Packages for Universal Scale-up of Newborn Care | | | | Estimated current coverage (percent) | | |
| Intervention package | Contents | Number of target population per year (millions) | Implementation strategy | South Asia | Sub- Saharan Africa | Reduction in all- cause NMR (percent) | Comments on evidence |
| Family- community care of the newborn at home after birth | Healthy home care practices (exclusive breastfeeding, warmth protection, clean cord care, care seeking for emergencies); if birth outside a facility, then clean delivery kit. | All newborn infants:SFTRETWorld 130SFTRETSouth Asia and Sub-Saharan Africa 63 | Women's groups and community health workers doing postnatal visits, with links to the formal health care system, including support for referral. If appropriate, extra care of moderately small babies at home and community-based management of acute respiratory infections. | 36 | 28 | 10-40 | Mortality reduction based on studies in high NMR settings with weak health systems. Extra care of LBW infants and community management of acute respiratory infections not included in range shown. |
| Essential newborn care at the time of birth | Immediate drying, warmth, early breastfeeding, hygiene maintenance, and infection prevention | All newborn infants:SFTRETWorld 130SFTRETSouth Asia and Sub-Saharan Africa 63 | Skilled attendant, or if no skilled attendant available, some simple postnatal practices are feasible at home with other cadres of workers. | 11 | 14 | 20-30 | Based on conservative combining of single interventions (for example, breastfeeding) in the package. |
| Neonatal resuscitation | Resuscitation after birth if required | Newborns not breathing at birth:SFTRETWorld 6.5SFTRETSouth Asia and Sub-Saharan Africa 3.2 | Skilled attendant. | 3 | 3 | 10-25 | Limited studies, mainly from lower NMR settings with high percentage of asphyxia deaths, so range from studies was reduced. |
| Extra care of small new-borns | Extra support for warmth (kangaroo mother care), feeding, and illness identification and management | LBW neonates:SFTRETWorld 20.0SFTRETSouth Asia and Sub-Saharan Africa 10.7 | Facility-based care for severely preterm babies. Community-based care is effective for moderately preterm babies. | <10 | <10 | 20-40 | Most studies are nonrandomized controlled trials at the community level in settings with extremely high LBW rates. Effect depends on baseline NMR and LBW rates. |
| Emergency care of ill newborns | Management of ill infants, especially those with neonatal infections | Neonates with illnesses:SFTRETWorld 13.0SFTRETSouth Asia and Sub-Saharan Africa 6.3 | Facility-based care with antibiotics and supportive care. Community-based management with oral antibiotics for acute respiratory infections. | <20 | <20 | 20-50 | Meta-analysis of effect on the NMR of oral antibiotic management of acute respiratory infections in the community in high-mortality settings. |
| Neonatal packages plus MCH package | Neonatal packages as above, in addition to family planning, prenatal care, and comprehensive obstetric care packages | All newborn infants:SFTRETWorld 130SFTRETSouth Asia and Sub-Saharan Africa 63 | Supply of care throughout pregnancy, childbirth, and postnatal period with increased demand and improved referral systems. | <5 | <5 | — | No study data identified. Marginal budgeting for bottlenecks tool suggests 58 percent in South Asia and 71 percent in Sub-Saharan Africa. |
Source: Local data or Darmstadt and others 2005; Knippenberg and others 2005; Lawn, Cousens, and Zupan 2005.
Note: The range of reduction of all-cause NMRs given for each package is independent of the others; hence, the total is greater than 100 percent.
