Setting Research Priorities to Reduce Almost One Million Deaths from Birth Asphyxia by 2015

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Abstract

Joy Lawn and colleagues used a systematic process developed by the Child Health Nutrition Research Initiative (CHNRI) to define and rank research options to reduce mortality from intrapartum-related neonatal deaths (birth asphyxia) by the year 2015.

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Most cited references 48

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Evidence-based, cost-effective interventions: how many newborn babies can we save?

Gary Darmstadt, Zulfiqar Bhutta, Simon Cousens … (2005)

In this second article of the neonatal survival series, we identify 16 interventions with proven efficacy (implementation under ideal conditions) for neonatal survival and combine them into packages for scaling up in health systems, according to three service delivery modes (outreach, family-community, and facility-based clinical care). All the packages of care are cost effective compared with single interventions. Universal (99%) coverage of these interventions could avert an estimated 41-72% of neonatal deaths worldwide. At 90% coverage, intrapartum and postnatal packages have similar effects on neonatal mortality--two-fold to three-fold greater than that of antenatal care. However, running costs are two-fold higher for intrapartum than for postnatal care. A combination of universal--ie, for all settings--outreach and family-community care at 90% coverage averts 18-37% of neonatal deaths. Most of this benefit is derived from family-community care, and greater effect is seen in settings with very high neonatal mortality. Reductions in neonatal mortality that exceed 50% can be achieved with an integrated, high-coverage programme of universal outreach and family-community care, consisting of 12% and 26%, respectively, of total running costs, plus universal facility-based clinical services, which make up 62% of the total cost. Early success in averting neonatal deaths is possible in settings with high mortality and weak health systems through outreach and family-community care, including health education to improve home-care practices, to create demand for skilled care, and to improve care seeking. Simultaneous expansion of clinical care for babies and mothers is essential to achieve the reduction in neonatal deaths needed to meet the Millennium Development Goal for child survival.

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4 million neonatal deaths: when? Where? Why?

Joy E. Lawn, Simon Cousens, Jelka Zupan (2005)

The proportion of child deaths that occurs in the neonatal period (38% in 2000) is increasing, and the Millennium Development Goal for child survival cannot be met without substantial reductions in neonatal mortality. Every year an estimated 4 million babies die in the first 4 weeks of life (the neonatal period). A similar number are stillborn, and 0.5 million mothers die from pregnancy-related causes. Three-quarters of neonatal deaths happen in the first week--the highest risk of death is on the first day of life. Almost all (99%) neonatal deaths arise in low-income and middle-income countries, yet most epidemiological and other research focuses on the 1% of deaths in rich countries. The highest numbers of neonatal deaths are in south-central Asian countries and the highest rates are generally in sub-Saharan Africa. The countries in these regions (with some exceptions) have made little progress in reducing such deaths in the past 10-15 years. Globally, the main direct causes of neonatal death are estimated to be preterm birth (28%), severe infections (26%), and asphyxia (23%). Neonatal tetanus accounts for a smaller proportion of deaths (7%), but is easily preventable. Low birthweight is an important indirect cause of death. Maternal complications in labour carry a high risk of neonatal death, and poverty is strongly associated with an increased risk. Preventing deaths in newborn babies has not been a focus of child survival or safe motherhood programmes. While we neglect these challenges, 450 newborn children die every hour, mainly from preventable causes, which is unconscionable in the 21st century.

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Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4.

Julie Knoll Rajaratnam, Jake R. Marcus, Abraham Flaxman … (2010)

Previous assessments have highlighted that less than a quarter of countries are on track to achieve Millennium Development Goal 4 (MDG 4), which calls for a two-thirds reduction in mortality in children younger than 5 years between 1990 and 2015. In view of policy initiatives and investments made since 2000, it is important to see if there is acceleration towards the MDG 4 target. We assessed levels and trends in child mortality for 187 countries from 1970 to 2010. We compiled a database of 16 174 measurements of mortality in children younger than 5 years for 187 countries from 1970 to 2009, by use of data from all available sources, including vital registration systems, summary birth histories in censuses and surveys, and complete birth histories. We used Gaussian process regression to generate estimates of the probability of death between birth and age 5 years. This is the first study that uses Gaussian process regression to estimate child mortality, and this technique has better out-of-sample predictive validity than do previous methods and captures uncertainty caused by sampling and non-sampling error across data types. Neonatal, postneonatal, and childhood mortality was estimated from mortality in children younger than 5 years by use of the 1760 measurements from vital registration systems and complete birth histories that contained specific information about neonatal and postneonatal mortality. Worldwide mortality in children younger than 5 years has dropped from 11.9 million deaths in 1990 to 7.7 million deaths in 2010, consisting of 3.1 million neonatal deaths, 2.3 million postneonatal deaths, and 2.3 million childhood deaths (deaths in children aged 1-4 years). 33.0% of deaths in children younger than 5 years occur in south Asia and 49.6% occur in sub-Saharan Africa, with less than 1% of deaths occurring in high-income countries. Across 21 regions of the world, rates of neonatal, postneonatal, and childhood mortality are declining. The global decline from 1990 to 2010 is 2.1% per year for neonatal mortality, 2.3% for postneonatal mortality, and 2.2% for childhood mortality. In 13 regions of the world, including all regions in sub-Saharan Africa, there is evidence of accelerating declines from 2000 to 2010 compared with 1990 to 2000. Within sub-Saharan Africa, rates of decline have increased by more than 1% in Angola, Botswana, Cameroon, Congo, Democratic Republic of the Congo, Kenya, Lesotho, Liberia, Rwanda, Senegal, Sierra Leone, Swaziland, and The Gambia. Robust measurement of mortality in children younger than 5 years shows that accelerating declines are occurring in several low-income countries. These positive developments deserve attention and might need enhanced policy attention and resources. Bill & Melinda Gates Foundation. Copyright 2010 Elsevier Ltd. All rights reserved.

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Journal

Journal ID (nlm-ta): PLoS Med

Journal ID (publisher-id): PLoS

Journal ID (pmc): plosmed

Title: PLoS Medicine

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Print): 1549-1277

ISSN (Electronic): 1549-1676

Publication date Collection: January 2011

Publication date (Print): January 2011

Publication date (Electronic): 11 January 2011

Publication date (Corrected, electronic): 02 February 2011

Volume: 8

Issue: 1

Electronic Location Identifier: e1000389

Affiliations

[1 ]Saving Newborn Lives/Save the Children, Cape Town, South Africa

[2 ]Department for Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland

[3 ]Division of Global Health, Karolinska Institutet, Stockholm, Sweden, and Averting Maternal Death and Disability Program, Columbia University, New York, New York, United States of America

[4 ]Division of Women & Child Health, the Aga Khan University, Karachi, Pakistan

[5 ]Family Health Division, Global Health Program, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America

[6 ]Community Child Health Partnership, Southmead Hospital, Bristol, United Kingdom

[7 ]KEMRI–Wellcome Trust Programme, Centre for Geographic Medicine Research–Coast, Nairobi, Kenya, and Department of Paediatrics, University of Oxford, Oxford, United Kingdom

[8 ]The National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom

[9 ]Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America

[10 ]Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

[11 ]George Washington University, Washington, D.C., United States of America

[12 ]Centre for International Health and Development, UCL Institute of Child Health, London, United Kingdom

[13 ]MRC Maternal and Infant Heath Care Strategies Research Unit at the University of Pretoria, Pretoria, South Africa

[14 ]Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

[15 ]Department of Pediatrics, Maulana Azad Medical College, New Delhi, India

[16 ]Department of Pediatric Research, Oslo University Hospital Rikshospitalet, University of Oslo, Norway

[17 ]Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States of America

[18 ]Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada

[19 ]Saving Newborn Lives/Save the Children, Washington, D.C., United States of America

[20 ]University of Cape Town and the Perinatal Education Programme, Observatory, South Africa

[21 ]Centre for Philosophy, Justice and Health, University College of London, London, United Kingdom, and Center for Women's Health, University College of London, London, United Kingdom

[22 ]Nossal Institute of Global Health, University of Melbourne, Melbourne, Australia

[23 ]Croatian Centre for Global Health, University of Split Medical School, Split, Croatia, and the Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, United Kingdom

Author notes

* E-mail: joylawn@ 123456yahoo.co.uk

ICMJE criteria for authorship read and met: J. Lawn R. Bahl S. Bergstrom Z. Bhutta G. Darmstadt M. Ellis M. English J. Kurinczuk A. Lee M. Merialdi M. Mohamed D. Osrin R. Pattinson V. Paul S. Ramji O. Saugstad L. Sibley N. Singhal S. Wall D. Woods J. Wyatt K. Chan I. Rudan. Agree with the manuscript's results and conclusions: J. Lawn R. Bahl S. Bergstrom Z. Bhutta G. Darmstadt M. Ellis M. English J. Kurinczuk A. Lee M. Merialdi M. Mohamed D. Osrin R. Pattinson V. Paul S. Ramji O. Saugstad L. Sibley N. Singhal S. Wall D. Woods J. Wyatt K. Chan I. Rudan. Designed the experiments/the study: J. Lawn R. Bahl S. Bergstrom G. Darmstadt I. Rudan. Analyzed the data: J. Lawn K. Chan I. Rudan. Collected data/did experiments for the study: J. Lawn M. Ellis J. Kurinczuk L. Sibley S. Wall. Wrote the first draft of the paper: J. Lawn I. Rudan. Contributed to the writing of the paper: R. Bahl S. Bergstrom Z. Bhutta G. Darmstadt M. Ellis M. English J. Kurinczuk A. Lee M. Merialdi D. Osrin R. Pattinson V. Paul O. Saugstad N. Singhal S. Wall D. Woods J. Wyatt K. Chan I. Rudan. Contributed to the scoring for the research priorities: Z. Bhutta. Was an expert collaborator who participated in the expert survey: M. Ellis. Part of expert panel providing data used: M. English. Read and agree with submission of the final version of the paper: J. Kurinczuk. The paper is based on surveying physicians & researchers who are public health experts and working in the field of decreasing mortalities related to birth process for mothers and their babies. The survey examined current and future research priorities concerning birth related mortalities. The survey was thorough and comprehensive. It required a significant amount of time to read, analyze, and answer each questions considering multiple factors. All participating experts are considered authors on this paper. I was a responder to the study: M. Mohamed. Contributed expert opinion to the process described in the paper: D. Osrin. Scored questions: R. Pattinson. Participated in the systematic assessment and ranking of the research priorities. Contributed to the interpretation of findings. Helped in refining the manuscript: V. Paul. Contributed to the technical inputs for the paper and commented on final draft of the paper: S. Ramji. Contributed with data: O. Saugstad. Helped with the coding of the different research priorities: N. Singhal. Took part as a technical expert contributing and commenting on the research questions: D. Woods. Was involved in contributing data for the research process and reviewed, checked, and approved various drafts of the manuscript: J. Wyatt.

¶ Joint senior authors.

Provenance: Commissioned; externally peer reviewed.

Article

Publisher ID: 10-PLME-GG-3971R2

DOI: 10.1371/journal.pmed.1000389

PMC ID: 3019109

PubMed ID: 21305038

SO-VID: 28cfff42-5440-4239-b5ff-36624c419529

Copyright © Lawn et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Setting Research Priorities to Reduce Almost One Million Deaths from Birth Asphyxia by 2015

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UCL: UN SDG 03 Good Health and Well-Being

Most cited references 48

Evidence-based, cost-effective interventions: how many newborn babies can we save?

4 million neonatal deaths: when? Where? Why?

Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4.

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