Accelerated Actions for Reducing Preventable Neonatal Deaths In

Bangladesh

Regional Consultation Meeting

Hyatt regency HotelKathmandu, Nepal

30 August, 2013

Demographic Profile of BangladeshEstimated Population (in million) Total: 160 (Projected)

Women age 15-49 year *54.3%

Children age less than 5 years *10%

Total fertility rate 2.3

Crude Birth Rate *19.2/1000 L.B

Crude death Rate *5.6/1000 L.B

Still Births rate 50/1000 L.B

Literacy rate of women age 15-49 Y 62.9%

Household with mobile phone 78.4%

Source: BBS 2011, BDHS 2011, * SVRS

ACHIEVEMENTS

2.4%Annual rate of reduction3.3%

Annual rate of reduction

39% 60

%

Bangladesh Demographic and Health Surveys

Bangladesh on track to achieve MDG 4 targets well before 2015

Bangladesh is one of 23 countries on track to achieve MDG4

&has the 4th most rapid rate of decline in child

mortality

Pneumonia

Birth asphyxia

Diarrhea

Drowning

Other neonatal

Other causes (including injury)

Prematurity/LBW

Possible serious Infection

18

13

7

3

1

6

5

20

12

7

1

5

3

3

4

8

BDHS 2011BDHS 2004

Under-5 Deaths per 1,000 live births

33%

46%

85%

20%

60%

Most causes of deaths among children are declining in Bangladesh

Disparities in child mortality has been generally reducing

Under-5 deaths per 1,000 live births

1984-1993 2007-2011

114

50

153

55

UrbanRural34%

higher

10% higher

1987-1996 2007-2011

87

40

179

71

KhulnaSylhet

106% higher

78% higher

Source- Bangladesh Demographic and Health Surveys

1984-1993 2007-2011

97

37

186

64

RichestPoorest

92% higher

73% higher

The National Neonatal Health Strategy and Guidelines provide specific directions to address neonatal mortality

C-IMCI Strategy; Bangladesh Country strategy for pneumonia, diarrhoea and malaria;IMCI Guidelines; GAPPD; APR-Bangladesh Call for Action and benchmark

EPI –Multi year Plan; Guidelines

16 out of 32 Operational Plans under HPNSDP, 2011-16 address various aspects of child survival including health care, nutrition, community-based care and behavior change

Nutrition PolicyIYCF Strategy and Guidelines; Guidelines for SAM and C-MAM

Revision of the National Maternal Health Strategy and Development of SOP

ECD Policy for Bangladesh; ECD guidelines

PMTCT StrategyHIV/AIDS Strategy

Strategies, Guidelines and Action Plan Developed

Data Source: Bangladesh Demographic and Health Survey 2011

Pneumonia22%

Possible serious in-fection

15%

Birth asphyxia13%

Drowning9%

Prema-tu-

rity / LBW7%

Di-ar-

rhea2% Other

7%

Other neonatal6%

Undefined19%

Under-5 Deaths

The intervention package to be guided by the causes of under-5 deaths

Annual number of deaths:

Neonatal (60% of all child deaths)Neonatal infections

38,500Birth asphyxia

21,500Preterm

12,000(+17,500)

Pneumonia and serious infections

64,000

Drowning

14,500

Rangpur

RajshahiSylhet

Khulna

Barisal

Dhaka

Chittagong

Bangladesh Demographic and Health Survey 2011

42 (27)

62 (38)

40 (32)

54 (36)

63 (39) 71 (45)

50 (21)

Child mortality is

much higher in some

parts of the countryChild

Mortality per 1000 live birth

Child/Newborn mortality rate by division

Reduction of Neonatal Mortality-wide disparities across among richest population

1993 1996 1999 2003 2007 2011 20160

10

20

30

40

50

60

5248

42 4137

32

2223 Highest quintile

34 Lowest quintile

Source BDHS

Rangpur

RajshahiSylhet

Khulna

Barisal

Dhaka

Chittagong

Bangladesh Demographic and Health Survey 2011

29%

28%

49%

32%

31% 24%

30%

Gains in skilled

attendance at birth has been slower

in some parts of the

country

Skilled attendance at birth-Coverage by Division

Contraceptive prevalence

ANC

TT (5 doses)

Skilled Birth At-tendance

Initiation BF

Post natal Vit A

BF

Vit A

Penta

Measles

Safe Sanitation

Hand washing

Drinking water

Compl. feeding

Diarrhea treat

Pneumonia

0% 20% 40% 60% 80% 100%

56%

47%

58%

32%

50%

35%

64%

62%

93%

88%

53%

20%

74%

21%

81%

35%

Missed Opportu-nities

Coverage of Key MNCH Interventions

Current Coverage of key interventions

Khulna Shyllet Urban Rural Richest quintile

Poorest quintile

0102030405060708090

100 93

8087 86

94

77

Fully immunised

Khulna Shyllet Urban Rural Richest quintile

Poorest quintile

0

10

20

30

40

50

60

70

45

21

49

22

60

10

Delivery in health facility

Khulna Shyllet Urban Rural Richest quintile

Poorest quintile

0102030405060708090

100

77

51

74

49

87

30

ANC

Khulna Shyllet Urban Rural Richest quintile

Poorest quintile

0

10

20

30

40

50

60

70

42

18

46

22

58

9

PNC < 2days

Bottleneck Analysis, Strategies and

Solutions

An evidence-based approach used to identify challenges and select actionsUse of best available data from national surveys, health information system, special studies

Equity analysis using best available global tools for analysis (LiST, Equity Patform etc.)

Selection of actions based on best available national and global evidenceGovernment, development partners, professionals, researchers and civil society experts participated in the analysisUnder the guidance of the NCC-NH for newborn health (MOHFW), National Technical Working Committee formed small Technical Group (TG)The Technical Group worked on the BNA tools based on the analysis done for promise Renewed-Bangladesh Call for Action using Equity Platform/List etc.A national Consultation Workshop was held to validate the findings GOB, UNICEF, WHO,USAID, SNL, Save The Children, ICDDRB and other partners were involved

Promise Renewed-Bangladesh Call For Action

Evidence-based Interventions &

Strategic Approaches

Maternal Health

interventions

a. Skilled birth attendance (CSBAs and Midwives)

b. Functional and 24/7

BEmONC and CEmONC at strategically

located facilities

Newborn health specific

interventionsa. Essential newborn care with newborn resuscitation & application

of chlorhexidineb. Antenatal

steroids for premature labour and Kangaroo

mother care (KMC) for

premature/low birth weight

babiesc. Neonatal

sepsis management at PHC level

d. Specialized newborn care at district & sub-district

level

Child Health specific

interventionsEffective referral linkage to ensure continuum of care – from community

clinics to district /tertiary

hospitalsIMCI at all levels

Multi-sectoral approach to

promote exclusive BF and IYCFCommunity based

child drowning prevention activities

New vaccines: pneumococcal and rotavirus

1. Establish midwives services

2. Adequate staffing and quality assurance of functioning 24/7 BEmONC and CEmONC facilities;

3. Increase efficiency of existing human resources: skills, task shifting and retention

4. Strengthen family planning program

5. Integrated approach to MNCH including mainstreaming nutrition

6. Differential programming and equity-focused resource allocation (rich/poor, urban/rural, and between regions

Strategic approaches

Equity- Focused implementation especially in low

performing districts

Effective partnerships

and collective

commitment :

(government, professionals, development partners, civil society, media

and communities)

Monitoring for Results

and adjustment of operational strategies

when necessary

Operational

modalities

Expected Increase in Intervention Coverage

Antenatal corticosteroid

CHX umbilical cord cleansing

KMC for pre-term baby

Neonatal sepsis treatment

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%

0

0

0

0.28

40%

50%

20%

50%

80%

90%

50%

80%

Skilled attendant at birth32%

50%80%

Target 2020 Target 2016 Current

Mat

erna

l H

ealt

h In

terv

enti

ons

New

born

Hea

lth

Inte

rven

tion

s

New Interventi

ons

Expected Increase in Intervention Coverage

Measles Rubella vaccine

Pneumococcal vaccine

Zinc with ORS for diarrhoea

Pneumonia treatment

0.9

0.9

0.5

0.5

0.950000000000001

0.9

0.8

0.8

0.34

0.35

Target 2020 Target 2016 Current

Chi

ld H

ealt

h In

terv

enti

ons

New Interventi

ons

1990 1995 2000 2005 2010 2015 2020 2025 2030 20350

20

40

60

80

100

120

140

3932 26 23 20

133

116

9488

6553

Actual

Projection

Under-5 Mortality Trends in Bangladesh: Actual Estimates and Projections till 2035

Actual: Bangladesh Demographic and Health Surveys

Indicators 2015 2020 2025 2030 2035

U5MR 38.8 31.6 26.4 22.7 20.0

NMR 24.8 21.5 19.0 17.2 16.0

17

How many child deaths will we prevent?

Under-5 Mortality

53Neonatal sepsis managementInjury & drowning prevention

Antibiotics for pneumoniaPneumococcul vaccineBreastfeedingClean postnatal practicesResuscitaion

Other interventions

Remaining deaths

Labour and delivery management

Prev

enta

ble

unde

r-5

deat

hsEstimated 108,000 child deaths

under five will be averted EVERY YEAR

It means approximately 300 child deaths averted EVERYDAY

Ending Preventable Newborn and Child Deaths by 2035: Next Steps

for Bangladesh• Action plan with detail

implementation modalitiesA• Budget allocation-Review and

revise relevant operational plans of HPNSDP

B• Confirm commitments from

development partners, NGOs, and Professionals

C•Decentralized analysis, planning, implementation monitoring (Scorecard), Reporting and accountability

D• Equity in reducing disparitiesE

Opportunities to Accelerate Progress of Newborn Health

• Highest level commitment-Launching of the ‘Promise Renewed’ and declaration of the ‘Bangladesh Call for Action

• Introduction and scale-up of new newborn interventions approved by the MOH&FW

• 16 out of 32 Operational Plans under HPNSDP address MNCH• Large Scale programs on MNCH are on-going which includes

newborn health• National neonatal health strategy, Guidelines, SOP and the on-

going revision of the maternal health strategy• Large networks of facilities including community clinics• Expanding human resources including doctors, nurse, midwives• Large network of NGOs and CHWs• Continued commitment of the development partners for MNCH

Thank You