West and Central Africa Regional Consultation on Global ‘Every Newborn’ Action Plan, July 2013 – Dakar, Senegal. Status of Newborn Health in the African Region

Presentation outline Why are 3 million newborns dying?  Causes of death  Risk factors Needed change: which interventions and at what level? Opportunities

Status of newborn survival Neonatal deaths account for 40% of the global 6.9 million under-five deaths Of the 3 million newborns who die every year 1.1 million (38%) are from the Sub-Saharan region These deaths contribute heavily to the under-five mortality rates disengaging the Region from reaching the targets for MDG4.

Major causes of deaths in neonates and under-five in the African Region, 2010 Prematurity is a complication to be dealt with starting in pregnancy Birth asphyxia needs to be dealt with in the first minutes of life

Why the deaths: Factors that increase risk of death. Undernutrition, increases the risk of death and ill-health for both mother and baby, during pregnancy, childbirth and the postnatal period through to early childhood. The 24 hours around childbirth and the first day of a baby’s life carry the greatest risk Skilled care can make a difference. Yet only 50% of births are attended to by a skilled health worker in the African Region Inequities in coverage for skilled attendant at birth and other interventions that require a strong health system are much wider in regions with the highest mortality rates, especially sub-Saharan Africa.

World Health Report, 2006 ) Critical shortage of health service providers (doctors, nurses and midwives)

Focus for improvement for newborn survival 1.Solutions exist now to prevent two-thirds of these deaths and some African countries are progressing 2.Addressing newborn deaths cannot be in isolation but has to be within the backbone of a healthy health system for MNCH

Framework for action: Continuum of care COMMUNITY HEALTH FACILITIES SERVICES  Essential newborn care  Identify and treat asphyxia and sepsis  Refer if necessary  Home based maternal, newborn care  Identify danger signs and refer  Seek appropriate care or refer

Facility 1-2 days Maternal and Newborn essential post partum care & emergency first aid or BEmOC and IMNCI Facility Skilled Attendant Essential Maternal and Newborn Care Package Ob-Newborn Emergency First Aid or BeMOC Facility Complete ANC Package  TT  Iron folic  Blood pressure  Treatment of infections  IPT if indicated  PMTCT if indicated  Management or referral of OB complications Health Facility Model ANCDELIVERYPOST - PARTUM Emergency Obstetric and Neonatal Care (Referral if needed) In Community during 1st week

1.Pregnancy Home Visits Home based maternal and newborn care Community model Pregnancy - 2 Home Visits Community Health Worker  registers all pregnant women  refer to ANC Key interventions   health/nutrition education  birth preparedness  danger sign awareness  breastfeeding preparedness  provide insecticide treated bednet (where appropriate) FOCUSED ANC Tetanus Toxoid Iron and Folic Tablets BP and urine test for protein Foetal Lie Syphilis (and other STI) detection and treatment IPT if indicated PMTCT if indicated Management or referral of obstetric complications (EmOC) 2. Delivery  Delivery under skilled care  Temperature management  Dry, wrap and skin to skin  Resuscitation if required  Immediate and exclusive breastfeeding  Cord Care  Temperature of newborn  Birthweight  Refer if necessary

3.Post Delivery Care – 2-3 home visits during first week Home based maternal and newborn care Community model Care of Newborn using checklist:  Assess newborn weight temperature feeding cord care  Assess for sepsis - refer if required  Counsel parents on thermal control, exclusive BF, danger signs  Refer for vaccination  Birth registration If Low Birth Weight: give extra care with 2 additional home visits  Kangaroo mother care  Keep warm  Assist with feeding if needed  Attention to hygiene  Review danger signs Care of Mother using checklist:  Assess mother check bleeding check temperature breast problems  Discuss danger signs  Nutrition counseling and family planning  Refer if necessary

Essential interventions linked to cause of mortality Asphyxia (27%) Resuscitation of newborn baby can reduce neonatal mortality by 5-20% Serious Infections (sepsis) 26%  Hygienic cord care, thermal care, breastfeeding can reduce up to 50% of newborn deaths  Malaria IPT can reduce 10-30% of newborn deaths  Case management pneumonia/sepsis can reduce deaths due to pneumonia by % Prematurity and low birth weight (29%) Extra care for low birth weight infants including extra warmth, hygiene, feeding, can reduce deaths due to prematurity % Tetanus 7 %  Tetanus toxoid can eliminate tetanus deaths  Hygienic cord care can reduce tetanus deaths by 75-85%

Programmatic progress in the implementation of the outlined packages By out of the 46 WHO African Region countries were implementing the Essential Newborn Care package. 22 countries had adopted the community newborn package.

Opportunities: Regional initiatives The African Union championed advocacy at the highest level through: Recommendations of the special session on the RMNCH during the 2010 AU meeting held in Kampala Uganda The adoption of the Campaign for Acceleration of Reduction of Maternal and Newborn Mortality in Africa (CARMMA) Governments have shown committed through increasing of MNCH funding and addressing financial barriers through various strategies like fee waiver, voucher system. Governments are individually committing to: Addressing human resources challenges Increased efforts to implement the MNCH Roadmaps Increased efforts to scale up the Child survival Strategies.

Opportunities Global ‘Every Newborn’ Action Plan Opportunity to re-align country orientations for newborn health based on the identified needs. Opportunity to rally all towards a common purpose and common deliverables. Opportunity to contribute to the Global ‘Every Newborn’ Action Plan.

Thank you Merci Beaucoup