1

TOGETHER WE CAN REPORT ON MATERNAL, NEWBORN & CHILD MORTALITY BURDEN,

CHALLENGES AND SOLUTIONS

Prepared for Health Care Professional Associations by Dr. Zulfiqar A BhuttaPresident of IPA

Robert Harding Chair in Global Child Health & PolicySickKids Center for Global Child Health, Toronto, Canada

Founding Director of Center of Excellence in Women and Child HealthThe Aga Khan University, Karachi, Pakistan

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Health professional associations, International Federation of Gynecology and Obstetrics (FIGO), the International Confederation of Midwives (ICM), the International Council of Nurses (ICN) and the Inter-national Pediatrics Association (IPA), represent millions of ynecologists, obstetricians, midwives, nurses and pediatricians whose expert care touches the lives of billions of people each year. They have come together to launch the Together We Can campaign.

Together We Can seeks to raise awareness of and advocate for the most critical life saving interventions that will help mothers, newborns and children worldwide. Simple interventions to the way mothers and babies are cared for could make a significant difference to maternal mortality, interventions like the rotavirus and hib vaccinations, active management of third stage labour (AMTSL) and kangaroo care.

This pack contains the information at the heart of the Together We Can campaign. It paints a picture of the challenges facing health professionals working in these fields but also highlights the areas in which small changes could bring life-saving solutions. It outlines the top 20 countries which share the maximum burden of global maternal, neonatal and under five mortality, the most prominent causes of death and which specific interventions, if scaled up, could make a difference.

To learn more about the campaign please visit www.TogetherWeCan.world. With your help we are one step closer to ensuring women and children, no matter where they live, have a healthy start in life.

This pack was produced by Dr. Zulfiqar A Bhutta, the President of the International Pediatric Association, on behalf of the Together We Can campaign.

FOREWORD

3

DAT

A PA

CK C

ON

TEN

TOVERVIEW Top 20 Countries of the World for Maternal and Child Deaths (MAP)Methods & Sources of DataTop 20 Countries of the World for Maternal and Child Deaths (CHART) MATERNAL MORTALITY Maternal Mortality (MAP)Causes of Maternal Mortality NEONATAL MORTALITY Neonatal Mortality (MAP)Causes of Neonatal Deaths (Overall)Causes of Neonatal Deaths (0-28 Days) CHILD MORTALITY Mortality of Children Under Five Years Old (MAP)Causes of Child Deaths (Overall)Causes of Child Deaths (1 - 59 Months) INTERVENTIONS & COUNTRY-SPECIFIC DATACoverage of Interventions Varies Across the Continuum of CareImpact Of Specific Interventions On Cause Specific MortalityInterventions Coverage - AfghanistanInterventions Coverage - AngolaInterventions Coverage - BangladeshInterventions Coverage - CameroonInterventions Coverage - ChadInterventions Coverage - ChinaInterventions Coverage - Cote d’IvoireInterventions Coverage - DR Congo Interventions Coverage - EthiopiaInterventions Coverage - IndiaInterventions Coverage - IndonesiaInterventions Coverage - KenyaInterventions Coverage - MaliInterventions Coverage - MozambiqueInterventions Coverage - NigerInterventions Coverage - Nigeria

456

79

101112

131415

161718192021222324252627282930313233

34353637

38

394042444546474849

50

51

52

Interventions Coverage - PakistanInterventions Coverage - SudanInterventions Coverage - TanzaniaInterventions Coverage - UgandaLives Saved (LiST) Analysis: How many lives can we save in these countries?List of Modelled InterventionsKey Interventions and CommoditiesImpact Of Interventions On Maternal MortalityMaternal Deaths Averted by Cause of InterventionsNeonatal Deaths AvertedNeonatal Deaths Averted by Packages of CarePost-Neonatal Deaths AvertedPost-Neonatal Deaths Averted by Packages of CareImpact of interventions in reduction of maternal mortality by three major causes of deathImpact of interventions in reduction of neonatal mortality by three major causes of deathImpact of interventions in reduction of post-neonatal mortality by three major causes of death CONCLUSIONS

4Copyright © Free Vector Maps.com

These countries account for 77% of all global maternal deaths and 74% of all global

newborn and child deaths respectively

Top 20 Countries of the World for Maternal and Child Deaths

China

India

Pakistan

Afghanistan

Bangladesh

Indonesia

SudanEthiopia

KenyaUgandaDRC

CongoTanzania

Mozambique

Angola

ChadNigerMali

Nigeria

CameroonCôte d’Ivoire

5

» Most recent coverage estimates were obtained from the Countdown to 2015 report

METHOD

Sources of Data

Under 5 and newborn mortality estimates:Levels & Trends in Child Mortality. Report 2015 Estimates. Developed by the UN Inter-agency Group for Child Mortality Estimation. Available at http://www.childmortality.org/files_v20/download/IGME%20Report%202015_9_3%20LR%20Web.pdf

CaUse speCifiC maternal deaths estimates:Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, Regional, and Na-tional Levels and Causes of Maternal Mortality During 1990–2013: A Systematic Analysis for the Global Burden of Disease Study 2013. Lancet 2014; published online May 2. http://dx.doi.org/10.1016/S0140S6736(14)60696S6.

CaUse speCifiC newborn & Child deaths estimates: For Overall distribution of cause of death: Liu L, Oza S, Hogn D, et al. Global, Regional, and National Causes of Child Mortal-ity in 2000–13, with Projections to Inform Post-2015 Priorities: An Updated Sys-tematic Analysis. Lancet 2014; published online Oct http://dx.doi.org/10.1016/ S0140S6736(14)61698S6.

Country specific estimates: UNICEF. Committing to Child Survival: A Promise Renewed. Progress Report 2015. Available athttp://www.apromiserenewed.org/wp-content/uploads/2015/09/APR_2015_8_Sep_15.pdf. 5. Countdown to 2015 (forthcoming) and equity data sets

6

Country + ISO code Ranking (by Maternal +U5 Deaths)

Maternal Deaths1

MMR1 U5 Deaths2 U5MR2 Neonatal Deaths2

NMR2 Stillbirths3 SBR3

India (IND)

Nigeria (NGA)

Pakistan (PAK)

DR Congo (COD)

Ethiopia (ETH)

China (CHN)

Angola (AGO)

Indonesia (IDN)

Bangladesh (BGD)

Tanzania (TZA)

Afghanistan (AFG)

Niger (NER)

Sudan (SDN)

Uganda (UGA)

Chad (TCD)

Mali (MLI)

Mozambique (MOZ)

Cote d’Ivoire (CIV)

Kenya (KEN)

Cameroon (CMR)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

50 000

40 000

7 900

21 000

13 000

5 900

4 400

8 800

5 200

7 900

4 200

5 600

4 600

5 900

5 800

4 000

4 800

5 300

6 300

4 900

190

560

170

730

420

32

460

190

170

410

400

630

360

360

980

550

480

720

400

590

1 201 000

750 000

432 000

305 000

184 000

182 000

169 000

147 000

119 000

98 000

94 000

88 000

89 000

85 000

83 000

83 000

82 000

75 000

74 000

71 000

48

109

81

98

59

11

157

27

38

49

91

96

70

55

139

115

79

93

49

88

696 000

240 000

245 000

94 000

87 000

93 000

53 000

74 000

74 000

39 000

36 000

25 000

39 000

30 000

24 000

27 000

29 000

31 000

34 000

21 000

28

34

46

30

28

6

49

14

23

19

36

27

30

19

39

38

27

38

22

26

21.3

41.5

46.0

27.4

25.2

8.3

23.9

14.1

34.8

25.0

29.1

41.5

23.7

24.6

29.2

23.1

28.1

25.7

21.6

25.5

549 200

295 000

231 400

76 500

78 400

155 600

22 200

69 100

112 200

47 300

31 000

295 000

29 600

38 500

16 700

15 900

27 100

18 800

33 000

20 600

Top 20 Countries of the World for Maternal and Child Deaths

1: Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional,and national levels and causes of maternal mortality during 1990–2013: A Systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; published online May 2. http://dx.doi.org/10.1016/S0140-6736(14)60696-6.2: Levels & Trends in Child Mortality Report 2015; Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation on http://www.childmortality.org3: Lawn JE, Blencowe H, Oza S, You D, Lee A CC, Waiswa P, Lalli M, Bhuma Z, Barros A, Chrisaan P, Mathers C, Cousens SN. 2014. Every Newborn: Progress, priorities, and potential beyond survival, Lancet 2014.

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Copyright © Free Vector Maps.com

Source:

Trends in Maternal Mortality: 1990 to 2013 : Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Popula-tion Division

Maternal Mortality in the Top 20 Countries of the World for Maternal and Child Deaths

China

India

Pakistan

Afghanistan

Bangladesh

Indonesia

SudanEthiopia

KenyaUgandaDRC

CongoTanzania

Mozambique

Angola

ChadNigerMali

Nigeria

CameroonCôte d’Ivoire

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Causes of Maternal Mortality

Othe rdirect:19.3%

Othe rdirect:19.3%

Late :15.7 %

Late :15.7 %

Sepsis:7 .9%

Sepsis:7 .9%

Obstructedlabour:6.5%

Obstructedlabour:6.5%

Hypertension:9.6%

Hypertension:9.6%

Haemorrhage :15.1%

Haemorrhage :15.1%

Abortion:14 .6%

Abortion:14 .6%

HIV:0.6%

HIV:0.6%Indirect:10.7 %

Indirect:10.7 %

Other direct Late Sepsis Obstructed labour HypertensionHaemorrhage Abortion HIV Indirect

meta-chart.com

Source:

Kassebaum NJ, Bertozzi S., Villa A, Coggeshall MS, et al. Global, Regional and National Levels and Causes of Maternal Mortal-ity During 1990–2013: A Sys-tematic Analysis for the Global Burden of Disease Study 2013. Lancet 2014; published online May 2. http://dx.doi.org/10.1016/S0140S6736(14)60696S6.

The major causes of maternal mortality include hemorrhage, hypertension, abortion and sepsis.

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Causes of Maternal MortalitySource:

Kassebaum NJ, Bertozzi S., Villa A, Coggeshall MS, et al. Global, Regional and National Levels and Causes of Maternal Mortal-ity During 1990–2013: A Sys-tematic Analysis for the Global Burden of Disease Study 2013. Lancet 2014; published online May 2. http://dx.doi.org/10.1016/S0140S6736(14)60696S6.

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Copyright © Free Vector Maps.com

Source:

Levels & Trends in Child Mortality Report 2015; Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation on http://www.childmortality.org

Neonatal Mortality in the Top 20 Countries of the World for Maternal and Child Deaths

China

India

Pakistan

Afghanistan

Bangladesh

Indonesia

SudanEthiopia

KenyaUgandaDRC

CongoTanzania

Mozambique

Angola

ChadNigerMali

Nigeria

CameroonCôte d’Ivoire

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Causes of Neonatal Deaths (Overall)

Infections:22.7%

Infections:22.7%

Congenitalabnormalities:8.2%

Congenitalabnormalities:8.2%

Diarrhea:0.8%

Diarrhea:0.8%

Otherconditions:8.4%

Otherconditions:8.4%

Intrapartum:24.3%

Intrapartum:24.3%

Preterm:35.5%

Preterm:35.5%

Infections Congenital abnormalities Diarrhea Other conditionsIntrapartum Preterm

meta-chart.com

Source:

Liu L., Oza S., Hogan D., et al. Global, Regional, and Nation-al Causes of Child Mortality in 2000–13, with Projections to Inform Post-2015 Priorities: An Updated Systematic Analysis. Lancet 2014; published online Oct 1. http://dx.doi.org/10.1016/ S0140S6736(14)61698S6.

(Sepsis and pneumonia)

(Asphyxia)

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Causes of Neonatal Deaths (0-28 Days) Source:

Source: Committing to Child Survival: A Promise Renewed Progress Report 2015, UNICEF

*Sepsis and pneumonia

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Copyright © Free Vector Maps.com

Mortality of Children Under Five Years OldSource:

Levels & Trends in Child Mortality Report 2015; Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation on http://www.childmortality.org

China

India

Pakistan

Afghanistan

Bangladesh

Indonesia

SudanEthiopia

KenyaUgandaDRC

CongoTanzania

Mozambique

Angola

ChadNigerMali

Nigeria

CameroonCôte d’Ivoire

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Causes of Child Deaths (Overall)

Malaria:13.6%

Malaria:13.6%

Measles:3.1%

Measles:3.1%

Injury:8.7%

Injury:8.7%

AIDS:2.7%

AIDS:2.7%

Meningitis:4.6%

Meningitis:4.6%

Otherconditions:25.6%

Otherconditions:25.6%Pertussis:1.6%

Pertussis:1.6%

Diarrhea:16.9%

Diarrhea:16.9%

Pneumonia:23.1%

Pneumonia:23.1%

Malaria Measles Injury AIDS Meningitis Other conditionsPertussis Diarrhea Pneumonia

meta-chart.com

Source:

Liu L., Oza S., Hogan D., et al. Global, Regional, and Nation-al Causes of Child Mortality in 2000–13, with Projections to Inform Post-2015 Priorities: An Updated Systematic Analysis. Lancet 2014; published online Oct 1. http://dx.doi.org/10.1016/ S0140S6736(14)61698S6.

15

Causes of Child Deaths (1-59 Months) Source:

Source: Committing to Child Survival: A Promise Renewed Progress Report 2015, UNICEF

16

Median coverage of essential interventions in select 20 countries

Coverage of Interventions Varies Across the Continuum of Care

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Impact of specific interventions on cause specific mortality

Maternal Mortality Neonatal Mortality

Interventions Hemmorrage Hypertensive disorders

Infections

Calcium supplementation

MgSO4 - Management of pre-eclampsia

Labor and delivery management AMTSL (Active management of the third stage of labor)

Antibiotics for pPRoM

Clean birth practices

Labor and delivery management

MgSO4 - Management of eclampsia

Hypertensive disorder case management

Maternal Sepsis case management

16%

40%

5%

6%

33%

12%

32%

56%

38%

20%

42%

Contribution of specific interventions in the reduction of maternal mortality

Interventions Asphyxia NN-Infections Prematurity

Syphilis detection and treatment

Antibiotics for pPRoM

Clean birth practices

Immediate assessment and stimulation

Labor and delivery management

Neonatal resuscitation

Antibiotics for pPRoM

Immediate assessment and stimulation

Labor and delivery management

Neonatal resuscitation

Promotion of breastfeeding

Chlorhexidine

Clean postnatal practices

Full supportive care for sepsis/pneumonia

Injectable antibiotics

Oral antibiotics

Full supportive care for prematurity

KMC - Kangaroo mother care

Thermal care

7%

67%

26%

45%

17%

11%

2%

3%

12%

11%

15%

23%

15%

13%

6%

4%

4%

8%

11%

Contribution of specific interventions in the reduction of neonatal mortality

18

Interventions Coverage - AfghanistanSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

19

Interventions Coverage - Angola

%

Source: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

20

Interventions Coverage - BangladeshSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

21

Interventions Coverage - CameroonSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

22

Interventions Coverage - ChadSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

23

Interventions Coverage - ChinaSource: Countdown 2014 snapshot da-tabase, coverage estimates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/reports-and-articles/previous-re-ports/2014-report

24

Interventions Coverage - Côte d’IvoireSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

25

Interventions Coverage - DR CongoSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

26

Interventions Coverage - EthiopiaSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

27

Interventions Coverage - IndiaSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

28

Interventions Coverage - IndonesiaSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

29

Interventions Coverage - KenyaSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

30

Interventions Coverage - MaliSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

31

Interventions Coverage - MozambiqueSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

32

Interventions Coverage - NigerSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

33

Interventions Coverage - NigeriaSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

34

Interventions Coverage - PakistanSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

35

Interventions Coverage - SudanSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

36

Interventions Coverage - TanzaniaSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

37

Interventions Coverage - UgandaSource: Countdown 2014 snap-shot database, coverage esti-mates, Countdown indicators, for countries with available data from 2008-2012. Prepared by the Coverage Technical Working Group; http://www.countdown2015mnch.org/re-ports-and-articles/previous-re-ports/2014-report

38

Lives Saved (LiST) Analysis: How many lives can we save in these countries?

Modelled Summary

BASE YEAR: 2015

TARGET YEAR: 2035

SCALE UP COVERAGE LEVEL: 90%

COUNTRIES: TOP 20 MATERNAL AND UNDER 5 MORTALITY COUNTRIESINTERVENTIONS: GIVEN IN NEXT SLIDE

39

List of Modelled Interventions (1/2)

Packages of Care Modelled Interventions

POST-ABORTION CARE

ANTENATAL CARE

CARE DURING LABOR AND CHILD BIRTH

NUTRITION

WASH

» Safe abortion services » Post abortion case management

» Calcium supplementation in at-risk populations » MgSO4 - For the management of pre-eclampsia » Syphilis detection and treatment

» Appropriate Labor and delivery management » MgSO4 for the management of eclampsia » AMTSL - active management of the third stage of labor » Clean birth practices » Antibiotics for Preterm Prolonged Rupture of Membrane (pPROM) » Immediate assessment and stimulation of the newborn » Neonatal resuscitation as required » Appropriate use of antenatal corticosteroids for preterm labor

» Vitamin A supplementation for children 6-59 months of age » Preventive Zinc supplementation in at-risk populations » Exclusive breastfeeding for 6 months and continued feeding beyond

» Improved and safe water source » Safe water connection in the home » Improved sanitation - Utilization of latrines or toilets » Hand washing with soap » Hygienic disposal of children’s stools

40

List of Modelled Interventions (2/2)

Packages of Care Modelled Interventions

POSTNATAL CARE

CASE MANAGEMENT

» ITN/IRS - Use of insecticide treated nets (ITN/LLIN) or household protected with indoor residual spraying

» Clean postnatal practices » Chlorhexidine for cord care

» Hypertensive disease case management » Maternal Sepsis case management » Thermal care of Newborn » KMC - Kangaroo mother care » Full supportive care for premature infants » Injectable antibiotics (simplified antibiotic therapy for neonatal sepsis) » Full supportive care for infections » ORS - oral rehydration solution » Antibiotics - for treatment of dysentery » Zinc - for treatment of diarrhea » Antimalarials - Artemesinin compounds for malaria » Oral antibiotics - case management of pneumonia in children

VACCINES » Rotavirus vaccine » Hib vaccine » Pneumococcal vaccine

41

Key Interventions and Commodities (Part 1/2)

Major Causes of Death Evidence-Based Interventions Healthcare Provider(s)

Key Commodities

ECLAMPSIA

HEMORRHAGE

PREMATURITY

» Calcium supplementation » MgSO4 - Management of pre-eclampsia » MgSO4 management of eclampsia » Hypertensive disease case management » Labor and delivery management » AMTSL--active management of the third stage of labor

» Labor and delivery management » AMTSL--active management of the third stage of labor » Management of post-partum hemorrhage:

a) uterine massage b) uterotonics

» Labor and delivery management » Full supportive care for prematurity » Extra support for feeding the small and preterm baby

» Antenatal steroids for fetal lung maturation

» Thermal care » Kangaroo mother care for preterm

and for < 2000g babies

Professional health workers

Professional health workers

Professional health workers

Professional health workers

Professional health workers

» Uterotonics: Oxytocin Ergometrine Misoprostol

» Nasogastric tubes » Feeding cups » Breast pump » Syringe drivers » Blood sugar testing sticks » Materials for counseling

» Steroids

» Materials for counselling, health education and health promotion

» Support Binder for KMC (KMC wrap)

» Hat » Nasogastric tube

» Calcium » Magnesium Sulphate (Injection)

42

Key Interventions and Commodities (Part 2/2)

Major Causes of Death Evidence-Based Interventions Healthcare Provider(s)

Key Commodities

CHILDHOOD PNEUMONIA

CHILDHOOD DIARRHEA

» Promote and provide H. Influenzae, meningococcal, pneumococcal

» Exclusive breastfeeding » Preventive zinc supplementation » Case management of childhood pneumonia Vitamin A

as part of treatment for measles- associated pneumonia for children above 6 months

» WASH interventions (Improved water source, water connection in the home Improved sanitation - utilization of latrines or toilets, hand washing with soap, hygienic disposal of children’s stools)

» Preventive zinc supplementation » Exclusive breastfeeding » ORS - oral rehydration solution » Zinc - for treatment of diarrhea » Antibiotics - for treatment of dysentery » Vitamin A supplementation » WASH interventions

(Improved water source, water connection in the home Improved sanitation - utilization of latrines or toilets, hand washing with soap, hygienic disposal of children’s stools)

» Rotavirus vaccines

All

All

All

» Respiratory rate timers » Vitamin A capsules » Appropriate antibiotics » WASH infrastructure

» Vaccines, syringes, safety boxes, cold chain equipment

» Materials for counselling, health education and health promotion

» Materials for counselling, health education and health promotion

» Zinc (tablets / solution) » Oral Rehydration Solution (ORS) » Appropriate antibiotics for dysentery according

to guidelines » Materials for counselling, health education and

health promotion » Vitamin A capsules » WASH infrastructure

» Materials for counselling, health education and health promotion

» Vaccines, syringes, safety boxes, cold chain equipment

43

Figure 4.1

Impact Of Interventions On Maternal Mortality

44

42% of all maternal deaths in the selected countries can be averted by packages

of care delivered at 90% coverage

Maternal Deaths Averted by Cause of Interventions

45

Neonatal Deaths Averted

46

Neonatal Deaths Averted by Packages of Care

Almost half (49%) of all neonatal deaths in these countries can be averted by these

packages of care delivered at 90% coverage

47

Post-Neonatal Deaths Averted

48

295???295035

Post-Neonatal Deaths Averted by Packages of Care

54% of all child deaths in these countries can be averted by these packages of care

delivered at 90% coverage

49

Impact Of Interventions In Reduction Of Maternal Mortality By Three Major Causes Of Death

50

Impact Of Interventions In Reduction Of Neonatal Mortality By Three Major Causes Of Death

51

Impact Of Interventions In Reduction Of Post-Neonatal Mortality By Three Major Causes Of Death

52

CONCLUSIONS

» The global burden of newborn, maternal and child mortality is considerable and the top 20 countries account for 77% of all maternal deaths globally and 74% of all newborn and child deaths

» With minor exceptions, the major causes of maternal, newborn and child deaths are comparable across these countries and largely preventable

» We have effective interventions but their overall coverage in these countries is very variable with poor coverage of interventions around the time of birth and post-natally, as well as management of severe childhood illnesses

» Scaling up effective evidence-based packages of care can potentially save 42% of all maternal, 49% of newborn and 54% of child deaths, all achievable within the targets of the SDGs

53