Every Newborn: Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?

BackgroundAlthough progress in reducing under-5 child deaths has been achieved since 1990s and the introduction of the Millennium Development Goals, progress in improving newborn survival has been  slower and even more so in stillbirths.  Meeting the Every Newborn targets (fewer than 12 neonatal deaths and fewer than 12 stillbirths per 1000 births in every country by 2030), will require scaling-up the most effective interventions focused on the major causes of newborn deaths.  As 3 million neonates continue to die annually, current global rates of decline would need to be doubled to meet these targets, and more than doubled in countries with the greatest burden of neonatal mortality.MethodsInterventions across the continuum of care affecting stillbirths and neonatal outcomes (preconception, antenatal, intrapartum, immediate postnatal period and after), and delivery platforms were reviewed systematically.  The effect and cost of scale-up of these interventions in the 75 high-burden Countdown countries were modelled.Key Findings & Facts

• Providing effective care for all woman and newborn babies delivering in facilities could prevent an estimated 113 000 maternal deaths, 531 000 stillbirths and 1.325 million neonatal deaths annually by 2020 at an estimated cost of US$4.5 billion per year (only US$0.90 per person).
• Evidence-based interventions exist to address the main causes of newborn deaths, including chlorhexidine cord cleaning, antenatal corticosteroids and other low-cost interventions, yet coverage remains low.  Achieving a high coverage of interventions could prevent 71% of neonatal deaths, achieving a fourfold return on investment of US $5.65 billion by 2025, and totals $1928 for each maternal and newborn life saved and stillbirth prevented. 
• The most effective packages could save 87% of preventable maternal and newborn deaths
• Providing quality of care at birth could save an estimated 1.325 million neonates, prevent 531 000 stillbirths and 113 000 women.
• The greatest impact on neonatal survival is through providing interventions during labour and birth, including obstetric complications (41%), followed by care of small and ill newborn babies (30%).  Evidence-based interventions have the potential of reducing preterm, intrapartum and infection-related neonatal deaths by 58%, 79% and 84% respectively.
• Breakdown of costs by intervention package is provided, with the greatest costs amongst each related to human resources and commodities, including drugs.
• Key components of the conceptual framework for risks and interventions to improve health for every newborn and other birth and maternal outcomes include: i) interventions before, during and between pregnancies; ii) interventions during labour and birth; iii) interventions for immediate care for every newborn baby and small and ill newborns.  Alongside improving quality of care and ensuring delivery channels for universal coverage.

Conclusions & Key Recommendations

• Research and evidence is available to show the impact that these interventions could have on the health of women and babies, but also societies as a whole.  This article highlights the case for investment, supporting the case that the implementation and integration of targeted interventions into existing health systems should be a matter of priority for all countries.

This is an open access article upon free registration. To read the article, click here.To read the Lancet Every Newborn Series, click here.Bhutta, Z., Das, J., Bahl, R., Lawn, J., Salam, R., Paul, V., Sankar, J., Blencowe, H., Rizvi, A., Chou, V., & Walker, N. (2014). Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? The Lancet, published online 20 May.