Learning more about the “N” in EmONC assessments: A review of newborn resuscitaon findings across 5 African countries Almamy Malick Kante Dahada El Joud Ghislaine Ouedraogo-Ametchie Wasihun Gobezie Emily Keyes Patsy Bailey October 2015, Mexico City Background

• Rapid decline of under-5 mortality rates in SSA • However, limited improvement for neonates • Most of newborn deaths can be averted if – Health intervenon reach 90 percent of households – Health facilies are well equipped and supplied • Increase of health facility delivery in most sub- Saharan countries but sll limited impact on Newborn health Aims

• To report about the readiness of facility health to provide EmoNC services and • To assess knowledge and pracces of facility health workers on Newborn care and Newborn resuscitaon • To analyze the relaonship between health workers’ knowledge and training on Newborn resuscitaon and level of mortality EmONC: Emergency Obstetric and Newborn care Assessment • Series of Naonal surveys in Developing countries at all facilies providing delivery services in general • Objecves – To provide baseline data for monitoring naonal & district strategies toward the aainment of MDGs 4 & 5 – To guide policy, planning, and priorizaon to strengthen the health system using EmONC as entry point

Method

• Analyze reports from 5 countries that have completed an EmONC in the last 5 years. – Malawi (2014) – South Sudan (2013) – Senegal (2013) – Gambia (2012) – Togo (2012) • Extracon of informaon related to EmONC services, newborn resuscitaon and newborn care, and intra-partum and very early neonatal mortality (within the 24hours aer delivery) Results presented in term of graph by countries Health facility providing EmONC

100%

90%

80% - Less than 20 70% percent of facility 60% were ready to 50% South Sudan provide EmONC Gambia 40% Malawi services 30% Togo - Gambia: 90 Senegal 20% percent of 10% hospitals equipped 0% Facilies Parally Facilies Facilies with CEmONC with EmONC EmONC with with services funconing bEmONC cEmONC facilies services services Health facility providing Newborn resuscitaon (percent)

% Facilies performed NR in last 3 months 100%

90%

80% • 90 percent of 70% facilies in 60% Malawi provided 50%

40% NR and only 15 30% percent of facility 20% in Togo 10%

0% South Gambia Malawi Togo Senegal Sudan Reasons for not providing Newborn resuscitaon (percent)

90%

80% 70% • Training and 60% 50% Equipment 40% South Sudan 30% are recurrent Gambia 20% Malawi issues for not 10% Togo 0% Senegal providing NR Availability of facilies 24/7

% Facilies with HR available 24/7 100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0% South Sudan Gambia Malawi Togo Knowledge newborn care (score)

5 • Overall health 4 workers have moderate knowledge of 3 South Sudan newborn care. Gambia Malawi 2 • Togo had the Togo lowest knowledge Senegal on care for 1 infected newborn and low birth weight newborn 0 Care for the infected Care for the low birth newborn (/5) weight newborn (/5) Knowledge newborn resuscitaon (score)

6

5 • Overall health 4 workers have 3 South Sudan Gambia moderate Malawi 2 Togo knowledge of Senegal 1 newborn

0 How to Preliminary If If baby is If baby does resuscitaon. diagnose steps of resuscitang breathing and not begin to birth asphyxia neonatal with bag & no respiratory breathe (/6) (/4) resuscitaon mask what do difficulty (/3) (/6) you do (/5) Intra-partum and very early neonatal mortality rates (IP&VENMR) (per 1000) 40.0

35.0 - The lowest mortality

30.0 rates is registered in Malawi 25.0 - High mortality rates

20.0 VENRM in Togo due to high fresh sllbirth as Fresh 15.0 sllbirths rates compared to Senegal

10.0 and South Soudan where the high fresh 5.0 sllbirth is low.

0.0 Malawi Senegal Gambia South Sudan Togo Relaonship between Provider training and IP&VENMR

100% 40

90% 35

80% 30 As percent of 70% provided trained 25 60% decreases, the Providers who 50% 20 reported training in Neonatal intra-partum 40% Resuscitaon 15 and very early IP&VENRM 30% neonatal 10 20% mortality rates 5 10% increases

0% 0 Malawi Senegal Gambia South Togo Sudan Discussion (1)

• Variaon between countries in term of facilies providing EmONC – However, the percent of facility providing EmONC services less than 20% – Malawi: 90% of facility provided NR while only 15% in Togo – Reason for not providing NR where lack of training and equipment Discussion (2)

• Variaon between countries in terms of health workers knowledge on newborn care and resuscitaon – Immediate newborn care in general moderate in other countries and low in Togo – Care for infected newborn and low birth weight newborn sll low in Togo (1/5) Discussion (3)

• Variaon between countries in term of intra-partum and very early neonatal mortality – High in Togo (33.7/1000) and moderate in Malawi (19.8/1000). è relaonship between providers training on NR and mortality • Limitaon – Analysis based only on reports – However, EmONC have big potenality but need more data analysis for example to develop models to understand how facility capability and workers knowledge and pracces impact of intra-partum and very early neonatal mortality