Pakistan can save 158,000 newborn lives

Karachi, May, 2014: Each year, 5.5 million babies enter and leave the world without being recorded and one in three newborns – over 45 million babies – do not have a birth certificate by their first birthday. Babies who are stillborn, born too early, or who die soon after birth are least likely to be registered, even in high-income countries. This lack of registration and official recognition reflects acceptance of these deaths as inevitable and is a key reason for slower progress in recent decades in reducing newborn deaths and stillbirths versus reducing maternal and child mortality.

Findings from the "Every Newborn Series", published in The Lancet recently, 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. New analyses indicate that 3 million maternal and newborn deaths and stillbirths can be prevented each year with proven intervention – including the promotion of breastfeeding, neonatal resuscitation, kangaroo mother-care for preterm babies, antenatal corticosteroids, and the prevention and treatment of infections. These interventions can be implemented for an annual cost of US$1.15 per person.

The research was led by Professor Joy Lawn, at the London School of Hygiene & Tropical Medicine and Save the Children, UK, with Professor Zulfiqar Bhutta at the Centre of Excellence in Women and Child Health, the Aga Khan University, Pakistan and Centre for Global Child Health, The Hospital for Sick Children, Canada in collaboration with more than 54 experts from 28 institutions in 17 countries. AKU was also represented by researchers Dr Jai K Das, Rehana A Salam and Arjumand Rizvi.

It provides the foundation for the forthcoming "Every Newborn Action Plan", an evidence-based roadmap towards care for every woman, and a healthy start for every newborn baby, which will be launched in June 2014.

“Evidence and experience from some of the most improved, as well as the worst affected, countries shows that maternal and newborn deaths are preventable,” says Professor Bhutta. “Our research shows that 3 million lives can be saved by 2025 if achievable interventions are scaled up to nearly universal coverage. Improving care at the time of birth gives a triple return on investment – saving mothers and newborns and preventing stillbirths. Care of small and sick newborns is the next highest impact package, yet this has received little attention up to now, despite extremely cost effective solutions such as antenatal steroids and kangaroo mother care.”

A systematic assessment of challenges in eight high-burden countries – Afghanistan, Bangladesh, Democratic Republic of Congo, India, Kenya, Nigeria, Pakistan and Uganda – which together account for more than half of all newborn and maternal deaths revealed important differences as well as several common bottlenecks impeding progress. A team of global health experts, led by Dr Kim Dickson, at UNICEF, USA, undertook detailed consultations with more than 600 health professionals and policy makers in these countries to find that common problems were related to the health workforce, financing, and service delivery. Countries that have made recent, rapid reductions in newborn and maternal deaths – such as Malawi, Nepal, and Peru – have done so by expanding their skilled workforce (especially midwives and nurses), rolling out innovative mechanisms to reach the poorest families, and focusing on improving care for small and sick newborns.

“In Pakistan, the rate of neonatal deaths has not changed for almost three decades. But with the required focus on integrating community-based approaches to newborn care through the Lady Health Workers’ programme, and improved linkages and transfers to district referral facilities, we have the potential in a decade to save 158,000 newborn lives, 80 per cent of all annual newborn deaths,” said Professor Bhutta.

Rooted in the evidence presented in the Series, the Every Newborn Action Plan (ENAP), co-led by the World Health Organization and UNICEF, will be presented at the Partners’ Forum hosted by the Partnership for Maternal, Newborn & Child Health in Johannesburg, South Africa on June 30. The ENAP sets a framework to end preventable deaths for newborns and stillbirths by 2035 as part of the A Promise Renewed effort. It also provides interim targets for 2030 and will lead to practical standards for quality of care, improved measurement of births and deaths, and increased programmatic coverage with accountability for results.

“In 2012, under A Promise Renewed, Pakistan committed to ensuring an accelerated decline in child and maternal mortality, with a special focus on improving neonatal survival,” said Dr Tania Goldner, Chief of Health Section, UNICEF Pakistan. “Under the ENAP framework, the country has a unique opportunity to use the results of the health system bottleneck analysis to identify the needed solutions and actions to scale up newborn care interventions for improved newborn survival and to make child health more equitable across Pakistan.”