Beruflich Dokumente
Kultur Dokumente
4 Executive Summary
48 Call to Action
Acknowledgments Melinda French Gates
Co-founder, Bill &
Melinda Gates Foundation
INTRODUCTION
TRAINING IN ESSENTIAL CARE FOR existing health care delivery systems cial, human, and material—that are
NEWBORN HEALTH to provide expectant mothers and available to improve newborn health. CARE OF FUTURE MOTHERS
Another success story comes from
their newborns healthy alternatives to While this can mean supplementing
the Gadchiroli district in India the chronic pattern of disease and existing resources, in many cases " Improve the health and status of women " Promote safer sexual practices
where the nonprofit organization death at the beginning of life. this is not realistic or even neces- " Improve the nutrition of girls " Provide opportunities for female education
SEARCH has trained village health A key part of this effort will be sary. A first effort should be to " Discourage early marriages and early childbearing
workers and traditional birth advocating for and creating policies at ensure that the resources presently
attendants to provide appropriate
health care for women during
all levels that address the special available are used as efficiently as
needs of newborns. If newborn care possible. For example, there may be CARE DURING PREGNANCY
pregnancy, assistance in clean
deliveries, proper response to programs are to receive the support scope to reallocate resources within
complications for both mother they need—the kind of support cur- government health budgets to add " Improve the nutrition of pregnant women SPECIAL ATTENTION
and baby, as well as support for " Immunize against tetanus " Monitor and treat pregnancy complications, such
rently available for reproductive those newborn health components
breastfeeding, care for low birth " Screen and treat infections, especially syphilis as anemia, preeclampsia, and bleeding
weight babies, and family plan-
health, child health programs, and that have been found to be cost- and malaria " Promote voluntary counseling and testing for HIV
ning. As a result, neonatal mortali- communicable disease prevention, for effective. Also, in countries where " Improve communication and counseling: birth " Reduce the risk of mother-to-child transmission
ty has been reduced by approx- example—they will need to become a several NGOs and assistance agen- preparedness, awareness of danger signs, and (MTCT) of HIV
imately 60 percent through home- national priority and figure promi- cies are working in health, better immediate and exclusive breastfeeding
based care among isolated, rural nently in national health plans and efforts to coordinate their activities
villagers.9 INDIA
health reform programs. When poli- will help to integrate these newborn
CARE AT TIME OF BIRTH
cies are in place, then other needed health components. Nevertheless, to
changes are more likely to follow; for go to scale with the essential inter-
" Ensure skilled care at delivery SPECIAL ATTENTION
POLITICAL COMMITMENT example, funding commitments, pro- ventions for newborn health, most
" Provide for clean delivery: clean hands, clean " Recognize danger signs in both mother and baby
“Africa needs intensive mobiliza-
fessional and technical changes such countries will require incremental delivery surface, clean cord cutting, tying and and avoid delay in seeking care and referral
tion of people who have the power as revised national curricula and resources that need to be provided stump care, and clean clothes " Recognize and resuscitate asphyxiated babies
and means to reduce maternal recruitment and deployment of staff, on a long-term, sustainable basis. " Keep the newborn warm: dry and wrap baby immediately
and neonatal mortality on the con- and the mobilization of nongovern- We also need to collaborate with immediately, including head cover, or put skin-to- " Pay special attention to warmth, feeding, and
tinent.” This observation by skin with mother and cover hygiene practices for preterm and LBW babies
mental organizations. local organizations and research
Madame Adame Ba Konare, First " Initiate immediate, exclusive
Lady of Mali, represents the kind
Another front in this effort will be institutions to advance the state of breastfeeding, at least within one hour
and level of advocacy needed to to strengthen and expand proven the art of newborn care, identifying " Give prophylactic eye care, as appropriate
advance the newborn agenda. At a cost-effective services. We can begin, and testing promising new, low-
meeting in May 2001, the first in short, by doing more of what we cost approaches and technologies,
ladies of West and Central Africa know works and, wherever possible, and improving our understanding of CARE AFTER BIRTH
argued eloquently for “leadership
and commitment from within
doing it better, such as promoting cultural factors that affect commu-
Africa itself.” Conferences such as tetanus immunization and breast- nity and household practices. " Ensure early postnatal contact SPECIAL ATTENTION
these are important for creating a feeding, as noted above. We can also Collaboration must be a com- " Promote continued exclusive breastfeeding " Recognize danger signs in both mother and new-
policy environment favorable to make a concerted effort to identify mon thread in all of these efforts, " Maintain hygiene to prevent infection: ensure born, particularly of infections, and avoid delay in
health reform and for helping key other feasible, cost-effective working together in strategic part- clean cord care and counsel mother on general seeking care and referral
agencies and individuals to move hygiene practices, such as hand-washing " Support HIV positive mothers to make appropri-
from rhetoric to action.10 MALI
approaches to newborn care that can nerships with a wide range of insti-
" Provide immunizations such as BCG, OPV, and ate, sustainable choices about feeding
be easily replicated at the household tutions in developed and developing hepatitis B vaccines, as appropriate " Continue to pay special attention to warmth,
and community level. Meanwhile, we countries, including universities feeding, and hygienic practices for LBW babies
can work on incorporating a newborn and other NGOs, government min-
care component into existing safe istries, and international agencies.
motherhood and child survival pro- The potential for impact expands
grams, ensuring that postnatal care greatly whenever resources and
for mother and baby becomes as experiences are shared. likely to space their pregnancies, breakthroughs, expensive technolo- the newborn. With the support and
routine as prenatal care. Finally, we All of these investments will pay thereby improving their own health gy, or the makeover of national collaboration of national decision-
can add a newborn component to off—and not just in reduced mortal- as well as that of their children. This health care systems. Major strides makers, community leaders, health
other ongoing health initiatives that ity rates. Evidence is growing that in turn leads to reduced fertility can be made by putting existing care professionals, and assistance
also target mothers, such as family healthy newborns are more likely to rates and contributes to the demo- solutions into general practice, while agencies, the world’s newborns can
planning and prevention programs be healthy adults, greatly reducing graphic transition from high to low the search continues for the most receive the care and resources they
for sexually transmitted infections. the social and economic costs of ill- fertility and mortality. effective way to bring about behav- need to survive and prosper.
Another piece of this effort must ness and disability. And when new- Reducing newborn and maternal ioral change and to treat certain
be to mobilize the resources—finan- borns survive, mothers are more mortality does not require medical complications, such as asphyxia, in
NEWBORN DEATH IS A mately 30 percent risk of one of her Africa and South Asia, respectively.13
MAJOR PROBLEM babies dying in the first month, It should be noted here that
Deaths during the neonatal period compared to a mother in Western measuring newborn mortality has
(the first 28 days of life) account for Europe or North America where the been difficult (see note, Table 1, " More than seven million infants
almost two-thirds of all deaths in likelihood is less than one percent. p.14). Even so, considerably more
die each year between birth to 12
the first year of life, and 40 percent Almost a third of mothers in west- information is available today than
of deaths before the age of five (see ern Africa have lost at least one was the case even a few years ago. months
“Two-Thirds Rule,” p.13). Current newborn baby—a commonplace but Thus, available estimates such as " Almost two-thirds of infant deaths
estimates suggest that 34 out of largely untold tale of grief. those from the World Health Orga- occur in the first month of life
every 1,000 babies born in develop- The neonatal mortality rate (42 nization (WHO) indicate the magni-
" Among those who die in the first
ing countries die before they reach per 1,000) and the perinatal mortali- tude of the problem rather than
one month of life.12 ty rate (76 per 1,000) are highest in provide precise figures.14 month of life, about two-thirds die
A disturbing feature of newborn Africa, and neonatal mortality is in the first week of life
mortality is the marked variation in highest of all in western Africa, at HEALTHY NEWBORNS HAVE A " Among those who die within the
rates between low-income and 54 per 1,000 live births. Asia actual- HEADSTART IN LIFE
first week, two-thirds die in the
high-income countries (Table 1, ly has a lower average neonatal While the alarming number of still-
p.14). For example, the neonatal death rate (34 per 1,000), but births and neonatal deaths is per- first 24 hours of life
mortality rate (NMR) in Mali is about because of that region’s higher pop- haps the most compelling reason to
60 per 1,000 live births, compared to ulation density, it accounts for 60 focus on newborns, another impor-
Sweden, where the rate is less than percent of the world’s neonatal tant reason is the fact that healthy
3. The disparity between regions is deaths (Table 1, p.14). Preliminary newborns are likely to enjoy better
even wider when we use the lifetime results from a recent analysis found health in childhood and in later life.
risk of a mother experiencing a that the loss of healthy life from Newborns who get off to an
neonatal death as the standard of newborn deaths represented 8.2 unhealthy start, especially low birth
comparison. A mother in western percent and 13.6 percent of the bur- weight (LBW) and preterm babies,
Africa, for example, has an approxi- den of disease in sub-Saharan are particularly vulnerable to illness
* This rule applies only to the world average. Local proportions will depend on progress in addressing newborn rel-
ative to post-newborn deaths. Historically, as the number of infant deaths has fallen, the proportion of newborns
has risen. SOURCE Data based on Hill 1999, WHO 2000, and WHO 200121
c
OCEANIA 225 34 8 2.4 8
a
Definitions of the indicators and sources of data are listed in the appendix. NMR is based on WHO estimates for
2001 using data collected circa 1999. The number of neonatal deaths was calculated by multiplying the number of
live births (1999 estimates) by the NMR (2001 estimates). TFR is from UNFPA 2000.
b
The lifetime risk of a mother experiencing a neonatal death is calculated by multiplying the neonatal mortality rate
by the total fertility rate. This is a simplification of complex statistical interactions between fertility and neonatal
deaths, but is used to illustrate the dramatic differences by sub-region.
c
Japan, Australia and New Zealand have been excluded from the regional estimate but are included in the total for
developed countries.
Very few countries in the developing world have a reliable system for registering births and deaths. While surveys by
governments and international agencies attempt to estimate the size of the problem, there are many sources of
ABOVE An early postnatal visit provides the
potential error, such as the under-reporting of newborn deaths and stillborns, and inaccuracies in fixing the time of
deaths (i.e., classifying neonatal deaths as stillbirths). Other problems include the reluctance of mothers to talk about
opportunity to promote healthy practices and
infant deaths for cultural reasons and the fact that the populations surveyed are often in easy-to-reach, relatively address complications. MALAWI
advantaged areas, thus introducing questions of sample bias and a tendency to underestimate the problem.
of future mothers.
CARE OF FUTURE MOTHERS
BLAME FOR PROBLEMS CARE OF FUTURE MOTHERS: for many pregnant women make it
OFTEN FALLS ON MOTHERS IMPROVING THE STATUS AND difficult for them to put these sound
Gopini shows little sympathy for
HEALTH OF WOMEN recommendations into practice (see " Improve the health and status
her daughter-in-law who has left Small girls grow into small women, Appendix, Table II, Percent of preg- of women
for a two-month stay at her moth- who develop into underweight moth- nant women with at least one antena-
er’s house following the stillbirth " Improve the nutrition of girls
ers who have undernourished tal visit).
of her first son. There has always babies, resulting in a cycle of ill " Discourage early marriages
been friction between Gopini and
health and high death rates.38 The Improve pregnant women’s nutrition and early childbearing
her daughter-in-law, and the
death of her grandson only adds to causes of the undernourishment and A malnourished mother not only " Promote safer sexual practices
her enmity. She cannot under- ill health of many women are com- endangers the health of her fetus
stand why the baby died, since she " Provide opportunities for
plex. In many societies, girls are but also her own health, increasing
herself gave birth to a breech baby uniquely disadvantaged, their options the likelihood of infection and dis- female education
20 years ago without problems.
“My daughter-in-law was very
in life limited by illiteracy, poor ease. Short-term options for improv-
lazy, she was always sleeping,” education, and lack of employment ing the nutrition of mothers include:
she says. “Perhaps because of this opportunities. They are often bur- " promoting a healthy and varied
the baby didn’t have enough space dened with heavy workloads, have diet through an adequate supply and
to move.” NEPAL lesser claims on scarce resources, equitable distribution of food;
and may not be free to make their " supplementing pregnant
own decisions regarding access to women’s diets through food-based
health care or their own fertility. or manufactured supplements or
DEMANDS OF HARD, PHYSICAL WORK Improving the status and health fortified foods;
CONTINUE THROUGH PREGNANCY of girls and women is clearly a long- " reducing work loads;
susceptible to low birth weight, the support of and coordination " treating conditions such as A recent study from the Gambia, that zinc supplements during preg- moting healthy diets, and defending
premature babies. If you ask her among individuals in numerous sec- malaria and worms. however, has reopened the debate. nancy improve infant outcomes, par- gender equity. In those cases where
whether she took care during tors, including health, education, Over the long term, the nutrition Undernourished pregnant women ticularly among LBW infants.43,44 supplements are the only interven-
pregnancy, she is nonplussed. and human rights. Changes in social of pregnant women can be improved were given supplements in the form Supplementation of women of repro- tion, however, the most important
“How can I take care?” she says.
“I’m always working, picking rice
and cultural beliefs and practices by studying how these women live. of a groundnut-based biscuit that ductive age in Nepal once weekly supplements to include in an ante-
and pulses (lentils), digging pits will also be necessary to support We also need to better understand provided an extra 900 calories per with vitamin A reduced pregnancy- natal care package are iron and
and fetching water. I was in the needed improvements in the status the demands on their energy and day and added calcium and iron. The related maternal mortality by 40 per- folate, and, in some regions, vitamin
fields until two hours before my and health of future mothers. time and to take into account their women also received prenatal care, cent, and modestly reduced maternal A, iodine, and zinc. The use of multi-
baby was born.” INDIA The ultimate objective is to teach needs as they perceive them.39 including iron and folate supple- morbidity and anemia.45 In other ple micronutrient supplements dur-
succeeding new generations of girls Providing food supplements has ments, tetanus toxoid immunization studies, maternal night blindness, ing pregnancy, a common practice
that their health—and that of their been a common component of pro- if needed, and chloroquine during indicative of vitamin A deficiency and in the industrial world, is now
children—will depend on improving grams to improve maternal nutrition. the malaria season. Overall, there present in 10-20 percent of women in undergoing evaluation in several
nutrition, delaying marriage and In the 1960s and 1970s, there were was a 35 percent decrease in LBW some populations, was associated developing countries.
childbirth beyond the customary several attempts to analyze the effect babies and a 49 percent reduction in with more severe infections, anemia, Adding micronutrients (such as
age, and ensuring that they and of such programs on neonatal out- perinatal deaths among women increased infant deaths, and iron, vitamin A, and iodine to fortify
their partners use safer sexual comes, but most studies showed rel- receiving supplements compared increased risk of maternal mortality flour and other staples) can be a
practices. All of these goals can be atively small effects on birth weight with those who did not.40 for up to two years after giving simpler and quicker means of
furthered by providing educational and perinatal mortality. The cost- Increasing the intake of vitamins birth.46 Although maternal vitamin A improving nutritional status than
opportunities for girls. effectiveness of these approaches and micronutrients during pregnan- supplementation did not impact changing diets. However, for this
was also called into question, and cy has also produced promising infant mortality through 6 months of strategy to be effective, fortified
CARE DURING PREGNANCY further troubles arose over claims of results. Recent studies of interven- age, vitamin A supplementation of foods must be readily available, rel-
Caring for newborn babies starts with “culture clash,” referring to situa- tions to reduce anemia in pregnancy newborns immediately after birth atively inexpensive, and widely con-
caring for their pregnant mothers, tions where women chose to restrict have demonstrated the beneficial may be a promising strategy.47,48 sumed by the target population.
ensuring that pregnant women are eating in the belief that having a effects of iron and folate supple- Ideally, the broad use of food and
adequately nourished, free from smaller baby would contribute to a ments, along with anti-worm treat- vitamin supplements to improve Immunize against tetanus
infections and exposure to harmful safer and easier birth. For these rea- ment.41 In one study, adding iodine to maternal nutrition should be part of As noted earlier, neonatal tetanus is
substances, and monitored for com- sons, food supplementation pro- a water supply in China reduced a wide-scale development effort an important cause of newborn death.
plications during pregnancy. Howev- grams were largely discredited and neonatal mortality by approximately aimed at alleviating poverty, ensur- Tetanus toxoid vaccination protects
er, the harsh realities of everyday life never introduced on a broad scale. 50 percent.42 Other studies suggest ing household food security, pro- women against tetanus infection
Decision-makers must also ment of complications. findings emphasize that the attitude
consider the social effects of new A primary barrier to delivering of those attending the birth is an
policies, such as isolation of or proper obstetric care in developing important factor along with the skill
" Ensure skilled care at delivery
violence against women who are countries is that on average 63 per- of the professional birth attendant,
identified to be HIV positive, and cent of births occur in the home and suggesting that personal support " Provide for clean delivery: clean hands, clean delivery surface,
the possibility of increased infant only 53 percent of all births are and skilled assistance in delivery clean cord cutting, tying and stump care, and clean clothes
deaths caused by the high rate of attended by a health worker skilled are important to women in labor. " Keep the newborn warm: dry and wrap baby immediately,
infections often associated with the in delivery care.57 In other words, 53
including head cover, or put skin-to-skin with mother and cover
use of breast milk substitutes. million women each year give birth Provide for clean delivery
without the help of a professional.58 A clean delivery is crucial to prevent " Initiate immediate, exclusive breastfeeding, at least within one hour
CARE AT TIME OF BIRTH In some countries the incidence of infection of the newborn and of the " Give prophylactic eye care, as appropriate
skilled care at deliveries is much mother. The standard message is to
Ensure skilled care at delivery lower; two percent in Somalia, for maintain a "clean chain" by ensur-
Special Attention
Historically, skilled care at delivery example, and nine percent in Nepal. ing clean hands, clean surfaces,
has been associated with lower Even in those cases where skilled clean cord-cutting and tying, and a " Recognize danger signs in both mother and baby and
neonatal death rates (Figure 4).55 health care is available, ongoing clean cloth to wrap the newborn. avoid delay in seeking care and referral
Skilled attendants at birth are training and supervision of personnel The use of a clean delivery kit " Recognize and resuscitate asphyxiated babies immediately
defined as “people with midwifery and quality referral care for obstetric helps to promote cleanliness at birth.
" Pay special attention to warmth, feeding, and
skills (e.g., doctors, midwives and emergencies must be ensured. Most clean delivery kits include soap,
nurses) who have been trained to Several randomized controlled a plastic sheet for delivery, a clean hygiene practices for preterm and LBW babies
proficiency in the skills to manage trials have shown the value of a blade, and a cord tie.
normal deliveries, and diagnose supportive companion in reducing
and manage or refer complicated the length of labor, producing fewer Keep the newborn warm
cases.”56 Skilled care providers may instrumental deliveries, and having A newborn baby regulates body
practice in facility or household set- a positive impact on Apgar scores temperature much less efficiently
tings and require a functioning (scores used to evaluate the condi- than does an adult and loses heat
referral system for the manage- tion of the newborn baby).59 These more easily, particularly from the
head. A naked newborn, for exam- keep it warm. In some countries, TRAINING FOR TRADITIONAL
ple, exposed to an environmental the newborn baby is left uncovered BIRTH ATTENDANTS
temperature of 23ºC (73.4ºF) suffers until the placenta is delivered, a A TBA who has assisted women
the same heat loss as a naked adult practice that considerably increases during birth over four generations,
FIGURE 4 SKILLED CARE AT DELIVERY AND NEWBORN MORTALITY BY REGION
at 0ºC (32ºF),60 and the loss is the risk of hypothermia. Skin-to- recalls how in the old days she
greater still in LBW babies, espe- skin or close contact with the would pour thick warm gruel over
cially if they are left wet and uncov- mother is the best way to keep the a child immediately after delivery,
cut the umbilical cord with a sickle,
ered. Hypothermia in the newborn baby warm. Another advantage of and check the newborn’s hearing
100
occurs in all climates and is due to continued close contact between by hitting a steel vessel with metal
a lack of knowledge or practice, not newborn and mother is that it near her ear. Then she would mas-
80 a lack of equipment. encourages breastfeeding on sage the head into shape. These
Wherever the birth takes demand. Breastfeeding within one days, she washes her hands with
Skilled attendance
soap and disinfectant before and
at delivery (%) place, it is important to maintain a hour of delivery provides the baby after delivery, uses sterilized scis-
60
“warm chain” immediately after with calories to produce body heat sors to cut the cord, and cleans the
Neonatal deaths per
1,000 live births
birth and during the following hours and of necessity keeps the baby mother and child with a clean
and days. The place where the birth close to the mother and warm. cloth. She is also trained in resus-
40
occurs must be warm (at least Bathing is generally not necessary citation skills. INDIA
25ºC/77ºF) and free of drafts, on the first day and should be post-
20 though ventilated. poned until the baby is stable.
At birth, the newborn should be
immediately dried and covered, Initiate exclusive breastfeeding
0 Africa Asia Latin America More Developed
and the Caribbean Regions including the head. While being Immediate breastfeeding is one of
dried, the baby should be placed on the most effective interventions; it
the mother’s chest or abdomen to provides nutrients, warmth, and
SOURCE WHO estimates 2001
1 World Health Organization 15 Barker DJ, Martyn CN, 27 Sejas, C. Save the Children, health: anthropological views Nutr 2001; 131;1510–1521. AIDS Acquired Immunodeficiency IMCH Integrated Maternal STI Sexually transmitted infection
2001 estimates. Based on data Osmond C, Hales CN, Fall CH. Bolivia. Personal communica- on intervention. In: Costello AM
tion. June 2001. de L, Manandhar DS, editors. 47 Humphrey JH, Agoestina T,
Syndrome and Child Health
collected around 1999. Growth in utero and serum TBA Traditional birth attendant
cholesterol concentrations in Improving newborn infant Wue L, et al. Impact of neonatal
2 World Health Organization. adult life. BMJ 1993; 28 Stoll, B. The global impact of health in developing countries. vitamin A supplementation on ANC Antenatal care IMR Infant mortality rate
Perinatal mortality: a listing 307:1524–1527. neonatal infection. Clin Perina- London: Imperial College Press infant morbidity and mortality. J
TFR Total fertility rate
of available information. FRH/ tol 1997; 24 (1): 1–21. 2000 distributed by World Sci- Pediatr 1999; 128:489–496. BCC Behavior change IUGR Intra-uterine growth
MSM.96.7. Geneva: WHO, 1996. 16 Hales CN, Barker DJ, Clark entific Publishing Co. P.O. Box TT Tetanus toxoid
PM et al. Foetal and Infant 29 UNICEF/WHO/UNFPA. 128, Farrer Road, Singapore, 48 Tielsch JM, Rahmathullah L,
communications retardation
3 World Health Organization growth and impaired glucose Maternal and neonatal tetanus 912805. Thulasiraj RD, Katz J, Coles C. UN United Nations
2001 estimates. Based on data tolerance at age 64. BMJ 1991; elimination by 2005. New York: Impact of vitamin A supplemen- BFHI Baby-Friendly Hospital LBW Low birth weight
collected around 1999. 303:1018–1022. UNICEF, 2000. 40 Ceesay SM, Prentice AM, tation to newborns on early Initiative UNDP United Nations
Cole TJ, Foord F, Weaver LT, infant mortality: a community- MIRA Mother and Infant
4 Kramer, MS. Intrauterine 17 Barker D. Intrauterine pro- 30 Victora CG, Smith PG, Poskitt EM, Whitehead RG. based, randomized trial in South Development Programme
growth and gestational duration gramming of coronary heart Vaughan JP, Nobre LC, Effects on birthweight and peri- India. Proc XX IVACG Meeting,
CDC Centers for Disease Research Activities, Nepal
determinants. Pediatrics 1987; disease and stroke. Acta Paedi- Lombardi C, Teixeira AM, Fuchs natal mortality of maternal Hanoi, Vietnam, 2001; p 70. Control and Prevention UNFPA United Nations
80(4):502–11. atr Suppl 1997; 423:178–182. SC, Moreira LB, Gigante LP, dietary supplements in rural MMR Maternal mortality rate
Barros R. Evidence for Gambia; five year randomised 49 http://www.who.int/
Population Fund
CEE Central and Eastern Europe
5 United Nations Population 18 Leon DA. Foetal growth and protection by breastfeeding controlled trial. BMJ 1997; vaccines-diseases/services/ MTCT Mother-to-child transmission
Fund. The State of the World’s adult disease. Eur J Clin Nutr against infant deaths from 315(7111):786–90. immschedule.htm UNICEF United Nations
infectious diseases in Brazil.
CHAPS Community Health
Population 2000:Lives Togeth- 1998; 52 (Suppl.1):S72-S82. NGO Nongovernmental organization International Children’s Fund
er, Worlds Apart. New York: Lancet 1987; Aug, 8:319–321. 41 Atukorala TM, de Silva LD, 50 Bellamy C. State of the Partnerships, Malawi
UNFPA, 2001. 19 Grantham McGregor SM, Lira Dechering WH, Dassenaeike World’s Children. UNICEF 1999.
PI, Ashworth A, Morris SS, 31. World Health Organization. TS, Perera RS. Evaluation of
NMR Neonatal mortality rate USAID United States Agency
CIS Commonwealth of
6 World Health Organization pres- Assuncao AM. The development World Health Report, 1998: Life effectiveness of iron-folate sup- 51 Steketee, RW Wirima JJ, for International Development
entation. Neonatal survival of low birth weight term infants in the 21st century—a vision for plementation and antihelminth- Slutsker WL, Khoromana CO, Independent States OPV Oral Polio Vaccine
intervention research work- and the effects of the environ- all. Geneva: WHO, 1998. ic therapy against anemia in Reman JG, Heymann DL. Objec- VCT Voluntary counseling and
shop. Kathmandu, Nepal: WHO, ment in northeast Brazil. J Pedi- pregnancy–a study in the plan- tives and methodology in a DHS Demographic and SEARCH Society for Education,
April 29-May 3, 2001. atr 1998; 132:661–6. 32. Kramer, MS. Intrauterine tation sector of Sri Lanka. Am J study of malaria treatment and testing program
growth and gestational duration Clin Nutr 1994; 60(2):286–92. prevention in pregnancy in rural
Health Surveys Action and Research in
7 World Health Organization. 20 Lawn J, McCarthy BJ, Ross determinants. Pediatrics 1987; Malawi: the Mangochi Malaria Community Health VHW Village health worker
Success stories in developing S. The Healthy Newborn: a ref- 80(4):502–11. 42 De Lon GR, Leslie PW, Wang Research Project. Am J Trop HDI Human development index
countries. Geneva: WHO, 2001. erence manual for program SH, Jiang XM, Zhang ML, Rake- Med Hyg 1996;55(Suppl 1):8–16. SNL Saving Newborn Lives WHO World Health Organization
Available at: http://who.int/ managers. Atlanta, GA: CDC, 33. Yasmin S, Osrin D, Paul E, man M, Jiang JY, Ma T, Cao XY. HIV Human Immunodeficiency Virus
inf-new/mate3.thm CARE, CCHI, 2001. More infor- Costello AM de L. Neonatal Effect on infant mortality of iod- 52 Shulman CE. Malaria in
mation from www.cdc.gov/ mortality of low birth weight ination of irrigation water in pregnancy: its relevance to
8 World Health Organization. nccdphp/drh. infants in Bangladesh. Bull severely iodine deficient area in safe-motherhood programmes.
Mother-baby package: imple- WHO (in press). China, Lancet 1997 Sep 13; 350 Ann Trop Med Parasitol 1999;
menting safe motherhood in 21 Lawn J, McCarthy BJ, Ross (9080):771–3. 93(Suppl 1):S59-S66.
countries. FHE/MSM/94.11. S. The Healthy Newborn: a ref- 34. Kramer, MS. Intrauterine Kramer TR. Companionship to Aalen O. Resuscitation of R. Evidence for protection by 75 http://www.who.int/ 80 O’Rourke K, Howard-Grab-
Geneva: WHO, 1994. erence manual for program growth and gestational duration 43 Merialdi M, Caulfield LE, 53 Coovadia HM and Rollins N. modify the clinical birth envi- asphyxiated newborn infants breastfeeding against infant vaccines-diseases/services/ man L, Seoane G. Impact of
managers. Atlanta, GA: CDC, determinants. Pediatrics 1987; Zavaleta N, Figueroa A, DiPietro Current controversies in the ronment: effect on progress with room air or oxygen; an deaths from infectious diseases immschedule.htm community organization of
9 Bang AT, Bang RA, Baitule CARE, CCHI, 2001. More infor- 80(4):502–11. JA. Adding zinc to prenatal iron prenatal transmission of HIV in and perceptions of labour and international controlled trial; in Brazil. Lancet 1987;2(8554): women on perinatal outcomes
SB, Reddy MH, Deshmukh MD. mation from www.cdc.gov/ and folate tablets improves developing countries. Seminars breastfeeding. Br J Obs Gynae the Resair 2 Study. Pediatrics 319–321. 76 Academy for Educational in rural Bolivia. Rev Panam
Effect of home-based neonatal nccdphp/drh. 35. Nielsen B, Liljestrand J, foetal neurobehavioural devel- in Neonatology 1999; 4:192–200. 1991; 98:756–764. 1998; 102:1. Development LINKAGES Pro- Salud Publica/Pan Am/Public
care and management of sep- Hedegaard M, Thilsted S, opment. Am J Obstet Gynecol 71 World Health Organization ject. Breastfeeding and Health 1998; 3(1).
sis on neonatal mortality: field 22 Zhu BP, Rolfes RT, Nangle Joseph A. Reproductive pattern, 1999 Feb; 180(2 Pt 1):483–90. 54 Vuthipongse P, Bhadrakom 60 World Health Organization. 66 Bergman JJ, Jurisoo LA. The presentation. Neonatal survival HIV/AIDS. FAQ sheet 1. Washing-
trial in rural India. Lancet BE, Horan JM. Effect of the perinatal mortality, and sex C and Chaisilwattana P. Admin- Thermal protection of the new- “kangaroo” method for treating intervention research work- ton DC: AED, May 2001. http:// 81 Bang AT, Bang RA, Baitule
1999;354:1955–61. interval between pregnancies preference in rural Tamil Nadu, 44 Osendarp SJM, van Raaij istration of zidovudine during born: a practical guide. low birth weight babies in a shop. Kathmandu, Nepal: WHO, www.linkagesproject.org SB, Reddy MH, Deshmukh MD.
on perinatal outcomes. N Engl J South India: community based, JMA, Darmstadt GL, Baqui AH, late pregnancy and delivery to WHO/RHT/MSM/97.2. Geneva: developing country. Trop Doc April 29-May 3, 2001. Effect of home-based neonatal
10 Madame Adame Ba Konare. Med 1999; 340:589–94. cross sectional study. BMJ Hautvast GAJ, Fuchs GJ. Zinc prevent perinatal HIV transmis- WHO, 1997. 1994; 24(2):57–60. 77 Coutsoudis A, Pillay P, care and management of sep-
Speech at the regional forum on 1997; 314(7093):1521–4. supplementation during preg- sion–Thailand. Morbidity and 72 Morrow AL, Lourdes Guer- Spooner E, Kuhn L, Coovadia sis on neonatal mortality: field
maternal and neonatal mortality 23 Caldwell JC, Reddy PH, nancy and effects on growth Mortality Weekly Report 1998; 61 World Health Assembly. 67 Academy for Educational rero M, Shults J, Calva JJ, Lut- HM. Influence of infant feeding trial in rural India. Lancet 1999;
reduction. Vision 2010. Bamako, Caldwell P. The causes of 36. United Nations Population and morbidity in low birth- 47:151–154. Resolution on infant and young Development LINKAGES Pro- ter C, Bravo J, Ruiz-Palacios G, patterns on early mother-to- 354:1955–61.
Mali: UNICEF, May 2001. demographic change—experi- Fund. The State of the World’s weight infants. Lancet 2001; child nutrition. Geneva: WHO, ject. LINKAGES results. Pre- Morrow RC, Butterfoss FD. Effi- child transmission of HIV-1
mental research in South India. Population 2000:Lives Together, 357:1080–85. 55 World Health Organization. May 2001. Available from sentation at USAID stakeholder cacy of home-based peer coun- in Durban, South Africa: a 82 Manandhar, D. Mother and
11 World Health Organization 1989: ISBN 0299116107. Worlds Apart. New York: UNF- Making pregnancy safer. http://www.who.int/inf-pr- meeting. Washington DC: AED, selling to promote exclusive prospective cohort study. Infant Research Activities
2001 estimates. Based on data PA, 2001. 45 West KP Jr, Katz J, Khatry RHR00.6. Geneva: WHO, 2000. 2001en/pr2001wha-6.html December 14, 2000. breastfeeding. Lancet 1999; Lancet 1999; 354:471–76. (MIRA). Nepal. Personal com-
collected around 1999. 24 de Graft Johnson J. Save the SK, LeClerq SC, Pradhan EK, 353:1226–1231. munication. June 2001.
Children, Malawi. Personal 37. Save the Children. The State Shrestha SR, Connor PB, Dali 56 MotherCare Policy brief #3. 62 Thaddeus S, Maine D. Too 68 Budin P. The Nursling. 78 Daly, P and Fadia S. Repro-
12 World Health Organization communication. June 2001. of the World’s Mothers 2001. SM, Christian P, Pokhrel RP, Washington DC: MotherCare, far to walk: maternal mortality English translation by Maloney 73 Haider R, Ashworth A, Kabir ductive Health in Indonesia: 83 Onis M de, Lossner M, Villar
2001 estimates. Based on data Available from http:// Sommer A, the NNIPS-2 Study May 2000. in context. New York: Columbia WJ. London: The Caxton K, Huttly SRA. Effect of com- Lessons from the Past and J. Levels and patterns of
collected around 1999. 25 Ministry of Health, India and www.savethechildren.org/ Group. Double-blind, cluster University, 1990. Publishing Co, 1907. munity-based peer counsellors Opportunities for the Future, intrauterine growth retardation
Trends in childhood mortality in mothers/learn/sowm2001/.htm randomized trial of low dose 57 World Health Organization. on exclusive breastfeeding Washington DC: World Bank, in developing countries. Eur J
13 Hyder AA, Morrow RH, Wali the developing world 1960–1996. supplementation with vitamin A Coverage of maternity care. A 63 World Health Organization. 69 World Health Organization practices in Dhakar, 2000. Unpublished paper. Clin Nutr 1998; 52:S5-S15.
S, McGuckin J. Burden of dis- New York: UNICEF, 1999: ISBN 38. Murray C, Lopez A. Gender or ß-carotene on mortality listing of available information. World Health Report, 1998: Life Effect of breastfeeding on Bangladesh: a randomised con-
ease for neonatal mortality in 92–806–3441–0. and nutrition in the global bur- related to pregnancy in Nepal. WHO/RHT/MSM/96.28. Geneva: in the 21st century—a vision for infant and child mortality due trolled trial. Lancet 2000; 79 Indonesia Central Bureau of 84 Aarts C, Kylberg E, Hornell
South Asia and Sub-Saharan den of disease, 1990–2020. In: BMJ 1999; 318:570–575. WHO, 1996. all. Geneva: WHO, 1998. to infectious diseases in less 356(9242). Statistics, State Ministry of A, Hofvander Y, Grebe-Medhin
Africa. Preliminary report sub- 26 Safe Motherhood Inter- Nutrition US-Co (ed.) Chal- developed countries: a pooled Population/National Family M, Greiner T. How exclusive is
mitted to Save the Children, Agency Group. Skilled Care Dur- lenges for the 21st century: a 46 Christian P, West KP Jr, 58 United Nations Population 64 Palme-Kilander. Methods of analysis. Lancet 2000;355 74 Academy for Educational Planning Coordinating Board, breastfeeding? A comparison of
USA. Baltimore, MD: Johns ing Childbirth: A Review of the gender perspective on nutrition Katry SK, LeClerq SC, Kim- Fund. State of World Population resuscitation in low-Apgar 451–455. Development LINKAGES Pro- Ministry of Health and Macro data since birth with the cur-
Hopkins University, 2001. Evidence. New York: Family through the life cycle. Geneva: brough-Pradhan, Katz J, 2000: Lives together, Worlds score newborn infants—a ject. LINKAGES results. Pre- International. Indonesia Demo- rent status data. Int J Epi 2000;
Care International (in press). ACC/SCN, 1998: 67–77. Shrestha SR. Maternal night apart. New York: UNFPA, 2000. national survey. Acta Paediatr 70 Victora CG, Smith PG, sentation at USAID stakeholder graphic Health Survey. Calver- 29:1041–1046.
14 World Health Organization For more information, see RH blindness increases risk of 1992; 81:739–44. Vaughan JP, Nobre LC, Lom- meeting. Washington DC: AED, ton, MD: Central Bureau of
2001 estimates. Based on data at a Glance fact sheet at 39 Panter-Brick C. Women’s mortality in the first 6 months 59 Hofmeyer GJ, Nikodem VC, bardi C, Teixeira AM, Fuchs SC, December 14, 2000. Statistics and Macro Interna-
collected around 1999. www.worldbank.org/hnp work and maternal-child of life among infants in Nepal. J Wolman WL, Chalmers BE, 65 Saugstad OS, Rootwell T, Moreira LB, Gigante LP, Barros tional, 1997.
EXPLANATORY NOTES
Writer/Editor Reviewers Vinod Paul, All India Institute of Medical World Health Organization, Photography Credits
Anthony Costello, Women & Carla AbouZahr, WHO, Switzerland Sciences, India European Office, Denmark Patricia Daly, Indonesia page 38
Children First, United Kingdom Abhay Bang, SEARCH, India Imogen Sharp, Women & Children First, World Health Organization, Family and Rebecca James, Haiti page 17
Victoria Francis Petra ten Hoope-Bender, United Kingdom Community Health, Switzerland Thomas L. Kelly, India pages 1, 6, 9, 13,
Ali Byrne International Confederation of Tomris Türmen, WHO, Switzerland 22, 25, 27, 32
Claire Puddephatt Midwives, The Netherlands David Woods, University of Capetown, Journalist Thomas L. Kelly, Nepal back cover,
Zulfiqar Bhutta, Aga Khan South Africa Marina Cantacuzino pages 4, 10, 11, 35, 36, 37, 41, 44, 46
Contributing Editors, Save the Children University, Pakistan Jelka Zupan, WHO, Switzerland Brian Moody, Malawi front cover, pages 3,
Anne Tinker, Director, Rose Kambarami, University of 9, 12, 15, 18, 19, 21, 24, 29, 31, 47, 48
Saving Newborn Lives Zimbabwe, Zimbabwe Institutions Providing Data Anne Tinker, Bolivia pages 2, 39
Patricia Daly Jerker Liljestrand, World Bank, Baby-Friendly Hospital Initiative, Design & Production
Gary Darmstadt United States Switzerland KINETIK Communication Photos in this publication may not
Joy Lawn, Consultant José Martines, WHO, Switzerland Centers for Disease Control and Preven- Graphics Inc., Washington, DC represent Save the Children programs.
David Marsh Dharma Manandhar, MIRA, Nepal tion, United States
Judith Moore Claudia McConnell, Women & Macro International, United States This report was printed by S+S Graphics
David Oot Children First, United Kingdom Medical Research Council, University of utilizing soy-based inks on Sappi Strobe
Ron Parlato Natasha Mesko, International Capetown, South Africa Gloss, a recycled paper containing 10
Ccoya Sejas, Bolivia Perinatal Care Unit, Institute of Child Pan Arab Program for Child percent post-consumer waste.
Dianne Sherman Health, United Kingdom Survival, League of Arab States, Egypt
David Osrin, International Perinatal United Nations Development Fund, Unit- ISBN 1-888393-05-X
Editorial Staff Care Unit, Institute of Child Health, ed States
Robin Bell, Save the Children United Kingdom United Nations International © Save the Children, 2001
Charlotte Storti Children’s Fund, United States
Rebecca Lowery