Thousands more mothers, babies can be saved in Ethiopia

New Lancet Series finds major progress in improving survival for Ethiopia’s babies, but more can be done

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ADDIS ABABA: 24 November 2014: By 2025, Ethiopia could save as many as 76,800 mothers and babies each year if it continues its aggressive efforts to develop and implement effective strategies to improve maternal and newborn health. These estimates were released in Addis today at the Ethiopia launch of The Lancet Every Newborn Series 2014 and the Every Newborn Action Plan.

The authors of the Series say that while Ethiopia is one of the 10 countries with the highest numbers of neonatal deaths, it is currently ranked fifth in the world as having the greatest potential to save maternal, perinatal and neonatal lives by 2025. A systematic assessment of challenges in high-burden countries like Ethiopia, revealed that the most common barriers to improving survival were related to the health workforce, financing, and service delivery. By addressing these challenges, many lives can be saved in the next decade alone.

Yet far too many babies and mothers in Ethiopia still die from preventable causes with 84,000 babies dying before their first month, and an additional 78,400 who are stillborn. The major killers were prematurity, complications during child birth including trouble breathing, and severe infections, which together cause more than 80 percent of neonatal deaths. More than two-fifths of Ethiopia’s under-five deaths are among newborns.[1][2]

Mother feeding her child plumpy nut
Mother taking care of here baby boy. ©UNICEF Ethiopia/2006/Getachew

Birth is the riskiest time for mothers and their babies, but there is an opportunity to accelerate progress towards ending preventable newborn and maternal deaths,” said John Graham, Country Director for Save the Children. “Our five-year research known as Community-based Interventions for Newborns in Ethiopia (COMBINE) shows community-based treatment of severe neonatal infections can reduce newborn deaths after the first day of life by as much as by 30 percent. This demonstrates investment in community-based newborn health programme will reduce newborn deaths and sustain the country’s remarkable achievements in tackling child deaths.”

The Series findings present the clearest picture to date of a newborn’s chance of survival in countries around the world and highlight the steps that must be taken to end preventable infant deaths. New analyses indicate that 3 million maternal and newborn deaths and stillbirths can be prevented each year around the world with proven interventions—including the promotion of breastfeeding, neonatal resuscitation, kangaroo mother care for preterm babies, and the prevention and treatment of infections.

These interventions can be implemented for an annual cost of US$1.15 per person. Providing quality care at birth yields a quadruple return on investment—saving mothers and newborns, and preventing stillbirthsand protects babies from disability.

“Newborn survival is as attainable as child survival, we know why and when newborns are dying,” said Patrizia DiGiovanni, Representative a.i., UNICEF Ethiopia. “We also know what we need to do to reduce neonatal death. Investment on newborn survival has a promising return for future generations. The time to act is now.”2

Examination of new born at Wukro Clinic ©UNICEF Ethiopia/2009/Tuschman

Ethiopia is using the lifecycle approach to implement a number of high impact interventions to ensure newborn survival; this starts before pregnancy, through pregnancy delivery and the postnatal period. The country is currently revising the national newborn and child survival strategy taking the newborn survival agenda as central.

“There is tremendous opportunity and we know what needs to be done to ensure every Ethiopian mother and her baby have a healthy start,” said Dr. Gary L. Darmstadt, Lancet Series author and senior fellow at the Bill & Melinda Gates Foundation. “Countries that have made recent, rapid reductions in newborn and maternal deaths have done so by expanding the number of skilled health workers, rolling out innovative mechanisms to reach the most underserved families, and focusing on improving care for newborns.”2

“The success in Ethiopia is primarily due to political commitment and the introduction of our home grown innovative community health workers programme called the Health Extension Programme”, said Dr. Kesetebirhan Admasu, Minister, Federal Ministry of Health.

Health extension workers are equipped with the skills and equipment to identify pregnant mothers early, conduct focused, antenatal care, facilitate skilled birth care, conduct postnatal home visits to identify complications in both mothers and newborns and take appropriate measures, including but not limited to the treatment of newborns with severe infections by using oral and injectable antibiotics when referral is not possible or acceptable by families. The Health Development Armies are supporting the 38,000 Government funded health extension workers in mobilizing communities to promote key healthy behaviors including early care seeking for newborns, children and mothers.

[1] The Lancet Every Newborn Series

[2] United Nations Inter Agency Group for Mortality Estimate, 2014 Report

In Ethiopia, the most common cause of death for children under five years of age is new-born death

Mother breastfeeding her new born for the first time
A mother breast feeds for the first time her new-born at Shire Clinic, Ethiopia ©UNICEF Ethiopia/2009/Tuschman

New York/Addis Ababa, 22 May 2014 – A ground-breaking series of papers released by The Lancet at UNICEF Headquarters today shows that the majority of the almost 3 million children who die before they turn one month old could be saved if they received quality care around the time of birth – with a particular focus on the most vulnerable and under-served.

New-born deaths account for a staggering 44 per cent of total mortality among children under five, and represent a larger proportion of under-five deaths now than they did in 1990. These deaths tend to be among the poorest and most disadvantaged populations.

“We have seen tremendous progress in saving children under five, but where the world has stumbled is with the very youngest, most vulnerable children,” said Dr Mickey Chopra, head of UNICEF’s global health programmes. “This group of children needs attention and resources. Focusing on the crucial period between labour and the first hours of life can exponentially increase the chances of survival for both mother and child.”

According to UNICEF, 2.9 million babies die each year within their first 28 days. An additional 2.6 million babies are still-born, and 1.2 million of those deaths occur when the baby’s heart stops during labour. The first 24 hours after birth are the most dangerous for both child and mother – almost half of maternal and new-born deaths occur then.

The Lancet’s Every Newborn Series identifies the most effective interventions in saving new-borns, including breastfeeding; new-born resuscitation; ‘kangaroo care’ for premature babies – that is, prolonged skin-to-skin contact with the mother; and preventing and treating infections. More funding and adequate equipment are also vital.

Countries that have made the most progress in saving new-born lives have paid specific attention to this group as part of the overall care extended to mothers and under-fives. Rwanda – alone among sub-Saharan African countries – halved the number of new-born deaths since 2000. Some low and middle-income countries are making remarkable progress by, among other methods, training midwifes and nurses to reach the poorest families with higher quality care at birth, especially for small or ill new-borns.

In Ethiopia, Neonatal Mortality Rate (NMR) has reduced from 54 in 1990 to 29 (per 1000 deaths) in 2012 according to the Inter-agency Group of Child Mortality Estimation 2013.

“Despite progress in child survival, the single most important remaining cause of death among children less than five years of age is new-born deaths – deaths within the first 28 days of life,” said Dr Peter Salama, UNICEF Representative to Ethiopia. “The government of Ethiopia is rapidly expanding access to basic health services to communities to prevent maternal and new-born deaths. With the strong commitment of the government and the sustained support of all our partners, we can speed up the reduction of maternal and newborn death even further.”

New Born baby taken care off by his nurse
A nurse takes care of a newborn baby at Shire Clinic, Ethiopia ©UNICEF Ethiopia/2009/Tuschman

To increase access, the Federal Ministry of Health has committed to the improvement of services based on the Health Sector Development Programme (HSDP) including the construction of 800 district hospitals (one per each woreda (district)). At present, over 120 hospitals are providing comprehensive emergency obstetric and neonatal care (CEmONC) services including caesarean sections, blood transfusions and emergency laparotomy for the entire population of the country.

A survey of 51 countries with the highest burden of new-born deaths found that if the quality of care received by the richest were to become universal, there would be 600,000 fewer deaths per year – an almost 20 per cent reduction.

The highest numbers of new-born deaths per year are in South Asia and sub-Saharan Africa, with India (779,000), Nigeria (267,000) and Pakistan (202,400) leading. For the highest burden countries, every $1 invested in a mother’s or baby’s health gives a nine-fold return on investment in social and economic benefit.

UNICEF and World Health Organization will roll out next month the Every Newborn Action Plan which aims to end preventable maternal and child deaths by 2035.

Lancet’s Every Newborn Series is co-authored by experts from UNICEF, the London School of Hygiene and Tropical Medicine, and the Agha Khan University, Pakistan, among others.

Find the press release here

Materials from the Lancet Every Newborn series launch are available at: http://www.thelancet.com/series/everynewborn