Kate Milner, Women Deliver 29 May 2013


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Beyond survival: Improving long-term outcomes for survivors of serious newborn illness in Asia and the Pacific
Dr Kate Milner
Centre for International Child Health, Department of Paediatrics
University of Melbourne

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Kate Milner, Women Deliver 29 May 2013

  1. 1. Beyond survival: Improving long-term outcomes for survivors ofserious newborn illness in Asia and the PacificDr Kate MilnerCentre for International Child Health, Department of PaediatricsUniversity of Melbourne
  2. 2. Background-Newborn morbidity in a survival context – the data gap-Rationale for increased focus on outcomes beyond survivalLong-term outcomes in resource-limited settings-Key considerations-Available literature - disability and early child developmentResearch to inform models of care beyond survival-Fiji Newborn Integrated Care InitiativeOutline
  3. 3. 134.6 million live births~14 million preterm survivors3.1 million newborn deathsSurvivors of intrapartumrelated events (‘birth asphyxia’)?Survivors of serious infections?World Health Organisation. Born too soon: the globalaction report on preterm birth. C.P Howson, Kinney M.V,Lawn J.E, Editor 2012: GenevaNewborn morbidity data gap
  4. 4. To improve:- quality of maternal and newborn care- follow-up care for newborns who survive serious illnessTo advocate for issues beyond survival in regional newborn health policyImportance of strengthened long-term outcomes data
  5. 5. • Post neonatal mortality• Growth and nutrition• Infectious and respiratory morbidity• Disability and early child development• Hospitalisation• Outcomes in adolescence and adulthood• Others - Impact on families, economic implicationsLong-term morbidity in resource-limited settings – key considerations
  6. 6. Disability and early child development
  7. 7. 153 studies22,161 survivors39.4% survivorsneurodevelopmental ‘impairment’Cognitive delay CerebralpalsyHearingimpairmentVisionimpairmentSeizuresNeurodevelopmental outcomes(Mwaniki et al, Lancet 2012)
  8. 8. Fiji Newborn Integrated Care Initiative
  9. 9. To assess the early childhood health and developmental outcomes for acohort of sick newborns in Fiji compared with compared with controls.Aims
  10. 10. To assess:• Prevalence of neurodevelopmental impairment at age 2-4 years.• Prevalence of stunting, wasting, anaemia, immunisation rates, feedingpractices.To explore:• Nurse-administered developmental screening compared with a goldstandard developmental assessment.Objectives
  11. 11. Sr Lanieta Koyamaibole and Dr Rakei KaariraColonial War Memorial HospitalProgress: team building and local linkages
  12. 12. Progress: logistics
  13. 13. Progress: developmental clinics
  14. 14. Progress: hearing clinics
  15. 15. • Fiji National Child Health Strategy for 2010-2015• Developmental screening for revised maternal and child health card• Health worker capacity building• Strengthening inter-sectoral linkages• Collaborative regional networksProgress: strengthening the platform for change
  16. 16. • Long-term morbidity amongst newborns who survive serious illness is anincreasing public health issue in resource-limited settings.• Improving outcomes requires improved maternal and newborn care andearly detection and intervention when complications arise.• Formative research through international collaboration provides a platformfor change.Conclusions
  17. 17. Knowledge Hubs for Health are a strategic partnership initiative funded by theAustralian Agency for International DevelopmentDr Joseph Kado & Paediatric TeamColonial War Memorial Hospital SuvaLanieta KoyamaiboleDr Rakei KaariraDr Raina PrasadMere GunaivaluKathryn O’HeirDr Sue WoolfendenUniversity of Melbourne AudiologyCarabez Ear Clinic SuvaProf Trevor Duke, Dr Gehan Roberts, Dr Andrew Steer, Centre for International Child HealthCureKids FijiThank you