Reducing newborn deaths achievable: AKU study

KARACHI – A significant drop in newborn deaths can be achieved by improving the public health system in Pakistan and the intervention could be widely applicable in countries around the world with high newborn mortality rates, says a new study.
The research trial was carried out by Aga Khan University’s (AKU) Division of Women and Child Health (DWCH) in partnership with the Health Ministry, the World Health Organisation (WHO) and Save the Children’s Saving Newborn Lives programme.
The research disclosed that the drop in newborn deaths requires no new technology and can solely rely on introducing counselling and educational outreach on well-known lifesaving newborn health practices into the National Programme for Family Planning and Primary Health Care.
For example, in Hala and Matiari in rural Sindh, it led to a 15 to 20 percent drop in newborn deaths and stillbirths, more mothers giving birth at a health facility with access to medical assistance, and newborn care practices improving substantially.
The two-year scale-up study ran from 2006 to 2008, differing from previous newborn care studies as it hired no new health workers and instead introduced a community-based intervention package, delivered through lady health workers (LHWs) from the national programme working with traditional birth attendants (dais) and community health committees.
“This study shows, for the first time, how proven newborn health interventions can be integrated effectively into an existing public health system, which means these kind of lifesaving results are feasible and sustainable,” said Dr Zulfiqar Bhutta, the lead author of the Lancet article and the AKU DWCH Chairman.
Newborn deaths account for 57 percent deaths in children aged below six years, which is one of the highest mortality rates in South Asia in this age group – 94 deaths per 1,000 live births versus an average rate of 50-60 per 1,000 live births in the region.
There are also significant urban-rural differences with 48 newborn deaths per 1,000 births in urban areas versus 55 in rural areas, where more than half of home births are assisted by dais.
Meanwhile, researchers in the Hala study provided additional training to LHWs, who were taught how to provide group counselling on maternal and newborn care practices, to partner with dais and to make home visits for teaching simple newborn care to new mothers, including early and exclusive breastfeeding, delayed bathing and early symptoms of serious newborn illnesses.
“In Pakistan alone, nationalising these simple measures could save around 100,000 lives a year – potentially more with wider coverage than what was achieved in the study area,” Bhutta said, adding ‘by adopting these methods, far greater number of babies could be saved globally as large countries with high newborn mortality – such as India and Ethiopia – have similar cadres of community health workers.’
In the Hala trial, lifesaving infant care practices improved significantly when families received the strengthened package of newborn care. As many as 60 percent more mothers breastfed their infants within one hour of the birth and 36 percent more mothers gave the antibody-rich breast milk, colostrum, which is often traditionally discarded.
Also, the number of mothers and their newborns receiving a postnatal visit from a LHW registered a three-fold increase, jumping to 28 percent from a mere 8 percent at the start of the study.
More than three million newborns die each year from largely preventable causes globally. “This trial proves that trained community health workers can effectively deliver essential newborn care and this type of training can and should be scaled up within the public sector programmes to save newborn lives,” said WHO Maternal, Newborn, Child and Adolescent Health Department Director Dr Elizabeth Mason.
Terming the Hala study results ‘groundbreaking,’ Save the Children President CEO Charles MacCormack said that a growing proportion of child deaths occur in the first month of life and this study’s findings show it doesn’t have to be like this.
“We urge governments and their partners to adopt this low-tech, high-impact strategy as it can save large numbers of newborn lives and quickly,” he added.
tThe Hala trial was funded by grants from the WHO and the Saving Newborn Lives programme, funded by the Bill and Melinda Gates Foundation.