Hearing the Unheard Cry: Pillars To Improve Newborn Survival Stephen Wall, Save the Children CORE Group Spring Meeting, April 28, 2010

1. Hearing the Unheard Cry: Pillars To Improve Newborn Survival Stephen Wall, MD MS MSW Saving Newborn Lives Save the Children/USA April 28, 2010

3. Neonatal deaths and the Millennium Development Goals Almost 40% of under 5 deaths are neonatal – almost 4 million a year MDG- 4 can only be achieved if neonatal deaths – especially early neonatal deaths – are addressed Source: Lawn JE et al Lancet 2005 0 50 100 150 Mortality per 1000 births (global av) 1960 1980 2000 2020 Year Under-5 mortality rate Late neonatal mortality Early neonatal mortality Target for MDG-4

5. When do neonatal deaths occur? Up to 50% of neonatal deaths are in the first 24 hours 75% of neonatal deaths are in the first week – approximately 3 million deaths Source: Lawn JE et al Lancet 2005, Based on analysis of 47 DHS datasets (1995-2003), 10,048 neonatal deaths)

6. Risk of stillbirth, newborn, maternal mortality: WHEN? Sources: Maternal deaths: from WHO/UNICEF/UNFPA 2000 estimates. Child deaths from UNICEF estimates for 2000, Neonatal deaths from WHO RHR estimates 2004. Stillbirths from WHO in SOWC 2001. Denominator used is the number of live births from UNICEF, adjusted to all births by adding the 4 million stillbirths. Timing of maternal deaths is based on Li XF et al, 1996 after subtraction of 13% estimated to be related to unsafe abortion, assuming these are prior to the last trimester (WHO 1997). Percent of stillbirths that are intrapartum from Lawn JE et al (WHO Bull June 2005)). Child deaths, percentage early neonatal, neonatal, months 2-12 and years 2-4.99 based on WHO and UNICEF estimated rates for 2000. Percentage of deaths on day 1 based on 2 inputs; DHS data (34 most recent surveys, 10,041 NNDs, median year 2000). Study input of 28 studies (NNDs 7369, median year 1991)

7. Direct causes of 3.72 million neonatal deaths - almost all are due to preventable conditions Source: Lawn JE, Cousens SN, Zupan J Lancet 2005. 60 to 90% of neonatal deaths are in low birth weight babies, mostly preterm

9. GAP 1 GAP 2 Where are actions needed? Covering the gaps Source: Lancet Countdown Coverage writing group, Lancet Countdown special issue, 2008

10. Evidence for newborn care ‘ packages ’ with CHW home visits

16. Evidence to Policy

19. Thank you!