Every year, around 2.9 million newborn unnecessarily die within first month and an additional 2.6 million are stillborn (Every Newborn Action Plan, 2014). Most of these deaths are due to few preventable and curable conditions such as prematurity, birth asphyxia and infections. Infection (36%), preterm birth (28%) and birth asphyxia (23%) account for 87% of neonatal deaths worldwide (Jehan et al., 2009). Undernutrition 1 is the underlying cause of death in an estimated 45% of all deaths among children under 5 years of age2 (WHO 2015).
Two-thirds of the world’s neonatal deaths occur in just 10 countries, mostly in Asia. Pakistan is number three among these countries (Black et al., 2003). With an estimated 298,000 neonatal deaths annually and a reported neonatal mortality rate of 46 per 1000 live births, Pakistan accounts for 7% of global neonatal death (Malik et al. 2016).
Birth Asphyxia is the second leading cause of neonatal mortality. Most of the babies dying due to birth asphyxia can be saved.
Helping Babies Breathe, a technique that teaches the initial steps of neonatal resuscitation to be accomplished within The Golden Minute to save lives and give a much better start to many babies who struggle to breathe at birth, have been shown to reduce neonatal mortality by up to 47% and fresh stillbirths by 24%.
Recent Pakistan Demographic and Health Survey 2017-18 has shown a significant decrease in the neonatal mortality, which was 55 per 1,000 live births five years earlier and has now decreased to 42 per 1,000 live births.
Similarly, infant mortality in Sindh has decreased as well. It was 74 per 1,000 live births and has now been recorded as 62 per 1,000 live births.
The ratio of mortality of children aged less than five years has also decreased by 15 per 1,000 live births. It is 74 per 1,000 live births now from earlier 89/1,000.
PPHI Sindh has started HBB intervention at almost all 300 BHU plus. Training have been provided to the staff that is accessible round the clock and training materials are available at district offices to continually equip technical staff and health care providers in HBB skills, where and when necessary.
Currently, all BHU plus are equipped with HBB interventions and provide information from the health facilities through District Health Information System and/or Summary of Additional Services data to see the effectiveness of the intervention on monthly basis.
- Identification and management of major causes of neonatal deaths.
- Introduction and implementation of possible serious bacterial infection (PSBI) management in young infants up to 2 months of age when referral is not feasible.
- Strengthening the implementation of Integrated Management of Newburn and Child Illness (IMNCI) by abridge course of IMNCI.
- Management of deliveries through provision of skilled birth attendants by implementing evidence-based interventions for mothers and newborn including use of Uterotonic, Partograph, Helping Babies Breathe, use of chlorhexidine and managing pregnancy complications.
- Improving referral through strengthening linkages with the community through LHWs, CHW hired for nutrition activities in district Jacobabad and using Community support groups.
- Prompt referral to higher level facilities by providing ambulance service when needed.
- Embedded implementation research in the programme setting to improve practice and health system.
Every Newborn: An action plan to end preventable deaths
World Health Statistics 2015
Imtiaz Jehan, Hillary Harris, Sohail Salat, Amna Zeb, et al, (2009). Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Bulletin of the World Health Organization
Helping Baby Breathe, Second Edition
PDHS 2017-18. Pakistan Demographic Health Survey