Neonatal Survival Series

"Eight million children are either stillborn or die each year within the first month of life. This figure never makes news." In this context, The Lancet has launched a series of papers in an effort "to erase the excuse of ignorance for public and political inaction once and for all". This special issue of The Lancet (Volume 365, Issue 9462) provides new epidemiological evidence detailing the time, place, and causes of neonatal deaths worldwide - and the low-tech, low-cost interventions that are available to prevent them. In sum, these papers include:

1.Newborn Survival: Putting Children at the Centre [PDF] by Richard Horton - "While the infant and mother have been at the centre of efforts to protect early childhood, the newborn period has been relatively neglected".

2.A Continuum of Care to Save Newborn Lives [PDF] by Anne Tinkera, Petra ten Hoope-Benderb, Shahida Azfarc, Flavia Bustreoc and Robin Bella - Places the issue of neonatal survival in the context of Millennium Development Goals (MDGs) 4 and 5, which aim to reduce maternal and child mortality. "Only collective responsibility and close coordination among governments, assistance agencies, and civil society will make achieving these goals possible." Describes three partnerships (Healthy Newborn Partnership, Partnership for Safe Motherhood and Newborn Health, and Child Survival Partnership), noting that they are coordinating advocacy efforts and mobilising resources; joining in national-level planning meetings to support countries' efforts to accelerate high and equitable coverage of evidence-based interventions; planning a high-level global meeting on World Health Day (April 7); and promoting accountability at the international level (with biannual conferences as one strategy being explored to track and accelerate progress).

3.Why Are 4 Million Newborn Babies Dying Each Year? [PDF] by Joy E. Lawn, Simon Cousens, Zulfiqar A. Bhutta, Gary L. Darmstadt, Jose Martines, Vinod Paul, Rudolf Knippenberg, Helga Fogstadt, Priya Shetty, Richard Horton - Considers barriers to action, such as the fact that "most neonatal deaths are unseen and undocumented", low visibility on the national agenda, and the perceived complexity of reducing neonatal deaths.

4.4 Million Neonatal Deaths: When? Where? Why? [PDF] by Joy E. Lawn, Simon Cousens, Jelka Zupan, for the Lancet Neonatal Survival Steering Team - Provides statistics and observations, such as the fact that child survival programmes focus on preventing pneumonia, diarrhoea, and malaria, which are important causes of death, but only after the first month of life. The lead author comments: "Every year, 4 million babies still die in their first 4 weeks of life, most from preventable causes. This number is double the deaths due to HIV/AIDS; although AIDS is rightly hailed as a global emergency, newborn deaths are largely ignored.."

5.Evidence-based, Cost-effective Interventions: How Many Newborn Babies Can We Save? [PDF] by Gary L. Darmstadt, Zulfiqar A. Bhutta, Simon Cousens, Taghreed Adam, Neff Walker, Luc de Bernis, for the Lancet Neonatal Survival Steering Team - Finds that nearly three-quarters of neonatal deaths could be avoided by 16 interventions, including tetanus toxoid vaccinations for pregnant women, promoting clean delivery, prompt and exclusive breastfeeding, extra care for lowbirth-weight babies, and antibiotics for neonatal infection. The paper emphasises that the strategy of combining interventions into packages to be delivered within existing maternal care and child survival programmes is more cost-effective than creating a separate programme. The lead author comments, "Early success in preventing neonatal deaths is possible, even in settings with high mortality and weak health systems, by improving home care practices, raising demand for skilled care and increasing care-seeking for illness through outreach services and a family-community care package."

6.Systematic Scaling up of Neonatal Care in Countries [PDF] by Rudolf Knippenberg, Joy E Lawn, Gary L Darmstadt, Genevieve Begkoyian, Helga Fogstad, Netsanet Walelign, Vinod K Paul, for the Lancet Neonatal Survival Steering Team - While stressing that there is no "one-size-fits-all" solution, this paper focuses on a shortage of skilled, well-trained staff as the biggest problem that those who seek to scale up clinical care in high-mortality settings encounter. Based on the 3 case studies summarised here, the authors suggest that outreach campaigns or community management of pneumonia with oral antibiotics might be feasible alternative strategies. The lead author comments: "In the very countries with the highest burden of neonatal deaths, coverage of cost-effective interventions is low, inequitable, and slow to progress...Action in countries, driven by countries, is essential."

7.Neonatal Survival: A Call for Action [PDF] by Jose Martines, Vinod K Paul, Zulfiqar A Bhutta, Marjorie Koblinsky, Agnes Soucat, Neff Walker, Rajiv Bahl, Helga Fogstad, Anthony Costello, for the Lancet Neonatal Survival Steering Team - The authors state that the cost of saving newborn babies is low, but requires political commitment and leadership at national and international levels. They outline 5 points of action on a national level; one section here focuses on strategies for improving community engagement and mobilisation (page 46). The article also lists 4 action points for the international community, which include promoting greater accountability of national governments, international agencies, and non-governmental organisations in meeting their commitments to address neonatal health.

Click here for the entire special issue in ActiveMagazine format (requires a browser capable of supporting iFrames), or click on each of the individual paper titles above for PDF access (Note: in some cases, a free registration process is required for access).