Essential Newborn Care African Regional Meeting on Interventions for Impact for Essential Obstetric and Newborn Care: 21- 23 February 2011, Addis Ababa,

Essential Newborn Care

African Regional Meeting on Interventions for Impact for Essential Obstetric and Newborn Care:

21-23 February 2011, Addis Ababa, Ethiopia

Dr P. Mongi

Africa Regional Meeting on Interventions for Impact on Essential Obstetrics and Newborn care, 21-23, Addis Ababa2 |

Presentation outlinePresentation outline

• Some Facts and Figures on Newborn health

• Essential Newborn Care• Definition of Essential Newborn

Care• Key components of Essential

Newborn Care

• WHO Essential Newborn Care Course- ENCC & Resuscitation


Progress towards MDG 4Progress towards MDG 4

Total number of deaths of children < 5 dropped from 12.4 million in 1990 to 8.8 million in 2008 (30%)

Neonatal mortality represents about 40% (3·575 million), most in the first week


7th MPS Orientation Workshop | Geneva 21 – 25 June 20105 |

Making Pregnancy Safer

Trends in Neonatal MortalityTrends in Neonatal Mortality

0

20

40

60

80

100

120

Sources:WHO/MSM 1996WHO/MPS 2006, 2007WHO 2010


3·6 Neonatal Deaths: Why ?3·6 Neonatal Deaths: Why ?

Under-nutrition contributes to one-third of child deaths

Prematurity is a complication to be dealt with starting in pregnancy

Birth asphyxia needs to be dealt with in the first minutes of life

CHERG Lancet 2010; 375: 1969–87


In Africa 1·2 Neonatal Deaths: Why?In Africa 1·2 Neonatal Deaths: Why?

CHERG Lancet 2010; 375: 1969–87

Lower contribution to overall child mortality

Prematurity and birth asphyxia contribute equally

Neonatal deaths likely to increase as child deaths fall


Causes of Newborn deaths in SS-AfricaCauses of Newborn deaths in SS-Africa

Newborn deaths constitute 29% of under five mortality

The main causes for almost 90% of Newborn deaths are:

1. Infections- 32%

2. Prematurity and Low birth weight- 29%

3. Birth Asphyxia and birth trauma- 27%

ALL are preventable and treatable

MDG- 4 can only be achieved if neonatal deaths are addressed and this necessitates both maternal and child health interventions


WhenWhen are the 1.2 million African newborn are the 1.2 million African newborn deaths occurring? deaths occurring?

WhenWhen are the 1.2 million African newborn are the 1.2 million African newborn deaths occurring? deaths occurring?

Source: Lawn JE, Kerber K -Daily numbers of death in 20 African countries during first month of life - based on 20 DHS datasets (2000 to 2004) with 5,763 neonatal deaths

0

5

10

15

20

25

30

0 5 10 15 20 25 30

Days of life

Pro

po

rtio

n o

f d

ea

ths

About a quarter of neonatal

deaths are on the day of birth

More than 70% of neonatal

deaths are in the first week

Birth and firs

t week is key:

when most babies die yet

when coverage

of care is lowest for

mothers and babies


Coverage of key Maternal and Child Survival Interventions, in WHO/AFRO 2008

Coverage of key Maternal and Child Survival Interventions, in WHO/AFRO 2008

71

44 46

8

31

74 73

37

43

35

17

0

25

50

75

100

ANC 1 vis. ANC at least4 vis.

Skilledattendant at

birth

Postnatalcare (within 2

days)

Exclusivebreastfeeding

<6 months

DPT3vaccination

Vit. A Suppl Diarrhoea recORT

Pneu Case toHW

Malaria caseRec antimal

ITN use in U5

Cov

erag

e (%

)

Source: WHO World Health Statistics 2010, UNICEF State of the World’s Children, 2010

The hours and days of highest risk

have the lowest

coverage of care


Definition of Essential Newborn Care- ENCDefinition of Essential Newborn Care- ENC

WHO Working Group Meeting in 1994 in Trieste, Italy- ENC was defined as consisting of eight components

These elements remain, even if some have slightly changed in content, since.

The concept of ENC was further divided into Basic Care and Special Care

Basic Care -includes interventions for all infants to meet their physiological needs.

Special Care -required for a small group of newborns because of diseases acquired before, during or after birth and/or because they are born too soon/small

This was the basis for developing the essential practice guide of the Integrated Management of Pregnancy and Childbirth (IMPAC) series as well as the guide for doctors, nurses and midwives Managing Newborn Problems.

The WHO Essential Newborn Care Course is part of these IMPAC series


Essential Newborn Care-ComponentsEssential Newborn Care-Components

1. Cleanliness

2. Thermal protection

3. Early and exclusive breastfeeding

4. Initiation of breathing, resuscitation

5. Eye care

6. Immunization

7. Management of newborn illness

8. Care of the preterm and/or low birth weight newborn


Integrated Management of Pregnancy and Childbirth (IMPAC)

Integrated Management of Pregnancy and Childbirth (IMPAC)

Clinical guidelines

Programme guides

Education modules

Advocacy material

Tools for monitoring and evaluation


Essential Newborn Care CourseEssential Newborn Care Course

New layout

French version in print


The 5 modules in the ENCCThe 5 modules in the ENCC

1. Care of the baby at the time of birth1. Introduction to the PCPNC guide

2. Universal precaution

3. Care of the baby at birth

4. Keeping baby warm

2. Examination of the newborn baby1. Breasting a newborn baby- ensuring

a good start

2. Communication skills

3. Examination of the newborn

3. Care of the newborn baby until discharge

1. Resuscitation of the newborn baby

2. Routine care of the newborn baby

4. Special situations1. Overcoming difficulties in

breastfeeding

2. The small baby

3. Alternative methods of feeding a baby

5. Optional module1. Giving an injection

2. Kangaroo mother care


The WHO Essential Newborn Care CourseThe WHO Essential Newborn Care Course

Five days course on essential and emergency newborn care

Any health facility dealing with mothers and newborns

For doctors, midwives and nurses


ENCC: State of ImplementationENCC: State of Implementation

By 2010 ENCC training has been introduced in 40 countries globally

– AFRO-20– EMRO– SEARO– WPRO

Mali

Kenya

No WHO AFRO

Trained trainers available (8 countries)

Al least one core national ENC training conducted (7 countries)

4 districts Training started in periphery (3 countries)

7 or more district/provincial courses (2 countries)


Asphyxia &Resuscitation of the newborn baby

Asphyxia &Resuscitation of the newborn baby

Asphyxia is failure to breath within one minute after delivery.

Good labour could prevent most birth asphyxia

This is treatable if births are attended by health worker skilled in neonatal resuscitation

One in 20 (5%) babies need help with breathing- resuscitation

Resuscitation must be anticipated at each delivery

Resuscitation skills are essential to the survival of babies


Training Newborn Resuscitation in the Context of Essential Newborn Care-1


Newborn resuscitation is a critical component of ENC, but one out of the eight components

The WHO ENCC training package contains a module on basic newborn resuscitation based on the 1998 guidelines currently updated

Countries may chose to replace that module by Helping Babies Breath (HBB)

The introduction of ENCC should trigger the review of the national neonatal resuscitation guidelines including by level of care




Efforts to improving ENC should go hand in hand with efforts to improving good quality obstetric care to prevent adverse neonatal outcomes including reduced need for resuscitation

National Ministries of Health and professional bodies (e.g. midwife associations, paediatric societies should take ownership of these training initiatives, partners should align and coordinate their support

The impact of any training (ENCC and/or HBB) on change of practice in all eight ENCC components in maternity services should be documented or evaluated, including in the context of other efforts such as the Baby Friendly Hospital Initiative (BFHI)

Thank youThank you

Documents

Essential Newborn Care African Regional Meeting on Interventions for Impact for Essential Obstetric and Newborn Care: 21- 23 February 2011, Addis Ababa,