READ: Women’s Health and Child Health (CoC)
Newborn and child health
The neonatal period ranges from birth until the age of 28 days. Newborn babies are vulnerable, and therefore newborn health ought to be understood and studied specifically within child health. The focus on the workshop’s session on newborn health was to understand where, when and why neonatal deaths and stillbirths occur, so that this data can be used to inform decision making.
WHO defines stillbirth as the death of a foetus after 28 weeks gestation, or when the foetus weighs 1000 grams or more. However, some countries use a different standard to define stillbirth; this might start at 18 weeks in some high-income countries. The WHO standard is used as the international comparison definition.
Neonatal death can occur during the neonatal period if the baby was born alive. The Lancet series has revealed that around 75% of newborn deaths are preventable without intensive care. Birth facilities have a high impact herein: care at birth accounts for 41% of preventable neonatal deaths, and care of small and sick newborns for 31%. Studies have also shown that community care could avert 25% to 30% of preventable newborn deaths. Furthermore, the WHO recommends midwife-led CoC, where one midwife or a few midwives provide care to a woman, newborn baby and their family throughout the antenatal, intrapartum and postnatal periods.
Babies who weigh between 2000 and 2500 grams are considered to have low birth weight (LBW), and babies weighing under 1500 grams are considered to have very low birth weight. LBW is often caused by preterm birth, and contributes to 60% to 80% of all neonatal deaths.
It is important to consider what type of care is needed for babies and children with LBW and/or malnutrition. A baby can be small but growing well, or small (or big!) but now growing well. Do all need the same treatment and care management? What has and has not worked, and what gaps need to be addressed? Let us know your thoughts by leaving a comment down below.
Strongly related to newborn health is women’s health. Three key aspects of women’s health are:
Reprodutive health – sexual health – maternal & child health
In 2013 the Lancet series on Maternal and Child Nutrition published a list of proven interventions to reduce undernutrition rates. Most of these are related to pregnant and/or lactating women, and young children during the first 1000 days of their lives. They are integrated in health services along the Continuum of Care, from pre-pregnancy to childhood.
“Strengthening nutrition-sensitive and nutrition specific services as part of the minimum health package, such as family planning and ante and post-natal care, are critical to break the intergenerational vicious cycle of under nutrition.”
Key facts on morbidity and risks during pregnancy:
- Iron deficiency in pregnant women increases the risk of LBW, and the risk of bleeding and infection during delivery.
- Undernutrition during pregnancy affects: foetal growth and the first two years of life; maternal health; and delayed foetal growth retardation. This is associated with small size mothers, and causes 12% of neonatal deaths.
- A period of less than 24 months between two births in a mother increases the risk of premature birth, LBW and neonatal deaths.
Key facts on maternal mortality:
- Maternal mortality dropped by about 44% worldwide between 1990 and 2015.
- Complications in pregnancy and childbirth is the leading cause of death among adolescent girls in developing countries.
- 99% of all maternal deaths occur in developing countries.
- 73% of maternal deaths are due to direct obstetrical causes, and 27% due to indirect obstetrical causes.
Three delays influence maternal mortality. The first delay takes place at the community level, when the need for obstetrical care is not recognised. The second delay occurs when getting to a health facility, due to low access caused by for example a referral system or lack of money. The third delay is the administration of appropriate treatment, due to a lack of health care providers, equipment and/or materials. Finally, a fourth delay can take place regarding the access to referral structure (secondary hospital).
A number of essential interventions are proposed to reverse this trend:
- Access to adequate package of antenatal care
- Birth with skilled attendant
- Care and support during postnatal period
- Pre-pregnancy interventions
WHO, “Care of the preterm and low-birth-weight newborn – World Prematurity Day 17 November 2018,” Maternal, newborn, child and adolescent health, https://www.who.int/maternal_child_adolescent/newborns/prematurity/en/.