EVERY NEWBORN€¦ · • Verbal autopsy for stillbirths and neonatal deaths + Social autopsy • Birth weight, birth size and gestational age Measurement tools to be improved/developed

An Action Plan To End Preventable Deaths

EVERY NEWBORN

#globalmnh #EveryNewborn

Measurement improvement

roadmap

www.everynewborn.org #EveryNewborn

Overview of panel Moderator Suzanne Fournier 5mins

1 Count every newborn: a 5-‐year measurement improvement roadmap Joy Lawn 15 min

IMPACT

2 Coun>ng births, neonatal deaths and cause of death: Improving measurement especially in vital registra>on

Peter Waiswa

15 min

COUNTING COVERAGE AND QUALITY AND LINKING TO ACTION

3 Care for all mothers and newborns: Measuring coverage and content of care

Agbessi Amouzou

12mins

4 Care for newborns with complica>ons: Measuring coverage and content of care

Sarah Moxon 12 mins

5 Coun>ng every s>llbirth and neonatal death: Perinatal audit tools and implementa>on for improving quality of care linked to maternal death surveillance and response

Kate Kerber 10 mins

DISCUSSION PANEL Tanzania and improving and using the data, links to scorecards Bangladesh and improving and using the data WHO’s role in co-‐ordina>ng maternal and newborn metrics

Georgina Msemo Shams El Arifeen Ma^hews Mathai

3 mins each

Discussion from the floor Close

10mins

5 mins


Where to get more information Lancet Every Newborn series: http://www.thelancet.com/series/everynewborn

Every Newborn Action Plan (ENAP): http://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en/

BMC Pregnancy and Childbirth series: http://www.biomedcentral.com/bmcpregnancychildbirth/supplements/15/s2

ENAP WHO meeting report: http://www.who.int/maternal_child_adolescent/documents/newborn-health-indicators/en/

MARCH MOOC: http://www.lshtm.ac.uk/study/freeonlinecourses/women-children-health/index.html

UNICEF: www.childmortality.org

Healthy Newborn Network: http://www.healthynewbornnetwork.org/page/newborn-numbers

INDEPTH: http://www.indepth-network.org/

@joylawn @katekerber

An Action Plan To End Preventable Deaths

EVERY NEWBORN

#globalmnh #EveryNewborn

Counting births, deaths and cause of death:

Improving measurement including through vital registration

Dr Peter Waiswa

@waiswap


Indicators to track progress of Every Newborn Ac>on Plan

Focus of this talk


Outline

§ What is the status for the impact indicators?•  Neonatal deaths

•  Stillbirths

§ What data platforms to collect data?§ What to do to improve the data?

Impact


Lawn et al h*p://www.nature.com/pr/journal/

Neonatal mortality data: report card

UNICEF, A Promise Renewed 2014 Shefali Oza et al WHO Bull 2015 Li Liu et al Lancet 2015

Number of countries with neonatal data by source

GOOD NEWS for neonatal mortality rate data and more regular esGmates! For cause of death have 65 countries with CRVS

Need to make major progress for CVRS with birth and death cerGficates and also Household Surveys

Civil/Vital Registra:on

Household Surveys

Other country data

No country data

(Model alone)

Total countries

Frequency of global

and country es:mates

Used as reported

As input

Neonatal Mortality Rate

44 132 20 196 Annual By UN IGME

Also IHME


Report card: Stillbirth rate data Number of countries with s>llbirth rate by data source, over >me

Civil /Vital Registra:on

Other country data

as input

No country data

(Model alone)

Total countries

Used as reported

As input

Household surveys

HMIS Facility Studies

Popula:on based studies

S:llbirth Rate 2009 Es:mates Cousens et al Lancet 2011

33 31 39 42 68 195

New es:mates

for 2015 (provisional for Lancet 2016)

114 57 57 38 195

Every Newborn Action Plan metrics group –data report cards

GOOD NEWS for sGllbirth rate data! Now for 157 countries, >2000 data points (more than double last Gme)

BUT BAD NEWS is major gap for intrapartum sGllbirth data SGll too many non comparable classificaGon systems so no global esGmates of causes

Model alone


Not counting stillbirths has consequences especially for women and health workers §  When a still birth occurs in the community mourning is

“silent and mainly left to women, as opposed to public mourning for older children”. There are no formal health system mechanisms to support or care for families affected by stillbirths.

§  To date many countries have no system to build the capacity or to support health workers to deal with stillbirths


Outline

§ What is the status for the impact indicators?•  Neonatal deaths

•  Stillbirths

§ What data platforms to collect data?§ What to do to improve the data?

Impact

•  Coverage –  Very few of the world’s neonatal deaths and sGllbirths each

year have a death cerGficate –  Not being counted means you do not count

•  Content –  Perinatal death/sGllbirth cerGficate –  Includes baby details and importantly maternal condiGons

and informaGon regarding birth

•  CerGficaGon quality

–  Quality improvement for death cerGficate filling –  Standard grouping of ICD codes, improve ICD11 codes

Improving impact data in CRVS Death cer>ficates

ICD 10 perinatal death certificate

5.5 million babies enter and leave the world without cer>ficates Urgent need to improve birth and death registra>on

Opportuni>es with facility-‐based minimum perinatal dataset and perinatal audit Given that >75% of world’s births are now in facili>es


§  Civil Registration and Vital Statistics•  Birth certificates (improved weight, possibly gest age)•  Death certificates and ICD codes (linked to new WHO ICD-perinatal mortality

classification)

§  Facility and HMIS•  Perinatal mortality audit (linked to maternal audit) and minimum perinatal

dataset•  DHIS2 and other HMIS collation for highly prioritised data points•  Health facility assessment tools (treatment indicators, process)

§  Population based surveillance and surveys (DHS/MICS)•  Mortality capture including recall, misclassification of stillbirth/neonatal

death and pregnancy vs life birth•  Verbal autopsy for stillbirths and neonatal deaths + Social autopsy•  Birth weight, birth size and gestational age

Measurement tools to be improved/developed and linked

Vital registraGon dataset

• Eg linked to birth/ death cerGficates

Facility based min perinatal dataset

• Eg facility based audit linked to HMIS/DHIS

More complex facility semng

• Eg Neonatal intensive care plus follow up

Research studies

• More detailed potenGally with biodata


Improving impact data to collect through household surveys by using demographic surveillance sites

Priority measurement research §  TesGng pregnancy and outcome

surveillance modules-‐ could inform inform birth or pregnancy module in DHS/MICS

§  analyse mulGsite VA data on neonatal COD and sGllbirths

§  Best pracGces for linking health facility data with community surveillance to improve pregnancy outcome reporGng

§  EffecGve methods for early pregnancy capture and gestaGonal age assessment

Mortality and popula>on-‐based data

•  PopulaGon-‐based pregnancy surveillance of births, sGllbirths, neonatal deaths.

•  OpportuniGes to advance validaGon of Survey modules for pregnancy history s, verbal autopsy, improved LBW assessment, etc.

INDEPTH Maternal & Newborn Working Group 30+ sites in Africa and Asia, led by Makerere University, Uganda


Improving data to track to risk newborns especially after intensive care, and preterm complications

“Beyond newborn survival” data

With UNICEF and other partners in India and beyond

§  Follow up at risk newborns by varying levels of health system

§  OpportuniGes to validate and test feasibility of follow up, screening for disability, ROP and models to improve care


Conclusion §  DATA

•  Vital registration− Fastest progress in middle income countries and key to advance also

in low income settings eg by closing gap between facility birth and birth/death certificates

•  Facility data− Urgent need for applied research to standardize and collate eg for

intrapartum stillbirths from labour ward registers, or in DHIS2•  Household surveys − Opportunities to improve data quality especially by using INDEPTH

sites

§  LEADERSHIP FOR IMPROVING AND USING DATA within and by high burden countries

Impact

Documents

EVERY NEWBORN€¦ · • Verbal autopsy for stillbirths and neonatal deaths + Social autopsy • Birth weight, birth size and gestational age Measurement tools to be improved/developed