Home based newborn care: the Bangladesh experience Professor Mohammad Shahidullah President National Technical Working Committee on Newborn Health President Bangladesh Neonatal Forum Pro-vice Chancellor, and Chairman Neonatology, BSMMU EVERY NEWBORN AN ACTION PLAN TO END PREVENTABLE DEATHS

Outline  Background  National Strategy and Program directives  Evidences on PNC home visit  PNC status in Bangladesh  Status of newborn care in home  Recent Initiatives on Newborn Health in Bangladesh

WHERE? Neonatal deaths Countries Ranking for Numbers of Neonatal Deaths India 1 Nigeria 2 Pakistan 3 China 4 DR Congo 5 Ethiopia 6 Bangladesh 7 Indonesia 8 Afghanistan 9 Tanzania 10 Ref: Lawn JE et al BJOG Sept Data sources: Estimates of neonatal (2008) deaths from WHO. Updated June 2010 Global  3.1 Million newborn deaths in 2010  28% decline in 2 decades Sources: UNICEF. Levels and Trends in Child Mortality: 2011 Report. NY: UNICEF; Bangladesh  newborn deaths in 2011 (CHERG)  49% decline in 2 decades Sources: State of the World’s Mother 2013/SC

2.4% Annual rate of reduction 3.3% Annual rate of reduction 39% 60% Bangladesh Demographic and Health Surveys Bangladesh on track to achieve MDG4 targets well before 2015 Bangladesh is one of 23 countries on track to achieve MDG4 & has the 4 th most rapid rate of decline in child mortality Bangladesh is one of 23 countries on track to achieve MDG4 & has the 4 th most rapid rate of decline in child mortality

Data Source: Bangladesh Demographic and Health Survey 2011 Neonatal Deaths Causes of neonatal deaths in Bangladesh Annual number of deaths:  Neonatal ( 60% of all child deaths)  Neonatal infections38,500  Birth asphyxia21,500  Preterm12,000 (+17,500) Annual number of deaths:  Neonatal ( 60% of all child deaths)  Neonatal infections38,500  Birth asphyxia21,500  Preterm12,000 (+17,500)

Facility Delivery Has Increased But Not Home Delivery By Skilled Attendants Increases in skilled attendance at deliveries has been entirely due to increases in facility deliveries, particularly in private facilities BMMSBDHS

PNC Home Visit 7 NATIONAL NEONATAL HEALTH STRATEGY AND GUIDELINES FOR BANGLADESH Approved in March 2009 STANDARD OPERATION PROCEDURE (SOP) FOR NEWBORN CARE SERVICES Approved in 2011 HEALTH POPULATION NUTRITION SECTOR DEVELOPMENT PROGRAM Prioritized Postnatal Home Visit by Trained Community Health Workers

National Neonatal Health Strategy

Page 7 Page 9 Health, Population, and Nutrition Sector Development Program

The national average of CHWs – 13.5 per 10000, 34% of them are trained in ENC ( 5 per 10000). There is geographical inequity among the distribution of CHWs Distribution of Community Health Worker and ENC trained Community Health Workers Save the Children Study 2011 Distribution of Community Health Workers (all) Distribution of ENC Trained CHWs

Community based PNC OR in Bangladesh (April 2009 to March 2010) %  Early PNC home visit by existing government field workers is feasible.  Birth notification within 24 hours of birth is closely associated with early PNC visit at home and it should be a program priority to ensure early PNC.  Use of multiple field workers is challenging.  Timing of 1st postnatal home visit may be extended up to 2 days instead of 24 hours. Community based PNC OR End-line Report -NIPORT

 In large scale community based MNCH projects trained community volunteers were able to make a home visit to 45% to 85% of home births within 2 days of delivery  These programs covered half of the country MNH DHSS MaMoni MNCH SMPP KOICA MNCS Community Based MNCH programs for Scale-up Community Based ENC with partners suppo rt

Essential Newborn Care Practices in Home

Trends in essential newborn care

Newborn care practices – Drying and Wrapping Source: Bangladesh Demographic Health Survey 2011

Application of material after the umbilical cord was cut Other includes spirits/alcohol, chewed rice, turmeric juice/powder, ginger juice, shidur, gentian violet and talcum powder The recommended practice of applying nothing to the umbilical cord increased slightly, from 56 % in 2007 to 59% in 2011 Source: Bangladesh Demographic Health Survey 2011

Newborn care practices: Timing of first bath Source: Bangladesh Demographic Health Survey 2011

Trend of PNC for newborn from a medically trained provider within two days of delivery Source: Bangladesh Demographic Health Survey 2011

Postnatal Care Practices of Newborn Source: Bangladesh Demographic Health Survey 2011

Coverage by District Data Source- BMMS 2010 Postnatal care visit in Bangladesh  6 District- <20%  14 District –20%-30%  19 District- 30%-40%  25 District - >40%

Recent Initiatives on Newborn Health in Bangladesh Plan for national scale-up of  KMC for preterm babies  Antenatal corticosteroid for preterm labor  Use of 7.1% CHX in newborn umbilicus  Sepsis management in lower level facilities National Scaling-up of HBB initiatives SBA trained

Challenge  Improving knowledge and practices regarding PNC and ENC in geographically remote and hard to reach are  Health workforce shortage  Training of huge numbers of CHWs and quality monitoring of training  Supportive Supervision, monitoring and mentoring for ENC care and PNC  Real time tracking of data through MIS for PNC and ENC

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