Nepalese Newborns and Chlorhexidine: Match Made in Heaven
Every year, thousands of Nepalese newborns die due to various life-threatening infections contracted early on that go unaddressed. Currently, one in 19 Nepalese children dies before they reach the age of five and half of that number die before reaching even 28 days of life.

Finding successful ways to nurse newborns to health in Nepal has been a challenge for decades. Navel Glazers, a simple topical application of chlorhexidine digluconate (CHX), are helping to pave the way to a brighter future for Nepalese children.

The application of CHX has been used in health care settings to reduce the development and transmission of infections for a number of years now. However, due to limited support regarding its effectiveness in reducing newborn umbilical cord infections, it is not a widely known practice.

Per the recommendation of the World Health Organization (WHO) more studies have been done to assess the navel-glazing strategy, specifically in high-risk environments like Nepal.

Country-wide clinical trials of CHX application post-birth were rolled out in Nepal through the support of the National Institutes of Health, the Bill and Melinda Gates Foundation and USAID.

It was found that applying a 4 percent chlorhexidine solution to the umbilical cord after birth significantly reduced neonatal mortality.

“This is very important because, after its implementation, the number of infected umbilical cord cases in my facility declined,” explains Birendra Ghale, a health worker in charge of this peripheral-level health facility in Banke, Nepal. “I have also seen that fewer babies are dying in my VDC [village development committee].”

For a long time, cultural barriers kept the implementation of the newly-found, life-saving technique from being used. Nepalese mothers are accustomed to applying substances like turmeric, ash, cow dung or vermilion to their child’s umbilical cord post-birth.

Now, single-dose tubes are freely distributed to all expectant mothers in their eighth month of pregnancy. They also receive a one-on-one educational session to explain how to apply the gel after cutting the cord as well.

Chlorhexidine has rolled out to 26 of 75 districts in Nepal as of July 2012. The country’s government has committed to incurring the full expense of buying the commodity as well as other program costs from its own resources. They are even using a local manufacturer to help with a production of a high-quality product, and distribution continues to rapidly expand — mainly through community health workers.

Delegates from more than 20 countries learned from Nepal and its implementation of the program. At least five of those countries have implemented similar interventions.

According to the Healthy Newborn Network (HNN), the application of CHX is recognized as being successful, acceptable, feasible and cost-effective newborn care intervention. The widespread practice of CHX cord cleansing, or navel glazing, could prevent more than 200,000 newborn deaths each year in South Asia.

Keaton McCalla

Photo: Flickr

Reduce Neonatal Deaths
The United Nations World Health Organization (WHO) has recently released three new publications that will help strengthen knowledge on how to prevent stillbirth and neonatal deaths. These publications are aimed to assist countries as they develop their classification, analysis and investigation processes on unreported deaths.

Over 2.7 million babies die within the first month of life, according to the U.N. health agency. Another 2.6 million are stillborn, and over 300,000 women die during childbirth. Most of these deaths are preventable if paired with the appropriate health care. “By reviewing the causes of maternal and infant deaths, countries can improve quality of health care, take corrective actions and prevent millions of families from enduring the pain of losing their infants or mothers,” stated the Director of Health and Research at WHO, Ian Askew.

When a baby is stillborn, they are not recorded in either a death or birth certificate. Therefore, many of the above numbers are an underestimate of the true amount of stillborn and newborn deaths. Countries are unable to truly investigate these deaths and find out appropriate prevention methods for future cases. This is why WHO decided to improve education efforts for countries by releasing these three new publications:

  1.  “WHO Application of the International Classification of Disease-10 to deaths during the perinatal period.” This publication aims to help countries link certain stillbirths to relevant causes. Such causes could be conditions like diabetes or hypertension in the mother. Before this recent publication, there was no classification system that would help countries record this information.
  2. “Making Every Baby Count: Audit and Review of Stillbirths and Neonatal Deaths.” This will be a guide to assist countries’ investigation of deaths, allowing them to develop solutions for future cases. It will incorporate the above classification system to publish a basic review of every stillbirth death. According to Anthony Costello — WHO’s director of maternal, children’s and adolescent’s health — every death review gives valuable information about what can be done in the future to prevent a child’s life from being lost.
  3. “Time to Respond: A Report on the Global Implementation of Maternal Death Surveillance and Response.” This will help strengthen countries’ review process of deaths in hospitals and clinics. It also details guidelines for hospitals to better improve their quality of care. WHO recommends hospital committees to meet at least twice a year. They also suggest conducting mortality audits and reviews of their past patients.

To strengthen other countries’ health information systems, WHO is partnering with more than 30 other global health organizations in hope of developing a more easily understood package of guidance and tools for countries to prevent neonatal deaths.

Katie Grovatt

Photo: Flickr

AIR

Breathing problems are at the root of 1.8 million stillbirths and neonatal deaths that occur every year. Many of these deaths could have been prevented if health facilities had adequate equipment and proper training programs available.

Having worked with over 1,000 healthcare providers in Uganda’s Helping Babies Breathe (HBB) program, Dr. Data Santorino is intimately familiar with this issue. Alongside Kevin Cedrone, Craig Mielcarz and Dr. Kristian Olson, Dr. Santorino developed the Augmented Infant Resuscitator (AIR) as an inexpensive and effective solution.

AIR is an add-on to already existing emergency ventilation equipment that provides real-time feedback to birth attendants. The feedback incorporates both an assessment of the quality of emergency ventilation administration and “actionable cues” for users to take up.

These cues are vital to the babies under neonatal care. They not only help users improve their performance but also build their confidence in the abilities that they have to care for the newborn.

Because the feedback also helps to improve skills, AIR alleviates former inadequacies in neonatal resuscitation training. With the device, users can put their skills to use while also learning and maintaining proper practices.

AIR may prove especially helpful in developing countries where proper equipment is often too costly or inaccessible and training of healthcare professionals remains seriously insufficient.

Currently, birth attendants administering emergency assisted ventilation will periodically stop the process in order to manually check and monitor the baby’s heart rate. This interruption within the first “golden minute” after a baby is born could prove detrimental, according to Santorino, as the lack of oxygen could either kill the baby or cause other health issues such as brain damage.

As the first place winner for the best pitch at the Boston Children’s Hospital Innovation Tank, AIR continues to be developed and improved. Its first deployment is projected for January 2017.

Jocelyn Lim

Sources: Elsevier, Augmented Infant Resuscitator, Boston Children’s Hospital, MIT Ideas Global Challenge
Photo: Flickr

maternal health

Saving Mothers, Giving Life is a public-private partnership that works with impoverished communities whose mothers have no functioning health care during pregnancy. The organization facilitates health services in Uganda, Zambia and Nigeria in order to better equip their network to ensure a focus on the most vulnerable period for mothers and their newborns – during labor, delivery and 48 hours after birth.

Maternal and infant mortality often mingle together because when a woman dies during childbirth (which occurs around every 2 minutes) her baby’s chance of dying instantly increases by 10 percent. However, institutionalized deliveries have far less complications and drastically improve the conditions of both the mother and newborn postpartum.

In Uganda and Zambia alone there are an estimated 2 million births annually of which 50,000 maternal and infant mortality rates occur because there is no accessible health care service to provide a safe and sanitary facility for women during their pregnancy. Coupled with the fact that nearly half of all Africans lack essential drugs to treat basic infections, these conditions substantiate the reason why approximately 3 percent of births account for infant mortality in the two states combined.

Saving Mothers, Giving Life offers a solution to the detrimental situation of mothers in Uganda and Zambia through various methods that, since their application, have reduced the maternal mortality ratio in Uganda by 45 percent and in Zambia by 53 percent. The foci of the organization all occur within a couple days and because of this a few approaches have proven to be the most effective in practice:

  • Training and mentoring has been a paramount tactic utilized by the organization. In doing this, they establish a means of aiding communities who have no physician or facilities, creating self-reliance.
  • Generating and providing facilities with essential health care supplies that have increased in number of institutionalized births in Uganda by 30 percent and in Zambia by a staggering 90 percent.
  • Mobilizing the community to vie for a health care service in their region in order to strengthen their network empowers communication and transportation along with stabilizing the means by which people seek treatment or consultations.

Currently, the organization only operates in 26 districts across Uganda and Zambia; however, it has extended its reach into Nigeria where 14 percent of the world’s maternal mortality and 25 percent of newborn mortality occur. Since its arrival in Cross River State in southern Nigeria, a 40 percent increase of women giving birth in a facility marks its success.

Since 2012 when the organization launched, the drops in mortality rates have only solidified that saving women in low-resource settings and reaching the “audacious 50% reduction of maternal deaths in both countries now seems not only possible, but probable,” secretariat of Saving Mothers, Giving Life said in its 2015 Mid-Initiate Report.

Emilio Rivera

Sources: Saving Mothers Giving Life 1, Saving Mothers Giving Life 2, Saving Mothers Giving Life 3, Saving Mothers Giving Life 4Our Africa
Photo: Save The Children

newborn_health_conference

In response to the recent sustainable development goals created by the UN, Mexico City hosted a Global Maternal Newborn Health Conference to focus attention on and propel efforts towards improving maternal and newborn health and healthcare around the world.

Representatives of more than 50 countries, which included policymakers, healthcare workers, researchers and organization leaders, attended the conference.

The general public or those unable to attend in person had ample opportunity to participate virtually through webcasts, live converge and social media engagements. The theme of the Conference was “Reaching every mother and newborn with quality care.”

The talks, group sessions and skill demonstrations focused on six primary tracks: innovating to accelerate impact at scale, measuring for evaluation and accountability, bridging equity divides, generating new evidence to fill critical knowledge gaps, strengthening demand for health care and increasing health systems’ capacity to respond to population needs.

The conference was hosted with the intention of increasing collaboration to encourage innovation and improved global health.

Every day, about 800 women die from preventable causes related to pregnancy or childbirth. These deaths are often due to the fact that the women did not have access to adequate healthcare.

This helps explain why 99 percent of all maternal deaths occur in developing countries where woman are restricted geographically or economically from the medical care they need.

Mexico City was selected to host the conference because Mexico is a recognized global leader in maternal and newborn health improvements.

Their national maternal and newborn health agenda has been greatly improved through successful government policies and programs, as well as through assistance from local and national NGOs, philanthropic entities and academic organizations.

In order to abide by and accomplish the UN’s Sustainable Developmental Goals, nations and international organizations must find ways to work together to set satisfactory standards and procedures and flush out what strategies and techniques work and what ones do not.

Conferences like the Global Maternal Newborn Health Conference allow information to be shared as well as spur insight to solutions and inspire hope for progress.

Brittney Dimond

Sources: Global MNH 2015, The Guardian, WHO
Photo: Flickr

Nursery of the Future
Premature births are a very real scare for mothers in developed countries like the U.S., but in developing countries, they can mean almost certain death. Worldwide, premature birth is the leading cause of death for children under five years of age. Despite advances in technology that have made tremendous strides in improving health outcomes for babies born earlier than 37 weeks, in developing countries, where women may be at a higher risk for giving birth prematurely, this technology is generally widely unavailable due to high prices and lack of access to adequate healthcare. Nursery of the Future is working affordable alternatives to those who need it most.

 

The Birth of Nursery of the Future

 

A bioengineering professor at Rice University in Texas, Rebecca Richards-Kortum, consistently saw this problem and wanted to do something about it. Along with colleagues and students, Richards-Kortum has begun to develop “the Nursery of the Future.” The team has developed prototypes of alternatives to high tech, and high cost medical machinery that is common across the U.S., for use in more underdeveloped areas around the world.

One such example of a low cost alternative is a belly band. One common problem in preemies is neurological underdevelopment that can cause the baby to stop breathing. In hospitals across the countries, monitors alert nurses if a baby stops breathing and the nurse then stimulates the baby somehow to remind them to breathe. In developing countries, these monitors are often too expensive to be used and often times infants die before a nurse notices. The belly band developed by Richards-Kortum and Maria Oden, a colleague, was designed with a tiny motor attached to it that detects when a baby’s air intake is low, or they stop breathing, and vibrates to remind the baby to breathe.

The belly band is just one step towards the development of a whole “Nursery of the Future” kit. Richards-Kortum and the team hope to make the Nursery available for under $10,000 and widely accessible for community hospitals. The belly band has been tested in Texas and is approaching its first international trial in Malawi in the near future. The Nursery of the Future is a huge step in the global fight against child mortality and overall accessibility and affordability of medical devices. Innovations made in the Nursery Kit for preemies hold promise for innovations in other medical technologies that could improve access to essential medical devices around the world.

Emma Dowd

Sources: Houston Chronicle, TED Talks

breastfeeding
It has been proven that the first 6 months of a child’s life are amongst the most crucial for establishing their longstanding health immunities and development of antibodies. However, in the rural areas of northern India, UNICEF estimates that only 46 percent of infants are exclusively breastfed during this time. Furthermore, it is believed that approximately 2 million Indian children die each year before the age of 5.

A 2009 study was conducted at the Pravara Rural Hospital in Loni, Uttar Pradesh. Three hundred mothers of children between ages 0 and 5 were surveyed regarding socio-demographics, religious affiliations and breastfeeding practices. In like manner, the children themselves were clinically examined to determine the severity, if any, of their malnutrition.

These data sets were examined, compared and analyzed to determine any patterns or similarities. Male and female children surveyed were split approximately 60 percent to 40 percent, respectively, but there were no indications implying the biological sex was a factor in nourishment.

The data did not reveal a correlation regarding religion, which would imply that the various faith teachings did not object to breastfeeding. It was found that socio-economic and educational status were the primary indicators of malnourishment. Ninety-seven percent of the mothers surveyed were under the age of 30. Additionally, of the 300 mothers, 147 had completed high school or less and had malnourished children.

While the sample size is very small, it is certainly representative of rural breastfeeding habits and conditions during the first few months. Children of young, uneducated mothers in rural areas appear to be at most risk. Initially, this would indicate a lack of understanding regarding the benefits of breastfeeding. Although there appeared to be a common understanding of necessary benefits, the prevalence of this knowledge does not correlate to perfect practice in reality.

Responses revealed an absence of any scheduled patterns for breastfeeding other than as a means to stop the child’s crying. The lack of an organized routine and the late start for breastfeeding practices are central contributors to malnutrition in rural India.

In rural communities, there is also a belief that colostrum, the nutrient milk produced directly after delivery, is unhealthy for children. In many communities, goat’s milk is traditionally provided as a substitute. For these reasons, 80 percent of the mothers surveyed began periodically breastfeeding their children between 4 and 8 months old.

In an effort to encourage earlier, more consistent breastfeeding habits, UNICEF has partnered with local organizations in the northern states to provide home visits to encourage earlier breastfeeding and to dispel any false notions. Durowpadi Bedia, a health worker in the Northern state of Assam says, “Whenever we go on home visits, we talk to all members of the family – the parents, the grandparents, adolescent girls…They have faith in what I am saying.”

“When they come and talk in our own language, I understand better. I feel comfortable with them,” said Monika Bedi, a young mother. Home visits are scheduled with expectant mothers 3 to 4 times per month in the third trimester of their pregnancy. Jeroo Master, UNICEF’s Chief of Field Officer in Assam states, “Now mothers understand how vital breast milk is to the health of their babies…having health and nutrition workers actively promoting breastfeeding at the village level will ensure each child has the best start possible in life.”

Dr. Victor Aguayo, UNICEF India’s Chief of Child Nutrition and Development states, “Unquestionable global evidence demonstrates that breastfeeding counseling and support is the most important child-survival intervention.”

Frasier Petersen

Sources: Research Gate, UNICEF, NIC
Photo: Baby Center

Twin_births
Multiple births, two or more babies born at the same time, are a relatively small percentage of all the births worldwide. Twins represent only 3.3 percent of births in the United States (CDC) and, depending on the global region looked at, the rate is even lower in the developing world.

But even with such small numbers, twin births can present a large health concern for both mother and unborn children alike. The risks are even more pronounced in the developing world.

Twins have a much higher chance of being born prematurely, and they can be underweight, which often leads to more time in the NICU. Also, twin-twin transfusion, “when identical twins share a placenta and one baby gets too much blood flow, while the other baby doesn’t get enough,” is a possibility. The most startling statistic is that in the developing world, “among stillbirths, the proportion of twins is probably somewhat higher than among live births, as fetal (and neonatal) mortality is higher among twins.”

Complications arise when mothers do not receive adequate prenatal care. Women in the developing world often do not receive enough care when they are pregnant with a single child, let alone the need for additional monitoring and ultrasounds when having a multiple birth.

A study conducted in urban Guinea-Bissau found that “sixty-five percent (245/375) of the mothers who delivered at the hospital were unaware of their twin pregnancy.” Sometimes a mother will not measure larger than average to indicate a twin pregnancy, a second heartbeat is not always discernable, and/or bloodwork is not drawn to measure hCG (pregnancy hormone). Even if any of those previous criteria were met, only an ultrasound can confirm a multiple birth.

The unborn children are not the only ones at risk; mothers also face pregnancy complications at a higher rate when carrying multiple children, like pre-term labor, anemia, gestational diabetes, preeclampsia, hyperemesis gravidarum (severe morning sickness), polyhydramnios (too much amniotic fluid), miscarriage/stillbirth, postpartum depression and postpartum hemorrhage.

While these issues have the possibility to affect all mothers experiencing a multiple birth, the complications can be exacerbated when they live in poverty. Access to a hospital for an emergency may not be possible, especially in regions that are remote. Finances to afford a hospital stay can also be an issue, especially since many multiple births are delivered through c-section.

A 2008 study done in a rural mission tertiary hospital in Nigeria found that of the twin deliveries that happened there, 60 percent of the twins were delivered c-section, 36.4 percent were vaginal deliveries and the remaining 4 percent had vacuum deliveries. C-sections are often performed due to emergencies, premature delivery and fetal malpresentation.

Even though it seems like twin pregnancy is bleak, the opposite can be true. The UN’s fifth Millennium Development Goal is to improve maternal health. While multiple births are not specifically addressed, the positive improvements to help mothers and their unborn babies will also help those pregnant with twins. Multiple births must be monitored as a high-risk pregnancy but not all (or any) complications may occur. But with improved medical care, when those complications do arise they can be addressed and the rate of stillborn twins can decline even further.

Megan Ivy

Sources: NIH 1, CDC, March of Dimes, UN, NIH 2, NIH 3
Photo: Babies Magz

public_breastfeeding_areas_in_india
Health experts and activists are calling for the government in the Indian state of Assam to create public breastfeeding areas in India.

Assam, a state in northeast India, has a bad record when it comes to maternal and infant mortality rates.

With Aug. 1-7 being World Breastfeeding Week, the spotlight has shifted to Assam, where there are no public facilities available for women to breastfeed. As a result, mothers who are lactating often have a difficult time comfortably attending to their infants.

The difficulty is greater for mothers in rural areas, where malnutrition rates in infants are higher. Additionally, mothers who are working do not have the ability to meet their babies’ needs in a timely matter.

To avoid malnutrition, the need for public breastfeeding areas in India, specifically Assam, is high. Creating designated areas, such as in buses and railway stations, would help avoid malnutrition.

Those engaged in World Breastfeeding Week are also asking for uniformity when it comes to maternity leave. Organizations such as the Association of Promotion of Child Nutrition (APCN) and Breastfeeding Promotion Network of India (BPNI) are calling on the state government to implement consistent leave in both the public and private sectors for working mothers.

Currently, women working in the public sector are granted a leave of six months, but most are unaware they can take a leave to care for their babies, as the parameter is not implemented uniformly in the sector.

While women are granted a leave of between three and four and a half months in the private sector, most workplaces in the public and private sectors lack the proper facilities to allow women to breastfeed, leading to problems for mothers.

Matt Wotus

Sources: Encyclopedia Britannica, The Times of India, World Breastfeeding Week
Photo: Healthy Newborn Network

Maternal_and_Infant_Mortality

“I believe it is relationships that save lives, that by working together with others we can serve so many more. No matter what you face in life, never give up. The ripple effect knows no boundaries.”

Those are the three main lessons that nurse Arlene Samen says she has learned over the course of many years. Samen, a maternal and fetal medical nurse practitioner for 33 years, decided to take her efforts to a broader level by founding the organization One Heart World Wide. The nonprofit organization works to encourage community wide support of mothers in remote and underserved areas around the world. The organization has been extremely effective in improving maternal and infant mortality rates because it works on improving healthcare from inside existing infrastructure.

Samen devoted her medical career to traveling around the world to improve birth outcomes for both mother and child. In particular, while in Tibet, she took to a special connection and pursued her interest—she researched local culture, traditions and conditions in communities in order to go back into the clinical setting and encourage adjustments based on those culture-specific findings, making certain changes. She created a “Network of Safety” model that was used far and wide, first throughout Tibet, then expanded into other regions of the world where conditions for pregnant woman were poor.

Samen’s path to where she is today, seeing the problem firsthand in one way and then setting out to improve it by looking at other avenues, is seemingly common. However, the tremendous success and praise that she has received for her efforts are not always so commonplace. Many intervention programs fall flat since they adhere strictly to intervening rather than combatting the problem where it is. One Heart World Wide does not just build fancy medical centers or go village-to-village delivering babies and then leaving—it works to implement sustainable system wide change that improves outcomes for mothers in the area for the long-term. By building clinics, training staff, and using culturally appropriate and tailor-made adjustments to a general model, each project that One Heart World Wide takes on is personal and comfortable for the communities, encouraging long-term sustained changes.

To date, Samen is credited with helping as many as 60,000 women directly, with many more yet to come. She has met with the Dalai Lama, led countless discussions and won many awards for her work. Samen, with One Heart World Wide, continues to change lives around the world and continues to serve as an exemplary example to public health initiatives.

– Emma Dowd

Sources: CNN, Forbes, Huffington Post, One Heart World Wide
Photo: Foot Soldiers of Change