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A Decade of Change for Newborn Survival

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A Decade of Change for Newborn Survival A Decade of Change for Newborn Survival Changing the trajectory of our future Overview of the supplement and Uganda analysis Health Policy and Planning, Supplement 3, 2012 Dr Anthony K Mbonye Ministry of Health Outline of presentations 1. Overview of a decade of change supplement Dr Anthony Mbonye, Ministry of Health 2. Changes in newborn health outcomes and coverage indicators Dr Olive Sentumbwe, World Heath Organization 3. Programmatic and policy changes over the past decade Dr Hanifah Sengendo, Saving Newborn Lives, Save the Children 4. Changing the trajectory for our future Dr Gelasius Mukasa, IBFAN; Newborn Steering Committee Uganda Decade of Change and Future Implications Analysis Group Allisyn Moran (Saving Newborn Lives Save the Children) Anthony K Mbonye (Community Health Services Ministry of Health) Christine Zirabamuzaale (Consultant) Newborn health Francine Kimanuka (UNICEF Uganda) Gelasius K Mukasa (IBFAN) champions: Geofrey Bisoborwa (WHO Uganda) Hanifah Naamala Sengendo (Save the Children Uganda) 11 authors Imelda Namagembe (AOGU) on behalf of 30 Jamil Mugalu (Mulago Hospital) Janex M Kabarangira (USAID) person expert Jessica Nsungwa-Sabiiti (Ministry of Health) Joy E Lawn (Saving Newborn Lives Save the Children) working group Kate Kerber (Saving Newborn Lives Save the Children) Representing Lillian Luwaga (Ministry of Health) Margaret Nakakeeto (Child Health Advocacy International – Uganda) government, heath Mary Kinney (Saving Newborn Lives Save the Children) Miriam Mutabazi [Management Sciences for Health (MSH)] professional Miriam Sentongo (Reproductive Health Division Ministry of Health) associations, local Nathalie Gamache (Saving Newborn Lives Save the Children) Olive Sentumbwe-Mugisa (WHO Uganda) academia and Patrick Aliganyira (Save the Children Uganda) Peter Waiswa (MUSPH; Karolinska Institutet) research Robinah Kaitiritimba (Uganda National Health Consumers Organization) institutions, UN, Romano Byaruhanga (Nsambya Hospital; AOGU) Sabrina Kitaka (Uganda Paediatric Association) donor partners, Sakina Kiggundu (Uganda Private Midwives Association) Sarah Kiguli (Makerere University) and civil society Purpose of the analysis and supplement To conduct a multi-country evaluation of progress in reducing neonatal mortality from 2000 to 2010 examining changes in context, coverage of care, health financing, and health systems and policy, in order to identify pathways to scale and potential accelerators or constraints. In some countries, newborns face a more certain future than 10 years ago, yet in other countries very little has changed. – Darmstadt et al, HPP editorial Overview of the papers in the supplement Editorial – Gary Darmstadt, David Oot, Joy Lawn 1. Overview and quantitative analysis: - Neonatal mortality rates and causes - Multi-country regression modelling to understand predictors of change - Financial analyses 2. Benchmarking readiness for scale up of newborn care 3. Bangladesh 4. Nepal 5. Pakistan Country case studies with 6. Malawi in-country expert teams 7. Uganda Over 150 contributors globally Uganda at a glance 39,000 newborn deaths in 2010 • High and stagnant total fertility rate • Most women access antenatal care and bring their children for immunisations • Institutional births are increasing: 39% in 2001 to 57% in 2010) • Gap in access and quality of care between the richest and poorest families • Human resource for health crisis: health worker density of 14.3 per 10,000 population (2005) compared to WHO benchmark of 23 per 10,000 population. • History of regional civil unrest and IDP/refugees Source: Mbonye et al. 2012. Newborn Survival in Uganda: a decade of change and future implications. Health Policy and Planning 27(Suppl. 3): iii104-iii117. Quantitative data analyses conducted • Neonatal, under-five and 1-59 months mortality change from 1990-2010 and comparison to other countries in the region • Changes in coverage levels from household surveys at national and sub-national levels • Changes in quality of care from health facility assessments and HMIS data • Changes in financial inputs from government and official development assistance and comparison to Countdown to 2015 countries Source: Mbonye et al. 2012. Newborn Survival in Uganda: a decade of change and future implications. Health Policy and Planning 27(Suppl. 3): iii104-iii117. Policy and programme change analyses • Changes in national socio-political and economic context • Progress in achieving 27 sentinal benchmarks reflecting readiness to scale up newborn care interventions • Inclusion of newborn survival specifically and in general in national health policies, programmes, and research activities using a policy and programme timeline Source: Mbonye et al. 2012. Newborn Survival in Uganda: a decade of change and future implications. Health Policy and Planning 27(Suppl. 3): iii104-iii117. Progress towards Scale-up Readiness Benchmarks for newborn care Source: Mbonye et al. 2012. Newborn Survival in Uganda: a decade of change and future implications. Health Policy and Planning 27(Suppl. 3): iii104-iii117. Note: The missing benchmark relates to financial commitments and does not have data. A Decade of Change for Newborn Survival Changing the trajectory of our future Quantitative data findings for the Uganda analysis Health Policy and Planning, Supplement 3, 2012 Dr Olive Sentumbwe WHO National progress towards Millennium Development Goal 4 for newborn and child survival from 1990 200 Under-five mortality rate (UN) Under-five mortality rate (IHME) 180 Under-five mortality rate (DHS) 160 Neonatal mortality rate (UN) Neonatal mortality rate (IHME) 140 Neonatal mortality rate (DHS) 120 100 99 80 60 58 Mortality per 1000 live births live 1000 per Mortality 40 MDG 4 target 20 26 0 1990 1995 2000 2005 2010 2015 Year Source:Mortality Mbonye et al. 2012. forNewborn children Survival in Uganda: ageda decade of change1-59 and futuremonths implications. Healthreduced Policy and Planning at 27(Suppl.nearly 3): iii104-iii117. twice the Data sources: Uganda Demographic Health Surveys. UN estimates of neonatal and under-five mortality (UNICEF et al. 2011) with a new analysis of mortality trends by age of death. IHME estimates (Lozano et al. 2011). Note: Survey point estimates are centred two years prior to survey date. MDG 4 target from Countdown to 2015 decade report reflecting a 2/3 reduction from 1990 rateU5MR. of newborn mortality (4.1% vs 2.2%) Neonatal mortality trends from 1990 Source:Newborn Mboye et al. 2012. Newborn mortality Survival in Ugand a:in a decade Uganda of change and is future reducing implications. Health atPolicy 2.2%and Planning per27(Suppl. year, 3): iii104-iii117. slightly Data sources: Uganda Demographic and Health Surveys.. UN estimates (UNICEF et al. 2011a). IHME estimates (Lozano et al. 2011). Note: Survey point estimates are centred two years prior to survey date. more than the regional average for Africa at 1.5% Understanding neonatal mortality change, 2000 -2010 144 countries, multiple regression modeling Developed region Other regions 3% reduction per year (including Southern Asia) 3.2% reduction per year Consistently rapid neonatal mortality Variable change in mortality reduction across countries reduction across countries Strongest predictors of NMR change Strongest predictors of - Increased national NMR change income - Reduced fertility - Reduced fertility Sub-Saharan Africa - Baseline level of 1.5% reduction per year neonatal mortality Mortality reduction is slow and therefore difficult to analyze what factors related to change. Countries with increased contraceptive use have made more progress in reducing newborn deaths Mortality reduction progress could not be attributed to changes in Source:coverage Lawn J,E. et al. 2012. due Newborn to survival:limited a mul ti-countrycoverage analysis of changea decade of change. and Health lack Policy of and coverage data. Planning. 27(Suppl. 3): iii6-ii28. Estimated causes of mortality in 2010 for 39,000 newborn deaths 3 causes account for 90% of all newborn deaths Source: Mbonye et al. 2012. Newborn Survival in Uganda: a decade of change and future implications. Health Policy and Planning 27(Suppl. 3): iii104-iii117. Data source: Uganda-specific mortality estimates (Liu et al. 2012). Note: Severe infections include sepsis, meningitis, pneumonia and tetanus. Trends in coverage data for newborn-related interventions and packages Contraceptive prevalence rate (any modern… Antenatal care (1 or more visits) Antenatal care (4 or more visits) Intermittent preventive treatment in pregnancy… Last birth protected against tetanus Skilled birth attendance 17% point increase Deliveries by caesarean section UDHS 2001 Babies weighed at birth UDHS 2006 Breastfeeding initiated within 1 hour UDHS 2011 Postnatal care within 2 days (home births) (preliminary) Case management for pneumonia (0-6 months) Exclusive breastfeeding (0-1 month) 0% 20% 40% 60% 80% 100% Despite increases in coverage of some interventionsPercent coverage many indicators Source: Mboye et al. 2012. Newborn Survival in Uganda: a decade of change and future implications. Health Policy and Planning 27(Suppl. 3): iii104-iii117. Data sources: Uganda Demographic and Health Surveys.remain low, eg contraceptive use, PNC Increases in coverage of skilled attendant at birth 100 90 Around the year 2000 80 Around the year 2010 71 70 59 60 56 50 39 39 40 36 Coverage (%) Coverage 30 27 20 18 12 11 10 0 Bangladesh Nepal Pakistan Malawi Uganda Over half of women deliver with a skilled attendant in Uganda Source: Lawn J,E.
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