3. Availability of mortality estimates MICS surveys can estimate NMR but not powered to do so unless sample size is increased eg Malawi 2006 Child mortality Neonatal mortality Sources Vital registration, censuses, DHS, MICS, other surveys Vital registration, censuses, DHS, (MICS), other surveys Frequency of estimation Every year Every 10 years? (1996 for 1995, 2006 for 2000) Frequency of publication (SOWC) Every year In SOWC since 2007 but using 2000 estimates Methods transparency Expert review group, Increasingly transparent inputs and methods Previously no expert review Limited detail on methods
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5. Progress to MDG 4 for child survival Source: Graph Lawn JE et al 4 million neonatal deaths- where? When? Why? Lancet 2005. Data updated 2009 for progress until 2008 using UN data 3.59 million neonatal deaths each year around 42% of under-5 deaths 2004 2008 28 Target for MDG-4 (32)
7. Invisible deaths…. Global estimates of causes of death for children under the age of 5 years country data in puts and Diarrhoea 20% Perinatal causes 22% Source: WHO and UNICEF under-5 causes of death estimates 2004 12% Other 29% HIV/AIDS 4% Malaria 8% Measles 5% ARI Malnutrition 54% Asphyxia Preterm Injuries Other Neonatal sepsis/ pneumonia Neonatal tetanus Congenital
8. Estimates of causes of neonatal death (year 2000) Lawn et al, Lancet 2005 WHO WHR 2005 Detailed methods: Lawn et al, IJE 2006 Bryce et al, Lancet 2005
9. Estimates of causes of neonatal death (year 2004) Countdown report 2008 – National level estimates New Countdown report to be released at Women Deliver and Countdown meeting June 2010
10. Sub-national estimates for cause of death eg Nigeria Neonatal tetanus nationally estimated at 8% and Northern zones at 17% Source: Saving Newborn Lives in Nigeria. FMOH Jan 2009 Estimates for 2005 by CHERG neonatal group
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12. Causes of death in the neonatal period for 193 countries (2000-2008) Note not final : India and China own data yet to be added Source: Lawn JE, Cousens SN, Adler A, Ozi S for the CHERG neonatal group. DO NOT CITE Cause of death 2000 2004 2008 “ Asphyxia” 0.91 (23%) 0.91 (24%) 0.84 (24%) Congenital 0.30 ( 7%) 0.31 ( 8%) 0.33 ( 9%) Infection Sepsis Pneumonia 1.04 (26%) 0.94 (25%) 0.89 (25%) 0.55 0.33 Preterm 1.12 (28%) 1.23 (33%) 1.19 (33%) Diarrhoea 0.11 ( 3%) 0.07 ( 2%) 0.06 ( 2%) Tetanus 0.26 ( 6%) 0.10 ( 2.7%) 0.09 ( 2.5%) Other 0.26 ( 6%) 0.19 ( 4.9%) 0.19 ( 5.3%) Total 4.00 million 3.75 million 3.59 million
16. Neonatal death data in DHS Heaping on certain days Source: Lawn JE et al Lancet 2005, Based on analysis of 47 DHS datasets (1995-2003), 10,048 neonatal deaths) Heaping index for deaths on days 7, 14, 21 and 30/31 Age heaping on day 7 may reduce the early NMR Age heaping on day 30/31 may reduce the overall NMR
17. Age heaping index in 106 DHS surveys (Hill et al 2006) Source: Hill K et al 2006, Neonatal mortality in the developing world There seems to be regional variation – is this cultural or due to training of the interviewers?
18. (Maharashtra, India, Bang et al., 2002) NHFS II – 5 year recall SRS – ongoing data collection by local part-time enumerator with 6- monthly supervision visits Are deaths misclassified to another day or missing especially in retrospective surveys? Prospective surveillance NFHS II (recall) SRS NMR 51 32 (-38%) 29 (-43%) Postneonatal IMR 18 12 (-33%) 20 (+14%) Child (1-4) MR 14 15 (+ 6%) 14 (- 4%)
The Bellagio Child Survival Series ( The Lancet 2003) identified newborn survival as a priority, lacking information and action 99% of newborn deaths are in developing countries - yet most information and investment is on high-tech solutions for the 1% of deaths in rich countries The sheer numbers – every year 4 million babies die in the first 4 weeks of life – 10,000 a day and 40% of under 5 deaths Despite large numbers of death, health of newborn babies was virtually absent from policies, programs, and research in the developing world The new series presents new information and analysis regarding critical factors related to neonatal deaths, where and why newborns die and assessments of the effectiveness and costs of interventions for newborn care.
Data from DHS surveys in 47 countries, 10,048 neonatal deaths. A very high proportion of deaths occur in the first hours and days after birth. Prevention of these early neonatal deaths will require improvements in care at the time of birth and improvements in care in the early neonatal period.
A real life example. Need to be cautious because although conducted in same areas not exactly the same populations. NFHS appears to be based on 5 years recall. SRS based on ongoing collection by a local part-time enumerator (often a teacher) with 6 monthly supervisory visits. Each enumerator covers a population of up to 1500.(?) Situation likely to be worse for stillbirths
The Bellagio Child Survival Series ( The Lancet 2003) identified newborn survival as a priority, lacking information and action 99% of newborn deaths are in developing countries - yet most information and investment is on high-tech solutions for the 1% of deaths in rich countries The sheer numbers – every year 4 million babies die in the first 4 weeks of life – 10,000 a day and 40% of under 5 deaths Despite large numbers of death, health of newborn babies was virtually absent from policies, programs, and research in the developing world The new series presents new information and analysis regarding critical factors related to neonatal deaths, where and why newborns die and assessments of the effectiveness and costs of interventions for newborn care.
![Outline ,[object Object],[object Object],[object Object],With thanks to Colin Mathers et al at WHO and to Simon Cousens in CHERG](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)