Kavitah Singh Analyzes Maternal and Newborn Health in Bangladesh and Nigeria

January 12, 2018

Photo by UNICEF Ethiopia via MEASURE Evaluation.

Every child born should have the optimum chance of survival.

Although that goal might seem obvious, the Sustainable Development Goals for 2030 (SDGs) have placed new emphasis on newborn survival as central to the global health agenda. The SDG target is for countries to reduce neonatal mortality to at least as low as 12 per 1,000 live births. Ambitious, but achievable, according to a special supplement of the Journal of Global Health—which asserts that 71 percent of newborn deaths could be averted by 2025 “with increased coverage and quality of preconception, antenatal, intrapartum and postnatal interventions.”

In 2015, neonatal mortality accounted for 45 percent of under-five mortality, which translates to 2.8 million deaths within the first 28 days of life.[1] The thesis of this journal supplement of 11 articles is that it’s already known what works, what to do, and what should be measured. The gap lies between what we know to measure and the means to do so, with high-quality data collected.

Recent large-scale household surveys have included measures of newborn health interventions. Writing on maternal and newborn health for the supplement, Kavita Singh, associate professor in the Department of Maternal and Child Health at the University of North Carolina at Chapel Hill, provides the first analysis to use population-level data from Nigeria and Bangladesh to look at the association between skin-to-skin contact between maternal and newborn and early breastfeeding, an intervention proven to reduce neonatal mortality. A second article, also authored by Singh et al., focuses on which newborns in Bangladesh receive postnatal care (PNC) and its effects on reducing neonatal mortality. Both analyses were supported by MEASURE Evaluation, funded by the United States Agency for International Development (USAID).

“We have interventions that can improve newborn survival in low and middle-income countries, but these interventions need to be taken to scale. Better data is needed so countries can know which newborns are being reached and which newborns are being left out,” Singh says.

The supplement argues that the need for more data is urgent, as is the need to increase service readiness at health facilities—in particular the quality of staff training to provide routine and emergency newborn care. The lead article authors[2] state “we propose that linking household survey data on coverage of interventions with facility-level data on service availability and readiness could help better measure effective coverage and identify its determinants and barriers.”

The suggested means to collect such data are country health management information systems (HMIS) and country DHIS 2 platforms. Currently, UNICEF, the World Health Organization and UNFPA are developing standard indicators that can be consistently tracked by these means.

Singh’s study on PNC finds that newborns of mothers having a skilled delivery or complications were significantly more likely to receive PNC. Urban residence and greater wealth were also significantly associated with the likelihood of PNC. PNC for the newborn includes the promotion of immediate and exclusive breastfeeding for six months, hand-washing, examination of mother and child for danger signs and referral for medical care if needed. Interventions provided as part of PNC can prevent newborn complications such as sepsis, meningitis, pneumonia and diarrhea.

Given that 79 percent of women in Bangladesh have a home delivery, the authors concluded that strategies are needed to reach newborns born to poor women in rural areas who deliver at home. They further suggested that engaging trained community health workers to conduct home PNC visits may be an interim strategy.

The other study in Nigeria and Bangladesh of early skin-to-skin contact between mother and newborn showed that the practice increases early initiation of breastfeeding, which aids newborn survival. However, despite the benefits and the ease of providing such contact, newborns are typically separated from their mothers, often due to routine procedures in health facilities. Many of these procedures could be done during skin-to-skin contact or afterwards, if the mother and newborn are healthy.

Singh’s analysis showed that in Nigeria, only 10 percent of mothers reported skin-to-skin contact and there was little difference between those who received it and those who did not—except that larger babies were significantly more likely to experience skin-to-skin contact than smaller newborns.

In Bangladesh, about 26 percent of mothers reported skin-to-skin contact and, again, there was little difference between newborns who did and did not receive it—except that newborns of mothers who had had two or three prior deliveries were significantly more likely to have skin-to-skin contact with their mothers compared to newborns who were first births and those born to mothers who had three or more prior births.

In both countries, newborns from wealthier households were significantly more likely to experience early breastfeeding and, in Bangladesh, newborns of Cesarean delivery were 67 percent less likely to breastfeed early. The paper suggested that health planners are recognizing that facilities must allow mothers who deliver by Cesarean to experience skin-to-skin contact and breastfeed early, if both mother and newborn are healthy. The paper also encourages ensuring that knowledge on the importance of early breastfeeding and skin-to-skin contact reaches delivery attendants, women, and families—regardless of wealth, number of children or geographic residence.

“Skin-to-skin contact between mother and newborn is a natural intervention and basically has no cost.  In addition to associations with early breastfeeding, skin-to-skin contact keeps the newborn warm, aids with mother-newborn bonding and reduces infant stress. To think that such a simple intervention can have such positive effects on mother and newborn outcomes is encouraging,” says Singh.

For more information

Kavita Singh, PhD, is an associate professor in the Department of Maternal and Child Health at the University of North Carolina in Chapel Hill (UNC) and works with the MEASURE Evaluation project, led by UNC and funded USAID. For more information on the project’s work on maternal and child health, visit: www.measureevaluation.org/our-work/maternal-and-child-health

[1] UNICEF estimates developed by the United Nations Interagency Group for Child Mortality Estimation: Levels and trends in under-five mortality. New York. 2015.

[2] L. Carvajal–Aguirre, L. ME Vaz, K. Singh, D. Sitrin, A.C. Moran. Measuring coverage of essential maternal and newborn care interventions: An unfinished agenda. JoGH. 2017. Retrieved from http://jogh.org/documents/issue201702/jogh-07-020101.htm