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What’s New for  Newborns? Claudia S. Morrissey  MD MPH Allisyn Moran PhD MHS  Saving Newborn Lives CORE 14 October 2011
Outline <ul><li>Newborn Survival:  A Decade of Progress  </li></ul><ul><li>Evidence as a Driver of Progress  </li></ul><ul...
Newborn Survival:  A Decade of Progress
Biggest News for Newborns <ul><li>Deaths are going down! </li></ul><ul><ul><li>3.1 Million deaths in 2010 </li></ul></ul><...
Global progress to MDG 4   MDG 4 target  (32) Ref:  Lawn, Kerber et al BJOG 2009 updated with data for 2008 from UN Child ...
A low-cost intervention that worked <ul><li>12/1999: </li></ul><ul><li>The Lancet publishes, “Effect of </li></ul><ul><li>...
A global commitment to act  <ul><li>9/2000:   </li></ul><ul><li>8 UN Millennium Development Goals are endorsed by the majo...
A funder for newborn health initiatives <ul><li>Fall/1999: </li></ul><ul><li>The Gates Foundation puts out an RFA focused ...
WHERE? Neonatal & maternal deaths 2.4 million  neonatal  deaths Approx  67%  of global  total 340,000  maternal  deaths Ap...
<ul><li>In sub Saharan Africa and South Asia: </li></ul><ul><ul><li>more than half of births  </li></ul></ul><ul><ul><li>t...
  Where: Among poorest Source:  Countdown to 2015 Nigeria Country profile (2010); analysis by Joy Lawn <ul><li>If all fami...
WHEN?  The first days are critical Up to 50% of neonatal deaths occur in  the first 24 hours Source: Lawn JE et al Lancet ...
WHY? Causes of newborn deaths  Three killers account for 81% of all neonatal deaths 3.1 million Source: CHERG/WHO 2010.  E...
Evidence:  a Driver of Progress
Intervention Packages Source: Lancet Neonatal Survival Series, 2005 Skilled obstetric and immediate newborn care including...
Preventive Community-based newborn care packages Preventive + referral Preventive + management
Generate New Evidence: SNL 1 The 36 research studies supported under SNL 1 built awareness that simple solutions for 3 kil...
SNL 2 Research: Overview <ul><li>28 Research Studies:   </li></ul><ul><li>Cluster RCT (9), RCT (1), OR (12), Cohort (1), P...
SNL 2 Research Examples Outcomes Description Influence Infection Management  RCT in Pakistan Postnatal Care Package OR in ...
What s New to Address the 3 Killers? <ul><li>In low resource settings: </li></ul><ul><li>Birth asphyxia:  </li></ul><ul><l...
Source:  Wall et al. Int J Gyn and Obstetr 2009; 107: s47-s64. Birth Asphyxia
Birth Asphyxia: Impact of training facility providers in neonatal resuscitation <ul><li>Training nurses, midwives, doctors...
Birth asphyxia – Helping Babies Breathe SM <ul><li>Simple color-coded Algorithm  </li></ul><ul><li>Drying and wrapping </l...
Evidence for Preterm/Low Birthweight Babies <ul><li>Facility-based Kangaroo Mother Care proven to reduce deaths in stable ...
Cochrane Database of Systemic Reviews 2011, Conde-Agudelo A  et al “ Compared with conventional neonatal care, KMC was fou...
Preterm/LBW: Community KMC <ul><li>Large reduction (54%) in NMR of package including skin-to-skin care for all babies </li...
Prevention of infections <ul><li>Chlorhexidine to cord Evidence: </li></ul><ul><ul><li>Nepal  </li></ul></ul><ul><ul><li>M...
Prevention of Infections <ul><li>Clean Birth Practices </li></ul><ul><li>30 published studies confirm benefit for babies <...
Management of Infections <ul><li>Community case management of neonatal pneumonia   </li></ul><ul><li>–  27%  reduction in ...
Management of Infections <ul><li>Simplified Antibiotic Therapy Trial </li></ul><ul><ul><li>Are simplified antibiotic regim...
Translating Research & Data for Action Regional Opportunities for Africa’s Newborns ASADI Science in Action LAC Alliance G...
III. Measuring Progress
Overview <ul><li>SNL Evaluation Strategy </li></ul><ul><li>Newborn Indicators TWG </li></ul><ul><li>Preliminary Findings <...
SNL Pathway to Scale
SNL Evaluation Strategy <ul><li>SNL has a comprehensive evaluation strategy for programs and implementation research:   </...
Newborn Indicators Technical Working Group <ul><li>Representation from: </li></ul><ul><ul><li>SNL, MICS, DHS, USAID, UNICE...
SNL Household Surveys Country Design Dates Sample size Bangladesh (GO) Pre/Post Intervention / Comparison Baseline:  2008 ...
Preliminary Findings from SNL Household Surveys
Skilled Birth Attendance *Statistically significant at p<.05
Immediate Breastfeeding  (within 1 hour of birth) *Statistically significant at p<.05
Delayed Bathing  (≥6 hours after birth) *Statistically significant at p<.05
Knowledge of Newborn Danger Signs *Statistically significant at p<.05
Preliminary Findings from Scale up Readiness Benchmarks
Scale Up Readiness Benchmarks <ul><li>Focus on “readiness” to implement newborn programs at scale </li></ul><ul><li>Benchm...
Scale up Readiness Benchmarks SNL Countries 2000
Scale up Readiness Benchmarks SNL Countries 2005
Scale up Readiness Benchmarks SNL Countries 2010
<ul><li>Nationally endorsed Essential Newborn Care Package </li></ul><ul><ul><li>SNL developed during SNL1; supported impl...
Segou Region
Lessons Learned <ul><li>Challenges of working within existing health systems </li></ul><ul><ul><li>Malawi HSAs </li></ul><...
Thank you! Visit the Healthy Newborn Network www.healthynewbornnetwork.org
 
SNL Evaluation: Baselines & Endlines  <ul><li>Baseline assessments : </li></ul><ul><ul><li>14 household surveys  </li></ul...
SNL Health Facility Assessments Country Design Components Dates Sample size Mali Endline only <ul><li>Inventory of essenti...
Follow up of resuscitated newborns in Indonesia using Bayleys scales (in press) <ul><li>Methods : Infants between 24 and 3...
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What's New for Newborns_Claudia Morrissey & Allyison Moran_10.14.11

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What's New for Newborns_Claudia Morrissey & Allyison Moran_10.14.11

  1. 1. What’s New for Newborns? Claudia S. Morrissey MD MPH Allisyn Moran PhD MHS Saving Newborn Lives CORE 14 October 2011
  2. 2. Outline <ul><li>Newborn Survival: A Decade of Progress </li></ul><ul><li>Evidence as a Driver of Progress </li></ul><ul><li>Measuring Progress </li></ul>
  3. 3. Newborn Survival: A Decade of Progress
  4. 4. Biggest News for Newborns <ul><li>Deaths are going down! </li></ul><ul><ul><li>3.1 Million deaths in 2010 </li></ul></ul><ul><ul><li>28% decline in 2 decades </li></ul></ul><ul><ul><li>358,000 maternal deaths </li></ul></ul><ul><ul><li>34% decline </li></ul></ul>Sources: UNICEF. Levels and Trends in Child Mortality: 2011 Report. NY: UNICEF; 2011. WHO. Trends in Maternal Mortality: 1990 to 2008. WHO; 2010
  5. 5. Global progress to MDG 4 MDG 4 target (32) Ref: Lawn, Kerber et al BJOG 2009 updated with data for 2008 from UN Child Mortality Group, WHO//CHERG and IHME (Rajaratnam J eta l 2010) 3.1 million neonatal deaths, 41% of under 5 deaths Links closely with maternal health and MDG 5 USA NMR is 4
  6. 6. A low-cost intervention that worked <ul><li>12/1999: </li></ul><ul><li>The Lancet publishes, “Effect of </li></ul><ul><li>home-based neonatal care and </li></ul><ul><li>management of sepsis on neonatal mortality: field trial in rural India ” </li></ul><ul><li>Home-based neonatal care reduced neonatal and infant mortality by nearly 50% among a malnourished, illiterate, rural study population </li></ul>
  7. 7. A global commitment to act <ul><li>9/2000: </li></ul><ul><li>8 UN Millennium Development Goals are endorsed by the majority of the world’s governments </li></ul><ul><li>MDG 4: Reduce by 2/3rds the mortality rate among children < 5 </li></ul>
  8. 8. A funder for newborn health initiatives <ul><li>Fall/1999: </li></ul><ul><li>The Gates Foundation puts out an RFA focused on decreasing neonatal mortality and morbidity </li></ul>
  9. 9. WHERE? Neonatal & maternal deaths 2.4 million neonatal deaths Approx 67% of global total 340,000 maternal deaths Approx 65% of global total Ref: Lawn JE et al BJOG sept 2009. Data sources: Estimates of maternal (2005) and neonatal (2008) deaths from WHO. Updated June 2010 Countries with the highest numbers of neonatal deaths are similar to those with high maternal deaths Ranking for numbers of neonatal deaths Ranking for numbers of maternal deaths India 1 1 Nigeria 2 2 Pakistan 3 8 China 4 13 DR Congo 5 3 Ethiopia 6 5 Bangladesh 7 6 Indonesia 8 7 Afghanistan 9 4 Tanzania 10 9
  10. 10. <ul><li>In sub Saharan Africa and South Asia: </li></ul><ul><ul><li>more than half of births </li></ul></ul><ul><ul><li>the majority of neonatal deaths </li></ul></ul>Where: At home
  11. 11. Where: Among poorest Source: Countdown to 2015 Nigeria Country profile (2010); analysis by Joy Lawn <ul><li>If all families in Nigeria got the same care as the richest families… </li></ul><ul><li>NMR would be halved </li></ul><ul><li>127,000 newborns would be saved </li></ul>
  12. 12. WHEN? The first days are critical Up to 50% of neonatal deaths occur in the first 24 hours Source: Lawn JE et al Lancet 2005, Based on analysis of 47 DHS datasets (1995-2003), 10,048 neonatal deaths) 75% of neonatal deaths occur in the first week
  13. 13. WHY? Causes of newborn deaths Three killers account for 81% of all neonatal deaths 3.1 million Source: CHERG/WHO 2010. Estimates for 193 countries for 2008. Black R et al Lancet 2010 UNICEF, State of the World's Children, 2011. Almost all deaths are due to preventable conditions
  14. 14. Evidence: a Driver of Progress
  15. 15. Intervention Packages Source: Lancet Neonatal Survival Series, 2005 Skilled obstetric and immediate newborn care including resuscitation Emergency obstetric care to manage complications such as obstructed labor and hemorrhage Antibiotics for preterm rupture of membranes # Corticosteroids for preterm labor # Emergency newborn care for illness, especially sepsis management and care of very low birth weight babies Clinical care Folic acid # Counseling and preparation for newborn care and breastfeeding, emergency preparedness Healthy home care including breastfeeding promotion, hygienic cord/skin care, thermal care, promoting demand for quality care Extra care of low birth weight babies Case management for pneumonia Family-community Clean home delivery Simple early newborn care 4-visit antenatal package including tetanus immunization, detection & management of syphilis, other infections, pre-eclampsia, etc Malaria intermittent presumptive therapy* Detection and treatment of bacteriuria # Outreach services Postnatal care to support healthy practices Early detection and referral of complications Infancy Neonatal period Pre- pregnancy Pregnancy Birth Antenatal 7-14% Reduction of NMR Intrapartum 19-34% Reduction of NMR Postnatal 10-27% Reduction of NMR
  16. 16. Preventive Community-based newborn care packages Preventive + referral Preventive + management
  17. 17. Generate New Evidence: SNL 1 The 36 research studies supported under SNL 1 built awareness that simple solutions for 3 killers could be feasibly delivered and have impact in low resource settings. Evidence for Joint Statement on PNC Home Visits Evidence for Joint Statement on PNC Home Visits Prevention + Management in India Prevention + Management in Bangladesh Prevention alone in India Prevention + Referral using Government model in Pakistan Ankur 2001-2005 Home-based newborn care (HBNC) replicated in 7 rural, urban and tribal districts 51% NMR Reduction Projahnmo 2001-2006 HBNC replicated in Sylhet district 34% NMR Reduction Shivgarh 2003-2006 HBNC with community mobilization and BCC only 54% NMR Reduction Hala 2003-2005 HBNC through existing CHW system (preventative care w/referral) 28% NMR Reduction in pilot areas
  18. 18. SNL 2 Research: Overview <ul><li>28 Research Studies: </li></ul><ul><li>Cluster RCT (9), RCT (1), OR (12), Cohort (1), Policy (5) </li></ul><ul><li>Regions: </li></ul><ul><li>Asia (10), Africa (11), LAC (2), Global (5) </li></ul>
  19. 19. SNL 2 Research Examples Outcomes Description Influence Infection Management RCT in Pakistan Postnatal Care Package OR in Bangladesh Integration of newborn care RCT in Uganda MNC & HIV Care RCT in South Africa Simplified Antibiotic Trial Testing if simplified antibiotic regimens are effective treatment for sepsis Treatment failure To modify global policy PNC Operations Research Testing existing cadres providing home visits to improve practices Coverage & Practices To inform MOH & partners how to deliver PNC in existing system and scale up UNEST Testing community-based package using volunteers linked to the health system Coverage & Practices To inform MOH how to scale up newborn care through health extension volunteers GOODSTART Testing govrn’t CHWs providing peer counseling at home to improve practices NMR, Coverage & Practices First study looking at integration of HIV/AIDS and ENC/PNC packages by CHWs and urban poor
  20. 20. What s New to Address the 3 Killers? <ul><li>In low resource settings: </li></ul><ul><li>Birth asphyxia: </li></ul><ul><li>Helping Babies Breathe </li></ul><ul><li>LBW/Preterm: Community KMC </li></ul><ul><li>Infection: </li></ul><ul><li>Community case management </li></ul>
  21. 21. Source: Wall et al. Int J Gyn and Obstetr 2009; 107: s47-s64. Birth Asphyxia
  22. 22. Birth Asphyxia: Impact of training facility providers in neonatal resuscitation <ul><li>Training nurses, midwives, doctors in neonatal resuscitation </li></ul><ul><ul><li>Meta-analysis of 6 before-after studies </li></ul></ul><ul><ul><li>All studies from middle-low-income countries </li></ul></ul><ul><ul><li>Results: 30% reduction in intrapartum neonatal deaths (range: 17% - 43%) </li></ul></ul>Source: Wall et al. Int J Obstetr Gynaecol 2009;107:S47-64
  23. 23. Birth asphyxia – Helping Babies Breathe SM <ul><li>Simple color-coded Algorithm </li></ul><ul><li>Drying and wrapping </li></ul><ul><li>Assess breathing – if not breathing then, </li></ul><ul><li>Clear airway and stimulate – if not breathing then, </li></ul><ul><li>Ventilate until breathing (or no response after 10 – 15 min) </li></ul><ul><ul><li>Developed by: </li></ul></ul><ul><ul><li>American Academy of Pediatrics with </li></ul></ul><ul><ul><li>Save the Children, USAID, ACCESS, NICHD, </li></ul></ul><ul><ul><li>WHO, & UNICEF </li></ul></ul>
  24. 24. Evidence for Preterm/Low Birthweight Babies <ul><li>Facility-based Kangaroo Mother Care proven to reduce deaths in stable preterm newborns by 50% </li></ul>Sources: Lawn et al (2010) ‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications. Int J Epidemiol: i1–i10.
  25. 25. Cochrane Database of Systemic Reviews 2011, Conde-Agudelo A et al “ Compared with conventional neonatal care, KMC was found to reduce mortality at discharge.” KMC reduced severe infections, hypothermia, severe illness, and length of hospital stay KMC: What’s the evidence?
  26. 26. Preterm/LBW: Community KMC <ul><li>Large reduction (54%) in NMR of package including skin-to-skin care for all babies </li></ul><ul><li>Source: Kumar et al. Lancet 2008 </li></ul><ul><li>Suggestion of mortality reduction for <2kg newborns </li></ul><ul><li>Source: Sloan et al. Pediatrics 2008 </li></ul><ul><li>Program feasibility in Nepal </li></ul><ul><li>Source: Access, 2008 </li></ul>
  27. 27. Prevention of infections <ul><li>Chlorhexidine to cord Evidence: </li></ul><ul><ul><li>Nepal </li></ul></ul><ul><ul><li>Mullany et al. Lancet 2006 </li></ul></ul><ul><ul><li>Bangladesh </li></ul></ul><ul><ul><li>Al Arifeen, in press </li></ul></ul><ul><ul><li>Pakistan </li></ul></ul><ul><ul><li>Bhutta, in press </li></ul></ul><ul><ul><li>Recent pooled analysis: chlorhexidine vs no chlorhexidine: 23% reduction in all cause mortality </li></ul></ul><ul><ul><li>Chlorhexidine Working Group, in press </li></ul></ul><ul><ul><li>2 Ongoing trials in Africa </li></ul></ul>
  28. 28. Prevention of Infections <ul><li>Clean Birth Practices </li></ul><ul><li>30 published studies confirm benefit for babies </li></ul><ul><li>3 studies suggest benefit for mothers </li></ul><ul><li>GRADE recommendation: strong </li></ul><ul><li>3 studies support the role of CBKs </li></ul><ul><li>No adverse effects </li></ul><ul><li>Source: Clean Birth Kit Working Group </li></ul>
  29. 29. Management of Infections <ul><li>Community case management of neonatal pneumonia </li></ul><ul><li>– 27% reduction in all-cause neonatal mortality </li></ul><ul><li>Source: Sazawal and Black. Lancet Inf Dis 2003;3:547056 </li></ul><ul><li>CHW identification and management of sepsis (injectables, oral/injectables) </li></ul><ul><ul><li>SEARCH: (India) Sepsis CFR declined from 16.6% to 6.9% </li></ul></ul><ul><ul><li>Source: Bang et al. J Perinatol suppl 2005 </li></ul></ul><ul><ul><li>Projahnmo (Bangladesh): Sepsis CFR 4.4% in CHW treated </li></ul></ul><ul><ul><li>Source: Baqui et al. PIDJ 2009 </li></ul></ul><ul><ul><li>MINI (Nepal): Sepsis CFR 1.5% in those given cotrimoxazole by FCHVs and gent by CHWs at peripheral health centers (compared to 5.3% not treated) </li></ul></ul><ul><ul><li>Source: Khanal et al, JHPN 2011 </li></ul></ul>
  30. 30. Management of Infections <ul><li>Simplified Antibiotic Therapy Trial </li></ul><ul><ul><li>Are simplified antibiotic regimens equivalent to WHO “gold standard” (14 injections)? - ongoing </li></ul></ul><ul><ul><ul><li>Common protocol </li></ul></ul></ul><ul><ul><ul><ul><li>Asia: Pakistan (SNL), Bangladesh (USAID) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Africa: Nigeria, Kenya, DRC (WHO) </li></ul></ul></ul></ul>
  31. 31. Translating Research & Data for Action Regional Opportunities for Africa’s Newborns ASADI Science in Action LAC Alliance Global Countdown to 2015 CHERG LiST UN Jt. Statement National Situation Analysis (15) Data Profiles
  32. 32. III. Measuring Progress
  33. 33. Overview <ul><li>SNL Evaluation Strategy </li></ul><ul><li>Newborn Indicators TWG </li></ul><ul><li>Preliminary Findings </li></ul><ul><li>Lessons Learned </li></ul>
  34. 34. SNL Pathway to Scale
  35. 35. SNL Evaluation Strategy <ul><li>SNL has a comprehensive evaluation strategy for programs and implementation research: </li></ul><ul><li>39 core indicators collected at national and sub-national levels </li></ul><ul><ul><li>NMR, Coverage, Behaviors, Practices </li></ul></ul><ul><ul><li>Availability of equipment, supplies, drugs </li></ul></ul><ul><ul><li>Quality of care </li></ul></ul><ul><ul><li>Demand for services </li></ul></ul><ul><li>Document SNL contribution to Scale Up </li></ul><ul><ul><li>Scale up Readiness Benchmarks </li></ul></ul><ul><ul><li>Policy timeline </li></ul></ul><ul><ul><li>Implementation tracker </li></ul></ul><ul><ul><li>Funding for newborn health </li></ul></ul><ul><li>Secondary analyses to answer key implementation questions </li></ul>
  36. 36. Newborn Indicators Technical Working Group <ul><li>Representation from: </li></ul><ul><ul><li>SNL, MICS, DHS, USAID, UNICEF, WHO, CORE group </li></ul></ul><ul><li>Objectives </li></ul><ul><ul><li>Ensure consistent use of newborn health indicators </li></ul></ul><ul><ul><li>Provide in-depth instruments on newborn care </li></ul></ul><ul><ul><li>Advance the state-of-the-art in newborn care measurement by identifying priorities and opportunities to validate indicators </li></ul></ul>
  37. 37. SNL Household Surveys Country Design Dates Sample size Bangladesh (GO) Pre/Post Intervention / Comparison Baseline: 2008 Endline: 2010 Baseline: 788 Endline: 794 Nepal Pre/Post Baseline: 2008 Endline: 2011 Baseline: 630 Endline: 630 Indonesia Pre/Post Baseline: 2007/8 Endline: 2011 Baseline: 400 Endline: 400 Vietnam Pre/Post Intervention / Comparison Baseline: 2007 Endline: 2011 Baseline: 1,073 Endline: 1,050 Malawi Pre/Post Baseline: 2007 Endline: 2011 Baseline: 903 Endline: 900
  38. 38. Preliminary Findings from SNL Household Surveys
  39. 39. Skilled Birth Attendance *Statistically significant at p<.05
  40. 40. Immediate Breastfeeding (within 1 hour of birth) *Statistically significant at p<.05
  41. 41. Delayed Bathing (≥6 hours after birth) *Statistically significant at p<.05
  42. 42. Knowledge of Newborn Danger Signs *Statistically significant at p<.05
  43. 43. Preliminary Findings from Scale up Readiness Benchmarks
  44. 44. Scale Up Readiness Benchmarks <ul><li>Focus on “readiness” to implement newborn programs at scale </li></ul><ul><li>Benchmarks revised based on: </li></ul><ul><ul><li>Technical input from experts </li></ul></ul><ul><ul><li>Consultation meeting in April 2011 </li></ul></ul><ul><ul><li>Data collection and analysis </li></ul></ul><ul><li>Ongoing verification of benchmarks </li></ul>
  45. 45. Scale up Readiness Benchmarks SNL Countries 2000
  46. 46. Scale up Readiness Benchmarks SNL Countries 2005
  47. 47. Scale up Readiness Benchmarks SNL Countries 2010
  48. 48. <ul><li>Nationally endorsed Essential Newborn Care Package </li></ul><ul><ul><li>SNL developed during SNL1; supported implementation under SNL2 with Government, UNICEF </li></ul></ul><ul><li>Package rolled out at CSCom level in 6 of 8 regions and 39 of 59 districts (66%) and by MOH, support from SC and UNICEF </li></ul><ul><ul><li>Regional trainers in all 8 regions </li></ul></ul><ul><ul><li>Trainers in 49 out 59 districts (83%) poised to train facilities </li></ul></ul><ul><li>Total of 2042 facility-based health workers have been trained nationwide </li></ul>Implementation Tracker - Mali
  49. 49. Segou Region
  50. 50. Lessons Learned <ul><li>Challenges of working within existing health systems </li></ul><ul><ul><li>Malawi HSAs </li></ul></ul><ul><li>Need for flexibility of newborn intervention packages with rapidly changing context </li></ul><ul><ul><li>Increasing facility delivery </li></ul></ul><ul><ul><li>Incentive schemes </li></ul></ul><ul><li>Need to understand the relationship between coverage and quality </li></ul><ul><ul><li>What happens during home visits? </li></ul></ul><ul><ul><li>How does quality differ by place of delivery? </li></ul></ul><ul><li>Progress in readiness to implement at scale in all SNL countries </li></ul>
  51. 51. Thank you! Visit the Healthy Newborn Network www.healthynewbornnetwork.org
  52. 53. SNL Evaluation: Baselines & Endlines <ul><li>Baseline assessments : </li></ul><ul><ul><li>14 household surveys </li></ul></ul><ul><ul><li>6 health facility assessments </li></ul></ul><ul><li>Adequacy surveys: </li></ul><ul><ul><li>2 in 2011and 2012 (Tanzania, Ethiopia) </li></ul></ul><ul><li>Endline assessments: </li></ul><ul><ul><li>10 household surveys </li></ul></ul><ul><ul><ul><li>3 in 2010 (Bangladesh, Bolivia, Guatemala) </li></ul></ul></ul><ul><ul><ul><li>5 in 2011 (Nepal, Malawi, Uganda, Indonesia, Vietnam) </li></ul></ul></ul><ul><ul><ul><li>1 in 2012 (Tanzania – if funding secured) </li></ul></ul></ul><ul><ul><ul><li>1 in 2013 (Ethiopia) </li></ul></ul></ul><ul><ul><li>5 health facility assessments </li></ul></ul><ul><ul><ul><li>2011(Nepal, Malawi, Uganda, Mali, Vietnam) </li></ul></ul></ul>Core indicators collected via baseline and endline evaluations:
  53. 54. SNL Health Facility Assessments Country Design Components Dates Sample size Mali Endline only <ul><li>Inventory of essential equipment/supplies </li></ul><ul><li>Provider knowledge/skills </li></ul><ul><li>Client exit interview </li></ul>2011 Hospitals: 4 First level facility: 40 Providers: 90 Clients: 280 Vietnam Pre/Post <ul><li>Provider knowledge/skills in neonatal resuscitation </li></ul>Baseline: 2007 Endline: 2011 Providers at Baseline: 76 Providers at Endline: 86
  54. 55. Follow up of resuscitated newborns in Indonesia using Bayleys scales (in press) <ul><li>Methods : Infants between 24 and 36 months assessed according to the Bayley Scales of Infant and Toddler Development III adapted for Indonesia </li></ul>Cognitive impairment Language Motor Adaptive beh. <ul><li>Results </li></ul><ul><li>Moderate/severe cognitive impairment higher in midwife-resuscitated newborns vs. non-asphyxiated newborns </li></ul><ul><li>Rate of moderate/severe impairment twice as high among hospital-resuscitated newborns vs. midwife-resuscitated newborns </li></ul>Social No statistical difference

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