Africa: 'No Excuse' for Newborn Death Rate

Cape Town — A series of papers published on Tuesday is laying the ground for concerted international action to reduce deaths among newborn babies – which reach their highest levels in sub-Saharan African countries.

Nine of the 10 riskiest countries in the world for a baby to be born are in Africa , the authors note.

"There has been a fatalistic acceptance from both communities and governments", Professor Joy Lawn, a Ugandan-born pediatrician at the London School of Hygiene and Tropical Medicine, told AllAfrica in a telephone interview.

A lead author of the series, Lawn says it is not inevitable that an African baby has the worst chance of survival . "Some of the poorest African countries have made the most progress in reducing newborn deaths, by picking simple things to do and doing them well."

She says over 70 percent of newborn deaths are preventable with currently available techniques. And in addition to saving the lives of newborns, applying the proven strategies will save the lives of mothers and improve the prospects for babies that would have survived but will also benefit from the interventions.

In 2012, the world's worst death rate for newborns was in Sierra Leone, with 49.5 deaths for every 1,000 live births. In Somalia and Guinea-Bissau, it was 45.7 deaths for every 1,000 live births, and only marginally better in the other African countries in the group: Angola, 45.4; Lesotho, 45.3; the Democratic Republic of Congo, 43.5; Mali, 41.5; the Central African Republic, 40.9; and Cote d'Ivoire, 39.9. Pakistan was the only non-African country in the world's worst 10.

"If current trends continue," a press release accompanying the studies says, "it will be over a century before a baby born in Africa has the same chances of survival as a baby born in North America or Europe."

The studies also show that Nigeria is one of three countries in the world – with India and Pakistan – which, with the highest number of births, also have the highest overall numbers of newborn deaths, and which have made slowest progress in reducing the death rate. Newborn deaths in Nigeria total 267,000 a year; for India the figure is 779,000 and Pakistan 202,400. The Democratic Republic of Congo is in the top five countries for newborn deaths, with 118,000 babies dying a year.

The studies name Nigeria, the DR Congo, Ethiopia, Tanzania and Uganda as among the 10 countries with the highest potential for overall numbers of newborn lives to be saved.

Lawn points to Rwanda and Malawi as examples of what public health policies can achieve, even in the poorest countries, if governments have the political will. Rwanda over the past decade has reduced newborn deaths more than any low-income country in the world – not just in Africa.

Malawi, Lawn says, which is among the world's poorest countries, "has reduced newborn deaths about three times as fast as the average in Africa – partly by providing better care for women, including better antenatal (afterbirth) care, and also by targeting newborn babies." Among the strategies are such easy, affordable interventions as Kangaroo Care – placing pre-term newborns against the mother or other caregiver, skin-to-skin. It can be done anywhere, without medications or electricity or specialized skills.

There are also low-cost medical therapies that have been developed, such as a class of drugs known as antenatal corticosteroids that can be given to a mother before birth – for about 50 cents – to improve the maturity of babies lungs. "A single injection", Lawn says, "can halve the risk of a baby developing lung complications. It's very evidence based."

The studies have been published in papers in the British medical journal, The Lancet, as the annual World Health Assembly – the decision-making body of the World Health Organisation (WHO) – gets under way in Geneva. The assembly will be asked to endorse an "action plan to end preventable deaths" arising from the evidence in the papers.

The global coalition of organisations involved in the initiative – including WHO, the UN Childrens' Fund, the Bill and Melinda Gates Foundation and Save the Children – say the series of papers "paint the clearest picture to date of a newborn's chance of survival and the steps that must be taken to end preventable infant deaths."

They add that nearly three million newly-born children die each year worldwide, and another 2.6 million babies are stillborn: "Nearly half of these deaths occur during labour and almost all go unrecorded."

Efforts to reduce deaths of children under five have been more successful than those to save the lives of newborns, the organisations say. As a result, "in most regions of the world, more than half of child deaths are among newborns."

In a commentary for The Lancet, Melinda Gates and Rwandan health minister Agnes Binagwaho cite an analysis by the Institute for Health Metrics and Evaluation showing that "as many children die in the first week as during the period from one to four years."

A review led by Dr. Gary Darmstadt at the Gates Foundation says that despite "considerable advances" in healthcare for newborn babies, "further progress has been hindered by disappointing levels of investment, poor coordination globally and with countries, and inadequate translation of attention into effective national policies, health care programmes, and evaluation and monitoring of newborn health…

"Despite the evidence showing that there are feasible and affordable solutions to this problem – which include political prioritisation, increased investment, and concerted country action – poor global leadership, and inadequate coordination, evaluation, and accountability, are hindering progress."

The studies cite specific steps , in addition to kangaroo mother care and steriods, which can improve newborns' chances of survival, including breastfeeding, neonatal resuscitation, and the prevention and treatment of infections – and can be implemented U.S. $1.15 per person per year.

One of the problems the studies highlight is that in most countries, babies who are stillborn do not get birth and death certificates.

The result, says Lawn, is that "most of the world's newborn deaths and almost all stillbirths enter and leave the world without a piece of paper to record their existence. "This, she says, "signifies acceptance that these deaths are inevitable, and ultimately leads to inaction…"

What these studies show, Lawn says, "is that there is no excuse anymore for fatalism. Our fate is in our hands."

The research for The Lancet's papers was led by Professor Lawn and Professor Zulfiqar Bhutta of the Hospital for Sick Children, Canada, and the Aga Khan University, Pakistan, in collaboration with more than 54 experts from 28 institutions in 17 countries.



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