80 90 100 1990 1995 2000 2005 2010 2015 2020 2025 2030 2035

Mortality rate (per 1,000 live births)

2000-2012 AAR = 2.7%

Proposed NMR target: National NMR of 10 or less Global NMR of 7

2000-2012 AAR = 3.8%

Global U5MR Global NMR APR target:

National U5MR of 20 or less Global U5MR of 15 Business as usual: U5MR

AAR = 4.3%

Business as usual: 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

5 10 15 20 25 1995 2000 2005 2010 2015 2020 2025 2030 2035 Global average stillbirth rate (per 1,000 total births)

2000-2009 ARR = 1.3%

ARR = 3.5%

Scenario 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

Business as usual: SBR

Proposed SBR target: National SBR of 10 or less Global 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 rate Av 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 leadership

Good governance, community participation, partner alignment

Integration

Integrated service delivery, continuum of care, programme coordination

Equity

Universal coverage, closing the equity gap

Accountability

Transparency,

• versight

Innovation

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

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

• pportunity 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_adoles cent/topics/newborn/enap_consultation/en

• r email everynewborn@who.int

For more information

visit www.everynewborn.org