West and Central Africa Regional Consultation on Global ‘Every Newborn’ Action Plan, 09-11 J uly 2013 – Dakar, S ene

1. West and Central Africa Regional Consultation on Global ‘Every Newborn’ Action Plan, 09-11 July 2013 – Dakar, Senegal. Status of Newborn Health in the African Region

2. Presentation outline • Why are 3 million newborns dying? • Causes of death • Risk factors • Needed change: which interventions and at what level? • Opportunities

3. Status of newborn survival • Neonatal deaths account for 40% of the global 6.9 million under-five deaths • Of the 3 million newborns who die every year 1.1 million (38%) are from the Sub-Saharan region • These deaths contribute heavily to the under-five mortality rates disengaging the Region from reaching the targets for MDG4.

4. Major causes of deaths in neonates and under-five in the African Region, 2010 • Prematurity is a complication to be dealt with starting in pregnancy • Birth asphyxia needs to be dealt with in the first minutes of life

5. Why the deaths: Factors that increase risk of death. • Undernutrition, increases the risk of death and ill-health for both mother and baby, during pregnancy, childbirth and the postnatal period through to early childhood. • The 24 hours around childbirth and the first day of a baby’s life carry the greatest risk • Skilled care can make a difference. • Yet only 50% of births are attended to by a skilled health worker in the African Region • Inequities in coverage for skilled attendant at birth and other interventions that require a strong health system are much wider in regions with the highest mortality rates, especially sub-Saharan Africa.

7. Critical shortage of health service providers (doctors, nurses and midwives) World Health Report, 2006

8. Focus for improvement for newborn survival Solutions exist now to prevent two-thirds of these deaths and some African countries are progressing Addressing newborn deaths cannot be in isolation but has to be within the backbone of a healthy health system for MNCH

9. Framework for action: Continuum of care HEALTH FACILITIES SERVICES COMMUNITY • Essential newborn care • Identify and treat asphyxia and sepsis • Refer if necessary • Home based maternal, newborn care • Identify danger signs and refer • Seek appropriate care or refer

10. Health Facility Model ANC DELIVERY POST - PARTUM Facility 1-2 days Maternal and Newborn essential post partum care & emergency first aid or BEmOCand IMNCI • Facility • Complete ANC • Package • TT • Iron folic • Blood pressure • Treatment of infections • IPT if indicated • PMTCT if indicated • Management or • referral of OB • complications Facility Skilled Attendant Essential Maternal and Newborn Care Package Ob-Newborn Emergency First Aid or BeMOC In Community during 1st week Emergency Obstetric and Neonatal Care (Referral if needed)

11. Community model Home based maternal and newborn care Pregnancy Home Visits Pregnancy - 2 Home Visits FOCUSED ANC Community Health Worker Tetanus Toxoid • registers all pregnant women • refer to ANC Iron and Folic Tablets BP and urine test for protein Foetal Lie Key interventions Syphilis (and other STI) detection and treatment • health/nutrition education • birth preparedness • danger sign awareness • breastfeeding preparedness • provide insecticide treated bednet • (where appropriate) PMTCT if indicated IPT if indicated Management or referral of obstetric complications (EmOC) 2. Delivery • Delivery under skilled care • Temperature management • Dry, wrap and skin to skin • Resuscitation if required • Immediate and exclusive breastfeeding • CordCare • Temperature of newborn • Birthweight • Referifnecessary

12. Community model Home based maternal and newborn care • Post Delivery Care – 2-3 home visits during first week Care of Newborn using checklist: If Low Birth Weight: give extra care with 2 additional home visits • Assess newborn • weight • temperature • feeding • cord care • Kangaroo mother care • Keep warm • Assist with feeding if needed • Attention to hygiene • Review danger signs • Assess for sepsis - refer if required • Counsel parents on thermal control, exclusive BF, danger signs • Refer for vaccination • Birth registration Care of Mother using checklist: • Assess mother • check bleeding • check temperature • breast problems • Discuss danger signs • Nutrition counseling and family planning • Refer if necessary

13. Essential interventions linked to cause of mortality Asphyxia (27%) Resuscitation of newborn baby can reduce neonatal mortality by 5-20% Serious Infections (sepsis) 26% Hygienic cord care, thermal care, breastfeeding can reduce up to 50% of newborn deaths Malaria IPT can reduce 10-30% of newborn deaths Case management pneumonia/sepsis can reduce deaths due to pneumonia by 20-55% Tetanus 7 % Tetanus toxoid can eliminate tetanus deaths Hygienic cord care can reduce tetanus deaths by 75-85% Prematurity and low birth weight (29%) Extra care for low birth weight infants including extra warmth, hygiene, feeding, can reduce deaths due to prematurity 20-50 %

14. Programmatic progress in the implementation of the outlined packages By 2012 • 30 out of the 46 WHO African Region countries were implementing the Essential Newborn Care package. • 22 countries had adopted the community newborn package.

15. Opportunities: Regional initiatives • The African Union championed advocacy at the highest level through: • Recommendations of the special session on the RMNCH during the 2010 AU meeting held in Kampala Uganda • The adoption of the Campaign for Acceleration of Reduction of Maternal and NewbornMortality in Africa (CARMMA) - 2009 • Governments have shown committed through increasing of MNCH funding and addressing financial barriers through various strategies like fee waiver, voucher system. • Governments are individually committing to: • Addressing human resources challenges • Increased efforts to implement the MNCH Roadmaps • Increased efforts to scale up the Child survival Strategies.

16. Opportunities Global ‘Every Newborn’ Action Plan • Opportunity to re-align country orientations for newborn health based on the identified needs. • Opportunity to rally all towards a common purpose and common deliverables. • Opportunity to contribute to the Global ‘Every Newborn’ Action Plan.

17. Thank you • Merci Beaucoup