accelerated actions for reducing preventable neonatal deaths in bangladesh regional consultation...
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Accelerated Actions for Reducing Preventable Neonatal Deaths In
Bangladesh
Regional Consultation Meeting
Hyatt regency HotelKathmandu, Nepal
30 August, 2013
Demographic Profile of Bangladesh
Estimated Population (in million) Total: 160 (Projected)
Women age 15-49 year *54.3%
Children age less than 5 years *10%
Total fertility rate 2.3
Crude Birth Rate *19.2/1000 L.B
Crude death Rate *5.6/1000 L.B
Still Births rate 50/1000 L.B
Literacy rate of women age 15-49 Y 62.9%
Household with mobile phone 78.4%
Source: BBS 2011, BDHS 2011, * SVRS
ACHIEVEMENTS
2.4%Annual rate of reduction
3.3%Annual rate of
reduction
39% 60
%
Bangladesh Demographic and Health Surveys
Bangladesh on track to achieve MDG 4 targets well before 2015
Bangladesh is one of 23 countries on track to achieve MDG4
&has the 4th most rapid rate of decline in child
mortality
Pneumonia
Birth asphyxia
Diarrhea
Drowning
Other neonatal
Other causes (including injury)
Prematurity/LBW
Possible serious Infection
18
13
7
3
1
6
5
20
12
7
1
5
3
3
4
8
BDHS 2011BDHS 2004
Under-5 Deaths per 1,000 live births
33%
46%
85%
20%
60%
Most causes of deaths among children are declining in Bangladesh
Disparities in child mortality has been generally reducing
Under-5 deaths per 1,000 live births
1984-1993 2007-2011
114
50
153
55
UrbanRural34%
higher
10% higher
1987-1996 2007-2011
87
40
179
71
KhulnaSylhet
106% higher
78% higher
Source- Bangladesh Demographic and Health Surveys
1984-1993 2007-2011
97
37
186
64
RichestPoorest
92% higher
73% higher
The National Neonatal Health Strategy and Guidelines provide specific directions to address neonatal mortality
C-IMCI Strategy; Bangladesh Country strategy for pneumonia, diarrhoea and malaria;IMCI Guidelines; GAPPD; APR-Bangladesh Call for Action and benchmark
EPI –Multi year Plan; Guidelines
16 out of 32 Operational Plans under HPNSDP, 2011-16 address various aspects of child survival including health care, nutrition, community-based care and behavior change
Nutrition PolicyIYCF Strategy and Guidelines; Guidelines for SAM and C-MAM
Revision of the National Maternal Health Strategy and Development of SOP
ECD Policy for Bangladesh; ECD guidelines
PMTCT StrategyHIV/AIDS Strategy
Strategies, Guidelines and Action Plan Developed
Data Source: Bangladesh Demographic and Health Survey 2011
Pneumonia22%
Possible serious in-fection
15%
Birth asphyxia13%
Drowning9%
Prema-tu-
rity / LBW7%
Di-ar-
rhea2% Other
7%
Other neonatal6%
Undefined19%
Under-5 Deaths
The intervention package to be guided by the causes of under-5 deaths
Annual number of deaths:
Neonatal (60% of all child deaths)Neonatal infections
38,500Birth asphyxia
21,500Preterm
12,000(+17,500)
Pneumonia and serious infections
64,000
Drowning
14,500
Rangpur
RajshahiSylhet
Khulna
Barisal
Dhaka
Chittagong
Bangladesh Demographic and Health Survey 2011
42 (27)
62 (38)
40 (32)
54 (36)
63 (39) 71 (45)
50 (21)
Child mortality is
much higher in some
parts of the country
Child Mortality per 1000 live birth
Child/Newborn mortality rate by division
Reduction of Neonatal Mortality-wide disparities across among richest population
1993 1996 1999 2003 2007 2011 20160
10
20
30
40
50
60
5248
42 4137
32
2223 Highest quintile
34 Lowest quintile
Source BDHS
Rangpur
RajshahiSylhet
Khulna
Barisal
Dhaka
Chittagong
Bangladesh Demographic and Health Survey 2011
29%
28%
49%
32%
31% 24%
30%
Gains in skilled
attendance at birth has been slower
in some parts of the
country
Skilled attendance at birth-Coverage by Division
Contraceptive prevalence
ANC
TT (5 doses)
Skilled Birth At-tendance
Initiation BF
Post natal Vit A
BF
Vit A
Penta
Measles
Safe Sanitation
Hand washing
Drinking water
Compl. feeding
Diarrhea treat
Pneumonia
0% 20% 40% 60% 80% 100%
56%
47%
58%
32%
50%
35%
64%
62%
93%
88%
53%
20%
74%
21%
81%
35%
Missed Opportu-nities
Coverage of Key MNCH InterventionsCoverage of Key MNCH Interventions
Current Coverage of key interventions
Khulna Shyllet Urban Rural Richest quintile
Poorest quintile
0102030405060708090
100 93
8087 86
94
77
Fully immunised
Khulna Shyllet Urban Rural Richest quintile
Poorest quintile
0
10
20
30
40
50
60
70
45
21
49
22
60
10
Delivery in health facility
Khulna Shyllet Urban Rural Richest quintile
Poorest quintile
0102030405060708090
100
77
51
74
49
87
30
ANC
Khulna Shyllet Urban Rural Richest quintile
Poorest quintile
0
10
20
30
40
50
60
70
42
18
46
22
58
9
PNC < 2days
Bottleneck Analysis, Strategies and
Solutions
An evidence-based approach used to identify challenges and select actionsUse of best available data from national surveys, health information system, special studies
Equity analysis using best available global tools for analysis (LiST, Equity Patform etc.)
Selection of actions based on best available national and global evidence
Government, development partners, professionals, researchers and civil society experts participated in the analysisUnder the guidance of the NCC-NH for newborn health (MOHFW), National Technical Working Committee formed small Technical Group (TG)The Technical Group worked on the BNA tools based on the analysis done for promise Renewed-Bangladesh Call for Action using Equity Platform/List etc.A national Consultation Workshop was held to validate the findings GOB, UNICEF, WHO,USAID, SNL, Save The Children, ICDDRB and other partners were involved
Promise Renewed-Bangladesh Call For Action
Evidence-based Interventions &
Strategic Approaches
Maternal Health
interventions
a. Skilled birth attendance (CSBAs and Midwives)
b. Functional and 24/7
BEmONC and CEmONC at strategically
located facilities
Newborn health specific
interventionsa. Essential newborn care with newborn resuscitation & application
of chlorhexidineb. Antenatal
steroids for premature labour and Kangaroo
mother care (KMC) for
premature/low birth weight
babiesc. Neonatal
sepsis management at PHC level
d. Specialized newborn care at district & sub-district
level
Child Health specific
interventionsEffective referral linkage to ensure continuum of care – from community
clinics to district /tertiary
hospitalsIMCI at all levels
Multi-sectoral approach to
promote exclusive BF and IYCF
Community based child drowning
prevention activities
New vaccines: pneumococcal and rotavirus
1. Establish midwives services
2. Adequate staffing and quality assurance of functioning 24/7 BEmONC and CEmONC facilities;
3. Increase efficiency of existing human resources: skills, task shifting and retention
4. Strengthen family planning program
5. Integrated approach to MNCH including mainstreaming nutrition
6. Differential programming and equity-focused resource allocation (rich/poor, urban/rural, and between regions
Strategic approaches
Equity- Focused implementation especially in low
performing districts
Effective partnerships
and collective
commitment :
(government, professionals, development partners, civil society, media
and communities)
Monitoring for Results
and adjustment of operational strategies
when necessary
Operational
modalities
Expected Increase in Intervention Coverage
Antenatal corticosteroid
CHX umbilical cord cleansing
KMC for pre-term baby
Neonatal sepsis treatment
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%
0
0
0
0.28
40%
50%
20%
50%
80%
90%
50%
80%
Skilled attendant at birth32%
50%80%
Target 2020 Target 2016 Current
Mate
rnal
Healt
h
Inte
rven
tion
s
New
born
H
ealt
h
Inte
rven
tion
s
New Interventi
ons
Expected Increase in Intervention Coverage
Measles Rubella vaccine
Pneumococcal vaccine
Zinc with ORS for diarrhoea
Pneumonia treatment
0.9
0.9
0.5
0.5
0.950000000000001
0.9
0.8
0.8
0.34
0.35
Target 2020 Target 2016 Current
Ch
ild
H
ealt
h
Inte
rven
tion
s
New Interventi
ons
1990 1995 2000 2005 2010 2015 2020 2025 2030 20350
20
40
60
80
100
120
140
3932
26 23 20
133
116
9488
6553
Actual
Projection
Under-5 Mortality Trends in Bangladesh: Actual Estimates and Projections till 2035
Actual: Bangladesh Demographic and Health Surveys
Indicators 2015 2020 2025 2030 2035
U5MR 38.8 31.6 26.4 22.7 20.0
NMR 24.8 21.5 19.0 17.2 16.0
17
How many child deaths will we prevent?
Under-5 Mortality
53Neonatal sepsis managementInjury & drowning prevention
Antibiotics for pneumoniaPneumococcul vaccineBreastfeedingClean postnatal practicesResuscitaion
Other interventions
Remaining deaths
Labour and delivery management
Pre
ven
tab
le
un
der-
5 d
eath
sEstimated 108,000 child deaths
under five will be averted EVERY YEAR
It means approximately 300 child
deaths averted EVERYDAY
Ending Preventable Newborn and Child Deaths by 2035: Next Steps
for Bangladesh• Action plan with detail
implementation modalitiesA• Budget allocation-Review and
revise relevant operational plans of HPNSDP
B• Confirm commitments from
development partners, NGOs, and Professionals
C•Decentralized analysis, planning, implementation monitoring (Scorecard), Reporting and accountability
D• Equity in reducing disparitiesE
Opportunities to Accelerate Progress of Newborn Health
• Highest level commitment-Launching of the ‘Promise Renewed’ and declaration of the ‘Bangladesh Call for Action
• Introduction and scale-up of new newborn interventions approved by the MOH&FW
• 16 out of 32 Operational Plans under HPNSDP address MNCH• Large Scale programs on MNCH are on-going which includes
newborn health• National neonatal health strategy, Guidelines, SOP and the on-
going revision of the maternal health strategy• Large networks of facilities including community clinics• Expanding human resources including doctors, nurse, midwives• Large network of NGOs and CHWs• Continued commitment of the development partners for MNCH
Thank You