Despite dramatic progress on child survival, 1 million children die during their first day of life from mostly preventable causes

Analysis points to health system failures at critical time around birth as a significant contributing factor to these needless deaths

New York, 16 September 2014 – Child survival rates have increased dramatically since 1990, during which time the absolute number of under-five deaths has been slashed in half from 12.7 million to 6.3 million, according to a report released today by UNICEF.
The 2014 Committing to Child Survival: A Promise Renewed progress report, indicates that the first 28 days of a newborn’s life are the most vulnerable with almost 2.8 million babies dying each year during this period. One million of them don’t even live to see their second day of life.

Many of these deaths could be easily prevented with simple, cost-effective interventions before, during and immediately after birth.

Analysis points to failures in the health system during the critical time around delivery as a significant contributing factor to these unnecessary deaths. It also shows that there is considerable variation – from country to country and between rich and poor – in the take-up and quality of health services available to pregnant women and their babies.

Key findings in this study include:

  • Around half of all women do not receive the recommended minimum of four antenatal care visits during their pregnancy.
  • Complications during labour and delivery are responsible for around one quarter of all neonatal deaths worldwide. In 2012, 1 in 3 babies (approximately 44 million) entered the world without adequate medical support.
  • Evidence shows that initiating breastfeeding within one hour of birth reduces the risk of neonatal death by 44 per cent, yet less than half of all newborns worldwide receive the benefits of immediate breastfeeding.
  • Quality of care is grossly lacking even for mothers and babies who have contact with the health system. A UNICEF analysis of 10 high mortality countries indicates that less than 10 percent of babies delivered by a skilled birth attendant went on to receive the seven required post-natal interventions, including early initiation of breastfeeding. Similarly, less than 10 per cent of mothers who saw a health worker during pregnancy received a core set of eight prenatal interventions.
  • Those countries with some of the highest number of neonatal deaths also have a low coverage of postnatal care for mothers. Ethiopia (84,000 deaths; 7 per cent coverage); Bangladesh (77,000; 27 per cent); Nigeria (262,000; 38 per cent); Kenya (40,000; 42 per cent).
  • Babies born to mothers under the age of 20 and over the age of 40 have higher mortality rates.

Additionally, the report shows that the education level and age of the mother has a significant bearing on the chances of her baby’s survival. Neonatal mortality rates among mothers with no education are nearly twice as high for those with secondary schooling and above.

“The data clearly demonstrate that an infant’s chances of survival increase dramatically when their mother has sustained access to quality health care during pregnancy and delivery,” said Geeta Rao Gupta, UNICEF Deputy Executive Director. “We need to make sure that these services, where they exist, are fully utilised and that every contact between a mother and her health worker really counts. Special efforts must also be made to ensure that the most vulnerable are reached.”
Inequality, particularly in health care access, remains high in the least developed countries: women from the richest households are almost three times as likely as those from the poorest to deliver their baby with a skilled birth attendant. Despite this, the report suggests that the equity gap in under-5 child mortality is steadily reducing. In every region, except sub-Saharan Africa, the proportion of under-five mortality among the poorest sections of society is declining faster than in the richest. More significantly, worldwide, the poor are registering greater absolute gains in child survival than their wealthier compatriots. “It is deeply heartening that the equity gap in child survival is continuing to narrow,” said Rao Gupta. “We need to harness this momentum and use it to drive forward programmes that focus resources on the poorest and marginalised households; a strategy which has the potential to save the largest number of children’s lives.”

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Note to editors:

About A Promise Renewed

A Promise Renewed is a global movement that seeks to advance Every Woman Every Child – a strategy launched by United Nations Secretary-General Ban Ki-moon to mobilize and intensify global action to improve the health of women and children around – through action and advocacy to accelerate reductions in preventable maternal, newborn and child deaths.

The movement emerged from the Child Survival Call to Action convened in June 2012 by the Governments of Ethiopia, India and the United States, in collaboration with UNICEF, to examine ways to spur progress on child survival. It is based on the ethos that child survival is a shared responsibility and everyone – governments, civil society, the private sector and individuals – has a vital contribution to make.

Since June 2012, 178 governments and many civil society organizations, private sector organizations and individuals have signed a pledge to redouble their efforts, and are turning these commitments into action and advocacy. More details on A Promise Renewed are available at www.apromiserenewed.org.

About Committing to Child Survival: A Promise Renewed 2014 Progress Report

This year’s annual report focuses on newborn survival. This report not only presents levels and trends in under-five and neonatal mortality since 1990, but also provides analysis on key interventions for mother and newborn.

About UNICEF UNICEF works in more than 190 countries and territories to help children survive and thrive, from early childhood through adolescence. The world’s largest provider of vaccines for developing countries, UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF is funded entirely by the voluntary contributions of individuals, businesses, foundations and governments. For more information about UNICEF and its work visit: http://www.unicef.org/

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For further information please contact: Rita Ann Wallace, UNICEF New York, +1 917 213-4034; rwallace@unicef.org  Melanie Sharpe, UNICEF New York, +1 917-485-3344, msharpe@unicef.org Najwa Mekki, UNICEF New York, nmekki@unicef.org, +1917 209 1804

 

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

Video makes Community Based New-born Care (CBNC) training more productive

By Hailemariam Legesse

The Community Based New-born Care (CBNC) initiative was launched in March 2013, following the national policy breakthrough of allowing Health Extension Workers (HEWs) to treat new-born sepsis. The programme is supporting four agrarian regions: Amhara, Tigray, Southern Nations Nationalities and Peoples’ Region (SNNPR) and Oromia.

One of the methods and tools used during the four day CBNC training in Ethiopia is a training video produced in English, Amharic and Oromiffa. The video helps to make CBNC training more productive through presentation of communication skills and specific technics and procedures performed by Health Extension Workers in a rural setting of Ethiopia.

Though, first and foremost produced to support the four-day standard training on CBNC, the individual components of the video can be used also to support specific separate skill’s training like; Measuring Temperature; Weighing the Baby; Hand Washing; Essential New-born Care; and Expressing Breastmilk.

The video demonstrates components designed to follow the principles of continuum of care for mothers and new-born.             

  1. Registering women in childbearing age by HEW
  2. Communication skills during antenatal care follow up
  3. Filling the birth preparedness plan
  4. Measuring temperature of the new-born
  5. Weighing the baby
  6. Postnatal care visit (PNC) for the mother and new-born
  7. Hand washing
  8. PNC visit for the sick new-born
  9. Essential new-born care
  10. Ikram case study
  11. Expressing breast milk

Federal Ministry of Health led the production of the video with the financial and technical support from UNICEF and WHO and help of CBNC partners through the National Technical Working Group.6

No mother should die while giving life

By Demissew Bizuwerk

Tena Esubalew Health Extension Worker comes to  Etenesh Belay's house for counselling on breast feeding practices
Tena Esubalew Health Extension Worker comes to Etenesh Belay’s house for counselling on breast feeding practices Amhara region of Ethiopia. ©UNICEF Ethiopia/2014/Tsegaye

ADDIS ABABA, 17 April 2014 close to 2 million mothers and new-borns in Ethiopia are to benefit from improved maternal health and new-born care services.  Enhancing Skilled Delivery in Ethiopia (ESDE), a joint initiative between the European Union, Federal Ministry of Health and UNICEF, aims to increase access to and utilisation of quality maternal and new-born health services. ESDE is a 1.1 billion birr (€40 million) project financed by the European Union for a three-year period, from 2014 to 2016. Of this grant, €20 million is allocated to the Millennium Development Goal (MDG) pool fund of the Federal Ministry of Health (FMoH) and the remaining half to UNICEF.

This maternal health initiative represents one of the largest grants to maternal health ever provided to Ethiopia. ESDE will be implemented jointly by the Federal Ministry of Health and UNICEF, with the support of other development partners and health professional societies working in the area of maternal and new-born health.

Left to right: Dr. Peter Salama, Dr. Kesetebirhan Admasu and Ambassador Chantal Hebberecht officially launches ESDE Project.
Launch of Enhancing Skilled Delivery in Ethiopia (ESDE) Project. 16 April 2014 Radisson Blu Hotel- Addis Ababa, Ethiopia ©UNICEF Ethiopia/2014/Ayene

ESDE comes at a time when Ethiopia is working hard to achieve the MDG target 5 of reducing maternal mortality, which is not yet on track. Currently, Maternal Mortality Ration (MMR) stands at 676 per 100,000 live births while Ethiopia hopes to bring down the level to 267 per 100,000 live births before the MDG deadline. ESDE project is expected to benefit 625,000 mothers and new-borns annually from improved access to maternal and new-born health services – a quarter of annual national deliveries.

Why maternal health matters in Ethiopia?

  • Only 29.5 per cent women delivered in Health Facilities[1].
  • MMR is 676 per 100,000 live births[2], while the expected MDG 5 target is to bring the level below 267 per 100,000 live births by 2015.
  • In Ethiopia, up to 15 per cent of mothers and new-borns suffer serious complications that warrant referral to facilities providing Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) services including caesarean sections, blood transfusions and emergency laparotomy. However, the availability of CEmONC has been limited to only over a hundred hospitals having the capacity to provide the service in the country[3].
Dr. Kesetebirhan Admasu, Excellency Federal Minister of Health
Dr. Kesetebirhan Admasu, Excellency Federal Minister of Health, makes a welcome remarks at the launch of Enhancing Skilled Delivery in Ethiopia (ESDE) Project. 16 April 2014 Radisson Blu Hotel- Addis Ababa, Ethiopia ©UNICEF Ethiopia/2014/Ayene

What are the Government plans?

  • The government sets ambitious targets for 2015 MDG deadline including availability of Basic and Comprehensive Emergency Obstetric and Neonatal Care (BEmONC and CEmONC) at 100 per cent of hospitals and health centres in the country.
  • Increase skilled birth attendance rate to 62 per cent of total deliveries and universal access of mothers and neonates for antenatal and postnatal care[4].
  • The construction of over 800 new primary hospitals [one primary hospital per woreda (district)]. The construction of over 200 hospitals has already been initiated in the various regional states and is expected to be completed soon.
  • The hospitals need to be equipped with basic supplies and equipment to provide maternal and neonatal care including equipment for basic operation facilities and essential neonatal care equipment.

ESDE project will provide:

  • Obstetric and new-born care supplies and equipment for 500 health centres and 50 hospitals.
  • Operation theatre equipment for 30 primary hospitals.
  • Training for 5000 health extension workers in community based new-born sepsis management.
  • Obstetric and new-born care training for 250 doctors and health officers from 100 hospitals.
  • Emergency obstetric and new-born care training and supportive supervision for 1000 midwives and nurses.

 

[1] EFY2006 report of the Federal Ministry of Health

[2] Ethiopia DHS 2011

[3]National EmONC Assessment Report, FEDERAL MINISTRY OF HEALTH, 2008

[4]Health Sector Development Program IV, FEDERAL MINISTRY OF HEALTH (HSDP IV), 2010

Ethiopia and its partners working together to achieve MDG 5

By Loza mesfin/WHO

Anneka Knutsson, Head of Development Cooperation (SIDA), signs ‘Accelerating Progress for Maternal and Newborn Health’ programme document
Anneka Knutsson, Head of Development Cooperation (SIDA), signs ‘Accelerating Progress for Maternal and Newborn Health’ programme document © WHO/2013/Loza Mesfin

Five United Nations agencies, known as UNH4+ (UNAIDS, UNFPA, UNICEF, UN Women and WHO) and the Federal Ministry of Health signed an agreement with the Government of Sweden (through the Swedish International Development Agency – Sida) on the work plan for a joint project on reproductive, maternal, newborn and child health in Ethiopia, 2013-2015. The signing ceremony took place in the presence of Hon Dr Kesetebirhan Admasu, Ethiopian Minister of Health, at the African Union Conference Center during the historic International Conference on Family Planning.

Speaking at the signing ceremony, Dr Kesetebirhan appreciated the support of development partners in the Government’s efforts to reduce maternal and newborn mortality. He further expressed his satisfaction at how the partnership is supporting the Government’s initiative, with the Government in the driving seat. “With such country ownership and continued support of partners, the achievement of MDG 5 is not out of reach,” he underscored.

WHO Representative, Dr Pierre M’pele speaks at launch of joint project on reproductive, maternal, newborn and child health in Ethiopia,
WHO Representative, Dr Pierre M’pele speaks at launch of joint project on reproductive, maternal, newborn and child health in Ethiopia,

Also speaking at the event, WHO Representative, Dr Pierre M’pele recalled that Ethiopia has already achieved MDG 4 two years ahead of schedule by reducing child mortality rates, and affirmed that the joint program comes “At the right time to strengthen the partnership of the UN agencies delivering as one and Sida with the Federal Ministry of Health to work together to achieve MDG 5.”

In its endeavor to maximize the impact of its support to the Government of Ethiopia, the United Nations Country Team (UNCT) is working with the principle of Delivering as One and strengthening joint efforts of the UN agencies in advancing priority areas within the development agenda. Both the Government of Ethiopia and the UNCT recognize maternal and newborn health as one of the top priority areas that require the concerted efforts of all stakeholders in the few years remaining of the MDGs. This work plan for the Sida/H4+ grant contributes to filling gaps in the current joint efforts by UN agencies in supporting the FMOH for implementation of the National Road Map for Accelerating Reduction of Maternal and Newborn Mortality and Morbidity, and thereby pave the way for Ethiopia to meet MDG 5 of by 2015, reducing maternal mortality ratio and increasing access to reproductive health.

This blog post is extracted from World Health Organization Ethiopia Country Office media release.