NEONATAL MORTALITY LEVELS FOR 193 COUNTRIES

Tuesday, 6th of September 2011

NEONATAL MORTALITY LEVELS FOR 193 COUNTRIES
PRESS RELEASE: NEWBORN DEATHS DECREASE BUT ACCOUNT FOR HIGHER SHARE OF GLOBAL CHILD DEATHS

The World Health Organization and Save the Children release most comprehensive newborn death estimates to date and call for more action to reduce newborn mortality

GENEVA/WASHINGTON, Tuesday 30 August 2011 — Fewer newborns are dying worldwide, but progress is too slow and Africa particularly is being left further behind. These are the findings of a new study published in the medical journal PLoS Medicine today. The study covering 20 years and all 193 WHO Member States was led by researchers from the World Health Organization (WHO), Save the Children and the London School of Hygiene and Tropical Medicine. The estimates are based on more data than ever and extensive consultations with countries. The study shows detailed trends over time and forecasts potential future progress.

Newborn deaths decreased from 4.6 million in 1990 to 3.3 million in 2009, but fell slightly faster since 2000. More investment into health care for women and children in the last decade when the United Nations Millennium Development Goals (MDGs) were set, contributed to more rapid progress for the survival of mothers (2.3% per year) and children under the age of five (2.1% per year) than for newborns (1.7% per year).

According to the new figures, newborn deaths, that is deaths in the first four weeks of life (neonatal period), today account for 41% of all child deaths before the age of five. That share grew from 37% in 1990, and is likely to increase further. The first week of life is the riskiest week for newborns, and yet many countries are only just beginning postnatal care programmes to reach mothers and babies at this critical time.

Three causes account for three quarters of neonatal deaths in the world: preterm delivery (29%), asphyxia (23%) and severe infections, such as sepsis and pneumonia (25%). Existing interventions can prevent two-thirds or more of these deaths if they reach those in need.

“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.”

Almost 99% of newborn deaths occur in the developing world. The new study found that in part because of their large populations, more than half of these deaths now happen in just five large countries – India, Nigeria, Pakistan, China and Democratic Republic of the Congo. India alone has more than 900,000 newborn deaths per year, nearly 28% of the global total. Nigeria, the world’s seventh most populous country, now ranks second in newborn deaths up from fifth in 1990. This is due to an increase in the total number of births while the risk of newborn death has decreased only slightly. In contrast, because the number of births went down and the risk of newborn death was cut in half (23 to 11 per 1000), China moved from second place to fourth place.

With a reduction of 1% per year, Africa has seen the slowest progress of any region in the world. Among the 15 countries with more than 39 neonatal deaths per 1000 live births, 12 were from the WHO African Region (Angola, Burundi, Chad, Central African Republic, Democratic Republic of the Congo, Equatorial Guinea, Guinea, Guinea-Bissau, Mali, Mauritania, Mozambique, and Sierra Leone) plus Afghanistan, Pakistan and Somalia. At the current rate of progress it would take the African continent more than 150 years to reach U.S. or U.K. newborn survival levels.

Of the ten countries with a newborn mortality reduction of more than two-thirds in these two decades, eight were high income countries (Cyprus, Czech Republic, Estonia, Greece, Luxembourg, Oman, San Marino, and Singapore), and two were middle income countries (Maldives and Serbia).

“This study shows in stark terms that where babies are born dramatically influences their chances of survival, and that especially in Africa far too many mothers experience the heartbreak of losing their baby,” said co-author Dr. Joy Lawn of Save the Children’s Saving Newborn Lives program. “Millions of babies should not be dying when there are proven, cost-effective interventions to prevent these deaths.”

To read the paper in PLoS Medicine please go to:

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001080

More information:

Country specific data on neonatal mortality >> link:
Audiovisual material http://terrance.who.int/mediacentre/broadcast_material/NMR/

CONTACTS

World Health Organization
- Media contact: Tel. +41-22-791-2222, mediainquiries@who.int

- Dr Mikkel Z. Oestergaard, Tel. +41-22-791-2361, oestergaardm@who.int

Save the Children
- Tanya Weinberg (Media), Tel. +1-202-640-6647(o), +1-202-247-6610(c), tweinberg@savechildren.org

- Dr. Joy Lawn, Saving Newborn Lives program, Tel +27-21-532 3494, joylawn@yahoo.co.uk

ARTICLE IN PLOS MEDICINE

This article, best viewed in its entirety at http://www.plosmedicine.org/article/info%3Adoi%2F10.1
371%2Fjournal.pmed.1001080

ives an insight into neonatal mortality, which remains a major obstacle, in some countries, to attainment of MDG 4.

If neonatal mortality is linked to maternal mortality, then getting to MDG 4 means, in many countries, getting to MDG 5 as well.

Good reading.

Public Library of Science, Open Access Research Article

Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities

Mikkel Oestergaard and colleagues develop annual estimates for neonatal mortality rates and neonatal deaths for 193 countries for 1990 to 2009, and forecasts into the future.

Mikkel Zahle Oestergaard1 *, Mie Inoue1, Sachiyo Yoshida2, Wahyu Retno Mahanani1, Fiona M. Gore1, Simon Cousens3, Joy E. Lawn4, Colin Douglas Mathers1, on behalf of the United Nations Inter-agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group

1 World Health Organization, Department of Health Statistics and Informatics, Geneva, Switzerland, 2 World Health Organization, Department of Child and Adolescent Health and Development, Geneva, Switzerland, 3 London School of Hygiene & Tropical Medicine, London, United Kingdom, 4 Saving Newborn Lives/Save the Children, Cape Town, South Africa

Abstract

Background

Historically, the main focus of studies of childhood mortality has been the infant and under-five mortality rates. Neonatal mortality (deaths <28 days of age) has received limited attention, although such deaths account for about 41% of all child deaths. To better assess progress, we developed annual estimates for neonatal mortality rates (NMRs) and neonatal deaths for 193 countries for the period 1990–2009 with forecasts into the future.

Methods and Findings

We compiled a database of mortality in neonates and children (<5 years) comprising 3,551 country-years of information. Reliable civil registration data from 1990 to 2009 were available for 38 countries. A statistical model was developed to estimate NMRs for the remaining 155 countries, 17 of which had no national data. Country consultation was undertaken to identify data inputs and review estimates. In 2009, an estimated 3.3 million babies died in the first month of life—compared with 4.6 million neonatal deaths in 1990—and more than half of all neonatal deaths occurred in five countries of the world (44% of global livebirths): India 27.8% (19.6% of global livebirths), Nigeria 7.2% (4.5%), Pakistan 6.9% (4.0%), China 6.4% (13.4%), and Democratic Republic of the Congo 4.6% (2.1%). Between 1990 and 2009, the global NMR declined by 28% from 33.2 deaths per 1,000 livebirths to 23.9. The proportion of child deaths that are in the neonatal period increased in all regions of the world, and globally is now 41%. While NMRs were halved in some regions of the world, Africa's NMR only dropped 17.6% (43.6 to 35.9).

Conclusions

Neonatal mortality has declined in all world regions. Progress has been slowest in the regions with high NMRs. Global health programs need to address neonatal deaths more effectively if Millennium Development Goal 4 (two-thirds reduction in child mortality) is to be achieved.

Please see later in the article for the Editors' Summary