Abstract
Globally, the neonatal mortality rate is the highest contributor to all deaths in children under five years of age. Children, particularly newborn infants, continue to face widespread regional disparities in their chances of survival. The year 2015 marked the official end of the period set by the United Nations to achieve the Millennium Development Goals (MDGs). New targets, the Sustainable Development Goals (SDGs), aim to end preventable deaths of newborns and children and to reduce the neonatal mortality rate in all countries. There is a sense of urgency to implement large-scale, high-impact interventions to improve maternal and newborn care before, during, and in the immediate period following birth. Two of the highly successful and widely available interventions to improve neonatal outcome are kangaroo mother care (KMC) and breast-feeding. However, the threat of COVID-19 to ongoing efforts may further compromise the chances of success in improving neonatal mortality, particularly in low- and medium-income countries (LMICs).
TopIntroduction
Global neonatal mortality rates have been decreasing during the last thirty years, but the rate of decline has been slower as compared to the overall decrease in the under-5 mortality rate (U5MR). The global decline in mortality has been faster among children aged 1-59 months than among children in their first month of life. Worldwide, there were 5 million deaths among children in the first month of life in 1990. This number declined to 2.4 million by 2019, which represents 47% of all under-5 deaths. (UN IGME 2020) A widespread regional disparity exists in the chances of survival among infants and children. The burden of child death remains highest in the World Health Organization (WHO) African Region. Sub-Saharan Africa continues to be the region with the highest U5MR in the world. In 2019, this region had an average of 76 deaths per 1,000 live births, which is 20 times higher than that of the highly industrialized countries. This disparity shows in the neonatal mortality rate, as depicted in Figure 1. (UN IGME 2019)
The year 2015 marked the official end of the period set to achieve the United Nations’ Millennium Development Goals (MDGs). Since child mortality is one of the largest problems in the world, the MDGs rightfully identified it as a key global issue to be addressed. The number 4A specific goal of the MDGs was to reduce the U5MR by two-thirds, i.e., from 91 to 60 deaths per 1,000 children, between 1990 and 2015. (Kanmiki 2014) However, the WHO estimated that the U5MR during that period declined only by approximately 53%, or 43 deaths per 1,000 children. This estimate came short of its original goal. (WHO 2015) Therefore, the international community has agreed recently on a new framework that has ushered in a new era of Sustainable Development Goals (SDGs), particularly in relation to maternal, newborn, and child mortality. The WHO in 2015, renewed its target to reduce the current U5MR of 43 deaths per 1,000 live births to as low as 25 deaths per 1,000 live births, and the neonatal mortality rate to 12 per 1,000 live births, by the year 2030. (WHO 2020) The complete list of SDGs 3 targets is shown in Table 1. (WHO 2015) To better understand the development and implementation of some of the currently effective maternal and newborn interventions, this chapter aims to provide a brief historical evolution, and describe those interventions to improve the survival of newborn infants in low-resource settings.
Key Terms in this Chapter
Maternal Mortality Rate: Number of registered maternal deaths due to birth- or pregnancy-related complications per 100,000 registered live births.
Perinatal Mortality Rate: Number of stillbirths and deaths in the first week of life per 1,000 total births.
Low Birth Weight (LBW): Infants born with a birth weight less than or equal to 2,500 grams.
Neonatal Mortality Rate: Number of newborns dying during the first 28 days of life, expressed per 1,000 live births.
Stillbirth Rate: Number of babies born with no sign of life at 28 weeks or more of gestation, per 1,000 total births.
Under 5 Mortality Rate (U5MR): Number of children dying between birth and exactly 5 years of age, expressed per 1,000 live births.
Stillborn: Is a baby born with no signs of life after 28 weeks of completed gestation.
Low- and Medium-Income Countries (LMICs): Defined by World Bank as countries and nations with per capital gross national income (GNI) of less than $1026 (low-income) and between $1026 to $12,475 (middle-income).
Infant Mortality Rate: Number of infants dying between birth and exactly 1 year of age, expressed per 1,000 live births.