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Structure
Context
Policy response
Program response
Key challenges
Way forward
Context
133
120
100
80
60
Bangladesh
is 1 of 23 countries on track to
116
achieve MDG4
MDG
UN-IAGCME
Target
94
&
2013
88
87
82 th
has the 4 most rapid rate of decline in childU-5 MR
IMR
66
65
65mortality
NMR
52
48
40
52
42
41
37
53
43
32
20
48
41
33
24
31
22
0
1993
1997
2001
2004
2007
2011
2013
2015
Source: BDHS, UN-IAGCME- UN Inter-agency group for Child Mortality Estimation, 2013
57%
60%
50%
40%
39%
41%
45%
60%
47%
30%
20%
10%
0%
1989-93
1992-94
1995-99
1999-03
2002-06
BDHS 2011
117,442
Maternal mortality ratio- 194 per 100,000 live births (2010) [3]
7,300 maternal deaths (2010) [3] [1] WHO (2013): Global Health Observatory Data Repository ( still birth rate originally published in Consens et al, Lancet 2011);
[2] UNICEF/WHO/The World Bank/UN Pop Div. Levels and Trends in Child Mortality. Report 2013.
[3] Bangladesh Maternal Mortality Survey 2010
[4] Estimated
22.5
20
15
Bangladesh
Region
Global
19.3
14.2
14
10
5.4
5
6.4
13.2
13.1
10.5
7.6
4.4
Early NMR
Late NMR
Day 828
19%
Day 27
31%
Day 0
37%
Day 1
13%
Prematurity
/LBW 11%
Undefined
20%
Pneumonia
13%
BDHS 2011
Prematurity
/LBW 11%
0-28 d
Undefined
20%
Pneumonia
13%
BDHS 2011
Prematurity
/LBW 11%
Undefined
20%
Pneumonia
13%
BDHS 2011
Policy response
based interventions. A home care strategy to promote an integrated package of preventive and
curative newborn care is effective in reducing neonatal mortality in communities with a weak
health systems, low health care use, and high neonatal mortality. (Lancet, 2008)
CHX, and severe cord infection reduction with multiple application of CHX was observed.
Chlorhexidine cleansing of a neonates umbilical cord can save lives, but further studies are
needed to establish the best frequency with which to delivery the intervention. (Lancet, 2012)
SATT trial
Results suggest that the two alternative antibiotic regimens (i. gentamicin single
dose and oral amoxicillin twice daily for 7 days and, ii. procain bezylpenicillin and gentamicin
single dose for 2 days followed by oral amoxicillin twice daily for 5 days) for outpatient treatment
of clinical signs of severe infection in young infants whose parents refused hospital admission are
as efficacious as thee standard regimen (procain bezylpenicillin and gentamicin single dose for 7
days). This finding could increase treatment options in resource-poor settings when referral care
is not available or acceptable. (Lancet 2015)
Scale-Up Plan
incorporated in the
MNCH-OP in 2013
National Scale-up of
HBB initiative 2012-13
National Technical
Committee formed in
2013
Training modules
developed in 2012
Capacity building of
service providers on
newborn care 2012
Community based
newborn care scaled-up
in >20 districts 2012
SCANU scaled-up in 34
districts by 2015
HIMS on newborn
health developed and
integrated in DHIS 2
(2013)
Newborn health
specific
interventions
3. Essential newborn care with
newborn resuscitation &
application of
Chlorhexidine
4. Antenatal steroids for
premature labor and
Kangaroo mother care
(KMC) for premature/low
birth weight babies
5. Neonatal sepsis
management at PHC level
6. Specialized newborn care at
district & sub-district level
9. Multi-sectoral approach to
promote exclusive BF and IYCF
10. Community based child
drowning prevention activities
11. New vaccines:
pneumococcal and rotavirus
Current
Target 2020
32%
50%
80%
Antenatal corticosteroid
Newborn Health
Interventions
Target 2016
40%
New
Interventions
20%
0%
20%
50%
90%
50%
28%
80%
40%
50%
60%
80%
80%
100%
Consensus
build on
priority
intervention
2012
COIA
UNCoLSC
Global
Initiative for
Child
Survival Call
for Action &
APR
Political
Commitments
and Target
Fixation
2013
National
Guideline
Development
under NTWC
and NCC
4 Guideline
Developed
2014
EMEN
ENAP
Initiatives
EPMM
GAPPD
Bangladesh
Every
Newborn
Action Plan
2014
Program response
Quality Improvement
Team (Facility level)
Divisional QI Committee
District QI Committee
Type of Hospitals/Facilities
# of facilities
3
14
3
77
97
Competency based
training and use of audiovisual tools for skill
development
Paper-based record
keeping and reporting to
individual case-tracking
through web-based MIS
23
40
30.6
20
22.2
20.7
0
CFR
2012
2011-13
District
Hospital
UNICEF
JICA
USAID
GOB/DPs
2014
2014-15
MCH District
Hospital
SDF (GOB)
2013
2015-16
MCH District
Hospital
MCH
2017-18
District
Hospital
MCH
10
12
7
1
10
2
3
5
12
18
Total
12
12
32
01
03
18
12
64
Scaling-up
National
Scaling of
Up HBB
of Helping Babies Breathe
National
scaling-up
Initiatives in Bangladesh
Pilot study, National
consensus for scaleup, Policy adoption
with High political
commitment
Partnership
development
and ensure
resource
Refreshers training
Incorporation in
training curriculums
Ensure Logistics
Training
Evidence Generation
Dissemination and
Advocacy
Consensus Building
Policy endorsement
Development of national
Guideline that includes
productione, application,
distribution and
communication guideline
Incorporation in OP with
budget allocation
Pilot study
Ensure Availability of
CHX
Partners engagement
Development of BCC
material and training
materials
Capacity building
Technical assistance
National Core
Committee (NCC) for
newborn health
Develop Leadership and
policy advocacy
MOH&FW
Systems strengthening
Intensive/pilot
implementation
Newborn Technical
Working Committee
(NTWC)
DGHS, DGFP, DPs, NGOs, Professional
Agencies, Academia, Research Organizations
Technical Support
Groups (TSG)
Technical Support
Groups (TSG)
As needed
As needed
Challenges
90
80
70
60
50
50
50
40
30
20
17
22
50
32
26
16
21
27
16
20
10
0
ANC 4 by MTP
Delivery by MTP
BDHS2004
BDHS2007
BDHS2011
Challenges
Demand side:
Supply side:
Health system:
Inequity:
Way forward
Unless we greatly accelerate newborn survival efforts, goal to end preventable child deaths
by 2035 unreachable
100
2035 target:
90
National U5MR of 20
80
70
2000-2012
AAR = 3.8%
Global U5MR
Business as
usual: U5MR
60
50
40
Business as
usual: NMR
30
20
Global NMR
2000-2012
AAR = 2.7%
10
0
1990
AAR = 4.3%
1995
2000
Scenario
2005
2010
2015
2020
2025
2030
13
1.8 million
0.9 million
2035
60
55
50
45
40
35
52
48
42
41
37
32
30
25
24
20
19
15
15
10
12
5
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Projected NMR
Priority actions
Launch massive, comprehensive campaign to promote newborn
behavior and practices, care seeking and utilization of services
Focus on quality improvement and ensure adherence to SOPs.
Improvement in effective coverage of services
Strengthen measurement and monitoring of adequacy of inputs,
processes and outputs
Prepare facilities with skilled HR and supplies. Primary level for
preventive, screening and follow-up care and, Secondary and tertiary
level for full supportive care for sick newborn
Reduce equity gap to reach the unreached and most vulnerable,
marginalized population with differential programming
Thank You