Early care crucial for babies
Across the human lifespan, we are most vulnerable to death during birth and in the first 28 days of life. This is even more so for children born in developing nations including South Africa.
Writing in UNICEF’s The State of the World’s Children 2009 report released last week, Joy Lawn of Save the Children in South Africa revealed that nearly four million newborns die worldwide during their first 28 days, equivalent to around 10 000 per day.
One out of four of these deaths take place within one week of birth and between one and two million die during the first day following birth.
‘Most of these deaths occur at home, are unrecorded, and remain invisible to all but their families. Millions more suffer severe illness each year, and an unknown number are affected with lifelong disabilities,’ said Lawn.
Most of these mothers and babies face complications such as neonatal (up to the age of 28 days old) sepsis or post-partum haemorrhage. Delaying care for even a few hours can have fatal consequences.
In South Africa, the under- 5 mortality rate currently stands at 59. This means that 59 out every 1 000 children die between birth and five years. The infant mortality rate equates to 46 out of 1 000 children facing the prospect of dying between birth and one year of age. The neonatal mortality rate was last measured in 2004 and shows that of every 1 000 births, 17 newborns face the likelihood of dying within 28 days of birth. South Africa’s life expectancy at birth currently stands at 50.
Important data from Bangladesh is showing that a home visit on the first or second day after birth can reduce neonatal deaths by two thirds, but later visits are less effective at reducing mortality.
Life saving behaviors during the neonatal period such as exclusive breastfeeding, hygienic cord care and keeping the baby warm, can make the difference between life and death ‘ particularly for babies who are often born prematurely.
Lawn said providing effective care for mothers and newborns during the early post-natal period had the potential to generate the greatest gains in survival and health of any period in the continuum of care. However, the first days following birth are the time when coverage of appropriate services and behaviour is currently lowest. Among the 68 priority countries identified, a median of just 21 percent of women received post-natal care.
Routine post-natal visits should ideally be provided close to home or at home within 24 hours (ideal) or 48 hours of birth ‘ instead of the more common visit at six weeks, said Lawn. She said that a curative element where neonatal infections could be treated by first level health workers able to prescribe antibiotics would also have a meaningful impact.
She added that almost all (98 percent) of newborn deaths occurred in low- and middle-income countries. Yet most research and funding have focused on incremental advances in highly technical care for the two percent of newborn deaths occurring in high-income countries.
However, a network of studies was currently underway in eight African countries examining national packages and details on the cadres of workers needed.
One of the biggest challenges for maternal and neonatal health is the shortage of skilled health personnel. A 2006 World Health Organisation survey reveals that while Africa accounts for more than 24 percent of the global disease burden, it has only three percent of the world’s health workers and spends less than one per cent of total global resources dedicated to health, even after loans and grants from abroad are taken into account.
In contrast, the Americas region, which covers Latin America and the Caribbean along with North America, has only 10 per cent of the global burden of disease but commands 37 per cent of the world’s health workers and spends more than 50 per cent of global resources allocated to health.
According to the World Health Organization, the world is facing a shortage of 4,3 million health workers, with every region except Europe showing a shortfall.
More specifically, there are not enough skilled health workers ‘ doctors, nurses or midwives ‘ to attend all the world’s births.
A study by the Joint Learning Initiative found that countries needed an average of 2,28 health-care professionals per 1 000 people to achieve the minimum desired level of coverage for skilled attendance at delivery.
Of the 57 countries that fall below this threshold, 36 are in sub-Saharan Africa. Although the countries with the largest shortages of health workers in absolute terms are found in Asia ‘ notably in Bangladesh, India and Indonesia ‘ the largest relative need is in sub-Saharan Africa.
This region would need to increase its numbers of health workers by 140 percent to reach the requisite density.
An earlier WHO estimate calculated that 334 000 skilled birth attendants would need to be trained worldwide in the coming years to cover 73 per cent of births.
Shortages of skilled health workers arise from many factors, including underinvestment in training and recruitment, weak incentives for health-care workers, low remuneration and high levels of stress.
A survey of 10 African countries showed that the number of locally trained doctors now working in eight countries that are part of the Organisation for Economic Co-operation and Development was equivalent to 23 percent of the doctors still domestically employed in those countries.
AIDS, too, is having a deleterious effect on health systems in the countries where it has reached epidemic proportions.
Health workers in these countries face the same risks in their private lives as other people in high-prevalence countries, but are also exposed to significant risks at work in circumstances where protective equipment and practices are often deficient.
A 2004 study in South Africa indicated that younger health workers had an HIV-prevalence rate of 20 percent.