Neonatal survival in Malawi Queen Dube Consultant Paediatrician Queen Elizabeth Hospital Blantyre Doug Simkiss Associate Professor of Child Health Warwick Medical School University of Warwick

MDG 4 – how is progress? These first three slides were used in module 1 and recap why tackling neonatal mortality is so important: The NMR is not falling as fast as U5MR and so now makes up 40% of all U5 deaths (next slide)

MDG 4 – how is progress? Neonatal deaths are falling, but not quickly. In 2008 neonatal deaths made up more than 40% of all under 5 deaths globally – 3.6 million neonates died that year. To make progress with MDG 4 we must tackle neonatal mortality

What are the major causes of neonatal deaths This last introductory slide highlights prematurity as an important cause of neonatal deaths (arrow)

Premature babies – global Slides 5 – 15 are taken from the Born too soon report. This slide emphasises that most preterm births are from 32-37 weeks gestation (more than 80%) and that more than three quarters of these deaths can be prevented by simple technologies without intensive care

Premature babies - numbers This slide show the estimated numbers of preterm births in the world. It’s main point is to heighten the impact of the next slide...

Premature babies – birth rate Here is the impact – by preterm birth rate Malawi is the country with the highest rate (around 18%) in the world. This is a very important issue in Malawi and for these advanced leaders.

This is a complicated slide but hopefully worth spending time on This is a complicated slide but hopefully worth spending time on! I would start in the middle. There are about 136 million births a year in the world, 120 million at term, but 4% of these (5 million) weigh less than 2.5 kg. These children need essential neonatal care – what do the students believe this should be? I would write up their answers for later. There are 12.6 million babies born between 32 and 37 weeks gestation. These babies need extra care for small babies. What do the students think that care should be? Again I would write up their answers to come back to later. Then I would look at the 1.6 million babies born between 28 and 32 weeks and the 780,000 born less than 28 weks gestation and discuss what they are likely to need, what is available in Malawi and the importance of focussing resources on the 32-37 week gestation babies at this point in the development of the health care system. Then I would turn to the right hand side of the slide and discuss with the students the loss of human capital of stillbirths and neonatal deaths.

This slide is aiming to be both encouraging – more neonates including premature neonates are surviving – and a challenge – the fall in the rate of death of preterm infants lags behind other neonates. We need to focus on good care of premature infants in all our nurseries.

I would go through this slide slowly – it outlines why premature infants die and therefore forms the basis of the rest of the training on this neonatal day.

The arrows on the right show what we will discuss in terms of interventions to reduce deaths among premature infants.

Priority evidence based packages and interventions This slides picks up on the terminology used in slide 8 – Essential Newborn Care for all babies, extra care for small babies and care for preterm babies with complications and shows the evidence basis for our interventions. We will look at these in more detail through the day.

This slides what technology we have at present to intervene This slides what technology we have at present to intervene. I would like the group to go down the list and see if all is available and, if not, why not.

Missed opportunities This slide is a management slide (if you like)! What it is saying is we have the interventions available along the bottom but have 1. in adequate coverage in the population and 2. inadequate provision in facilities. I would like the group to discuss this from their own perspectives and think about how to rectify the situation in their districts.

Here are some ideas on the issues discussed with the last slide that the students could consider for action locally

Neonatal survival in Malawi What can you do? A challenge to end this introductory session