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Abstract

Richard Lord, www.rlordphoto.com

Ten thousand newborns die each day?an unconscionable level of mortality given that most could be saved at relatively low cost. In the past, neonatal survival has not received enough attention, because these deaths are virtually invisible, occurring at home and often going unregistered. Of the 4 million known neonatal deaths each year, the majority occur in Sub–Saharan Africa and South Asia, where they are most often caused by infections, preterm birth, and asphyxia. Because neonate deaths account for more than one–third of the world's deaths of children under five, reduction in the under–five mortality rate cannot be achieved without substantial reduction in neonatal deaths.

Addressing newborn mortality requires links within the continuum of care from maternal health through pregnancy, childbirth, early neonatal care, and general child health. This creates a particular challenge in poor countries struggling with inadequate levels of skilled care and unstable health care systems. Nevertheless, community–level interventions form a first step. These encompass essential newborn care at time of birth, which can be carried out at home by a cadre of alternative health workers; basic newborn resuscitation using a self–inflating bag and air; and extra care for small babies, especially feeding and warming.

Not only are high–impact, low–cost, feasible interventions available, but they could avert close to 70 percent of the world's neonatal deaths. An interim, phased–in strategy may be most effective in developing countries. For example, community services could be used now, as professional care is being strengthened. While countries continue to seek funding for more comprehensive health systems, simpler approaches at the family–community level and through outreach services can save many lives.