Do we need a new global policy for ending preventable perinatal deaths in fragile low-income countries?

Abstract

In 2020, an estimated 2.4 million neonates lost their lives, and an additional 2 million were stillborn. The ten countries in the world with the highest estimated neonatal mortality rate (NMR) -all above 33 per 1000 live births -have had an average annual reduction in NMR of 1.3% in the last 30 years. This decline is significantly less than the world average of 2.6% and less than all of sub-Saharan Africa at 1.7% [1,2].The Every Newborn Action Plan (ENAP) is a globally-endorsed strategy for ending preventable newborn deaths that supports the Sustainable Development Goal 3.2 of an NMR of less than 12 per 1000 in every country by 2030 [3]. For this to happen, interventions are needed jointly at the community, primary, and secondary health care level, with a strong emphasis on continuity of care in reproductive-maternal-newborn-child-adolescence (RMNCA) programming.The consortium of Helping Newborns Survive and Helping Mothers survive has been or is in the process of developing several well-structured, tested, and efficient interventions at all care levels in low-and lower-middleincome countries (LLMIC). However, the most complex building block has received little attention until recently: the facility-based care of small and sick newborns who are not possible to stabilize with basic care [4]. Mainly due to substandard intrapartum care in many LLMIC, there is a disproportionally large need for such neonatal treatments in the first days after birth [5]. For example, in Nairobi County in Kenya, a relatively well-functioning capital city, estimates indicate that one in five newborns needs inpatient care above what can be handled in a maternity ward [6]. The ENAP proposed that, by 2020, at least 50% of this category of newborns should receive level 2 inpatient care, in-between basic and neonatal intensive care (Figure 1) [3].Recent assessments in 5 LLMIC show that only 66% of all facilities offering skilled labour care had performed some kind of resuscitation of a newborn,

Association between maternal high-risk fertility behaviour and perinatal mortality in Bangladesh: Evidence from the Demographic and Health Survey

“…Women in Bangladesh are mostly not aware of the obstetric complications that prevent timely access to healthcare services and present to hospital with serious obstetric complications when successful intervention is reduced [11]. Availability of critical care for newborns is also limited in Bangladeshi healthcare facilities [12] and where services are available, distance represents a key barrier to access [13]. Consequently, deaths among new borns occur at substantially higher rates in Bangladesh compared to older aged children.…”