Children under the age of five are increasingly likely to survive in poor countries, as efforts to reach millennium development goal 4 (reducing child deaths by two-thirds) pay off. But newborns are still at high risk – and a new study by the World Health Organisation, London School of Hygiene and Tropical Medicine and Save the Children shows that the slower progress in cutting death rates among babies in the first weeks of life is putting the goal in jeopardy. More than 8 million children die before they reach the age of five, but as more older children survive an increasing proportion of those deaths – now 41% – are among neonates (babies less than four weeks old). The report’s research showed that Africa’s progress in reducing the risk of newborn deaths was slow at under 1% over 20 years. Every year in Africa, approximately 1 million babies are stillborn, of whom at least 300,000 die during labour and a further 1.16 million babies die in their first month of life – up to half of which are not even surviving to the end of their first day. More than half of global newborn deaths now happen in just five large countries – India, Nigeria, Pakistan, China and Democratic Republic of the Congo. India has the worst record with more than 900,000 newborn deaths per year, nearly 28 percent of the global total.
Three main causes account for three quarters of newborn deaths in the world: premature delivery (29%), asphyxia (23%) and severe infections, such as sepsis and pneumonia (25%). These causes, combined with a massive shortage of nurses, doctors and midwives knowing how to deal with complicated births, have contributed to the death toll. A health worker with the right skills, equipment and support at every birth could save 1.3 million newborn lives.
"The global health worker crisis is the biggest factor in the deaths of mothers and children, and particularly the 3.3 million newborns dying needlessly each year. Training more midwives and more community health workers will allow many more lives to be saved," says Dr Joy Lawn of Save the Children's Saving Newborn Lives programme, a co-author of the report. The report is the most comprehensive estimate yet of the death toll among newborns worldwide over a 20 year period, from 1990 to 2009. The researchers find that newborn mortality dropped by 28% – but that was much slower than the drop in maternal mortality (34%) and the deaths of older children under five (37%).
"Newborn survival is being left behind despite well-documented, cost-effective solutions to prevent these deaths," says Dr Flavia Bustreo, WHO assistant director general for family, women's and children's health. "With four years to achieve the millennium development goals, more attention and action for newborns is critical. We know that solutions as simple as keeping newborns warm, clean and properly breastfed can keep them alive, but many countries are in desperate need of more and better-trained frontline health workers to teach these basic lifesaving practices."
The study authors urge more focus on newborn survival. "National governments, international organisations, non-governmental organisations, and other international health bodies must increase investment in care at birth and the first few weeks of life within existing health programmes, adding targeted interventions especially at the time of birth. The majority of neonatal deaths could be prevented with existing interventions, including some that can be delivered at community level with potential to reduce neonatal deaths by one-third, such as improved hygiene at birth, breastfeeding, and simple approaches to keeping babies warm," they write.
Access Health Editor of the Guardian Sarah Boseley’s coverage of the report
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