Newborn survival in Malawi: a decade of change and future implications

Abstract

Malawi is one of two low-income sub-Saharan African countries on track to meet the Millennium Development Goal (MDG 4) for child survival despite high fertility and HIV and low health worker density. With neonatal deaths becoming an increasing proportion of under-five deaths, addressing newborn survival is critical for achieving MDG 4. We examine change for newborn survival in the decade 2000-10, analysing mortality and coverage indicators whilst considering other contextual factors. We assess national and donor funding, as well as policy and programme change for newborn survival using standard analyses and tools being applied as part of a multi-country analysis. Compared with the 1990s, progress towards MDG 4 and 5 accelerated considerably from 2000 to 2010. Malawi's neonatal mortality rate (NMR) reduced slower than annual reductions in mortality for children 1-59 months and maternal mortality (NMR reduced 3.5% annually). Yet, the NMR reduced at greater pace than the regional and global averages. A significant increase in facility births and other health system changes, including increased human resources, likely contributed to this decline. High level attention for maternal health and associated comprehensive policy change has provided a platform for a small group of technical and programme experts to link in high impact interventions for newborn survival. The initial entry point for newborn care in Malawi was mainly through facility initiatives, such as Kangaroo Mother Care. This transitioned to an integrated and comprehensive approach at community and facility level through the Community-Based Maternal and Newborn Care package, now being implemented in 17 of 28 districts. Addressing quality gaps, especially for care at birth in facilities, and including newborn interventions in child health programmes, will be critical to the future agenda of newborn survival in Malawi.

The correlation of health spending and infant mortality rate in Asian countries

“…Similar data and results are seen all over the world, in Malawi for instance between 2000 and 2010 NMR reduced 3.5% annually. 12 This indicate that IMR has declined globally and the rate of decline is similar in third world countries. In our study what is clearly visible is that the per capita spend on health had a much larger impact on IMR than percentage of GDP budgeted for health.…”

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey

“…The Community-Based Maternal and Newborn Care (CB-MNC) package utilizes the community health worker cadre of Health Surveillance Assistants to promote healthy pregnancy-related behaviors and to refer pregnant women and infants presenting danger signs. Kangaroo mother care (KMC) and Helping Babies Breathe (HBB) programs have been introduced in facilities across the country to address the burden of preterm birth and intrapartum-related hypoxia respectively [2]. While at a rate slower than the national reduction in under-5 mortality, neonatal mortality has been falling in Malawi at 3.5% per year between 2000 and 2010, over double the pace of the regional average (1.5% per year) [2].…”

Evidence of the factors that influence the utilisation of Kangaroo Mother Care by parents with low-birth-weight infants in low- and middle-income countries (LMICs): a scoping review protocol

“…As such in LMICs, the management of LBWI complications has been more of Kangaroo Mother Care as compared to conventional/incubator care, since around 1978 [4, 10–13]. LMICs strive to improve neonatal health through the implementation of KMC, among other interventions [2, 14], for instance, incorporating KMC package and guidelines in medical and nursing college syllabi, in-service training and existing national health care initiatives [15–17]. However, although by 2015, 62 countries achieved the three-quarter child mortality reduction target, LBWI mortality contributed largely to child mortality deaths despite the LMICs implementing KMC [8, 18, 19].…”