Elsevier

Seminars in Perinatology

Volume 34, Issue 6, December 2010, Pages 371-386
Seminars in Perinatology

3.6 Million Neonatal Deaths—What Is Progressing and What Is Not?

https://doi.org/10.1053/j.semperi.2010.09.011Get rights and content

Each year 3.6 million infants are estimated to die in the first 4 weeks of life (neonatal period)—but the majority continue to die at home, uncounted. This article reviews progress for newborn health globally, with a focus on the countries in which most deaths occur—what data do we have to guide accelerated efforts? All regions are advancing, but the level of decrease in neonatal mortality differs by region, country, and within countries. Progress also differs by the main causes of neonatal death. Three major causes of neonatal deaths (infections, complications of preterm birth, and intrapartum-related neonatal deaths or “birth asphyxia”) account for more than 80% of all neonatal deaths globally. The most rapid reductions have been made in reducing neonatal tetanus, and there has been apparent progress towards reducing neonatal infections. Limited, if any, reduction has been made in reducing global deaths from preterm birth and for intrapartum-related neonatal deaths. High-impact, feasible interventions to address these 3 causes are summarized in this article, along with estimates of potential for lives saved. A major gap is reaching mothers and babies at birth and in the early postnatal period. There are promising community-based service delivery models that have been tested mainly in research studies in Asia that are now being adapted and evaluated at scale and also being tested through a network of African implementation research trials. To meet Millennium Development Goal 4, more can and must be done to address neonatal deaths. A critical step is improving the quantity, quality and use of data to select and implement the most effective interventions and strengthen existing programs, especially at district level.

Section snippets

Progress Towards Neonatal Survival and MDG 4

MDG 4 targets a two-thirds reduction in under-five mortality between 1990 and 2015 (Fig. 1). Remarkable progress was achieved before 1990, with a halving in risk of death for children younger than 5 between 1960 and 1990. Since 1990, the global under-five mortality rate has decreased a further 28%, and the total number of under-five deaths is now fewer than 9 million.2 However, the current rate of reduction must increase 6-fold between now and 2015 to reach MDG 4.

The global number of neonatal

Variation Between Countries

In all regions, neonatal deaths are an important proportion of all deaths in children younger than 5 years of age, ranging from 27% to 54% of under-five deaths.3 NMRs vary widely between regions (Table 1),2, 3, 15 and more than two-thirds of the world's neonatal deaths occur in sub-Saharan Africa and South Asia.5 The newborn health gap between rich and poor countries remains unacceptably high, ranging from an NMR of 1 in Japan with a gross national income (GNI) per capita of US$38,210 to an NMR

Progress for Solutions for the Main Causes of Neonatal Death

Most neonatal deaths in Africa and Asia are caused by conditions that are rarely seen in high-income countries and, when they are seen, would not usually result in death. Three major causes of neonatal deaths in high-mortality settings (infections, complications of preterm birth, intrapartum-related neonatal deaths or “birth asphyxia”) account for more than 80% of all neonatal deaths globally (Fig. 4).3 The most rapid reductions have been made in reducing neonatal tetanus and there has been

Progress for Coverage of Care

Evidence-based strategies to save the lives of women and children include a wide range of interventions, which are usually provided through integrated service delivery packages along the timeline of the continuum of care, notably59:

  • reproductive health services to provide contraceptive services;

  • antenatal care for pregnant women;

  • skilled attendance and emergency obstetrical care during birth; and

  • postnatal care services, including both preventive and curative interventions.

Global-tracking

Addressing Program Gaps and Delays

Delays in receiving appropriate care can be important for many conditions, but delays of even a few hours in addressing an obstetrical emergency around the time of birth or the onset of sepsis in a neonate can be significant. The “classic” 3 delays were first described in relation to delay for women with obstetrical emergencies.67 These 3 delays are:

  • 1

    Delay in recognition of the problem and the decision to seek care. Physical distance and financial and cultural barriers to seeking care are

Conclusions

Together, maternal, newborn and child deaths remain a massive burden but more low-income countries are making good progress towards MDG 4 and, with strategic investments, including more attention to neonatal deaths, MDG 4 is achievable for many countries.17, 19 Although some uncertainty remains about the figures, it is clear that there are huge numbers of maternal (358,000) and neonatal (3.6 million) deaths, also closely linked with stillbirths (3.2 million). Often, however, maternal health

Acknowledgments

The authors thank Gary Darmstadt for very helpful editorial input. We are also grateful to the Royal College of Obstetrics and Gynecology for permission to adapt from Lawn JE, Kerber K, Enweronu-Laryea C: Delivering on neonatal survival to accelerate progress for Millennium Development goal 4, in: Kehoe S, Neilson JP, Norman JE, eds. Maternal and Infant Deaths: Chasing Millennium Development Goals 4 and 5. London, RCOG Press; 2010, 29-48. No specific funding was received for this paper, but the

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