Cheap Simple Care Could Save Millions of Infants

More than 10,000 newborn babies die every day in poor countries, but more than 7,000 of them could be saved if simple, cheap — and deliverable — care is made available to them, according to new research.

While global attention has focused on improving the health of mothers and the survival of children in the developing world, the fate of the newborn has fallen through the gap between the two programs, according to a series of analysis papers to be published over the next four weeks in The Lancet medical journal.

Almost 40 percent — 4 million — of the annual 10 million deaths of children under the age of 5 occur during the first month of life, the neonatal period (search). That's more than the total number of people who die from HIV (search) every year, and experts say it's an "unconscionable" statistic for the 21st century.

Nearly 3 million of those babies could be saved by such simple interventions as tetanus shots, breast-feeding, clean delivery and antibiotics, as well as basic hospital emergency services such as Caesarean sections (search) and blood transfusions, according to the research, announced Thursday.

"At less than $1 per capita per year in additional spending to provide these lifesaving interventions to 90 percent of mothers and babies, the cost is affordable," said one of the investigators, Dr. Gary Darmstadt, director of the Center for International Neonatal Health at Johns Hopkins University in the United States.

The $1 per person per year price of reaching 90 percent of those in need adds up to a total cost of $4.1 billion a year.

Success is possible without access to high technology such as intensive care units stocked with incubators and ventilators. Many of those lives can even be saved without massive hospital building programs or the overhauling of health systems, according to a panel of public health experts who conducted the analysis.

The main causes of newborn death are prematurity, severe infections, diarrhea and suffocation. Tetanus and labor complications are also important causes.

Another 4 million babies are stillborn (search), and most of those die during labor, the researchers found.

Rich countries have reduced newborn death rates to an average of four per 1,000 live births. By contrast, the rate in poorer countries, where 99 percent of all neonatal deaths happen, sits at 33 deaths per 1,000 live births. The highest rates are seen in sub-Saharan Africa, where there has been no measurable progress in decades.

It's not the high-tech care that made the difference in rich countries.

In England, newborn death rates fell from 30 per 1,000 live births in 1940 to 10 in 1975 after the introduction of free prenatal care, better care during labor and the availability of antibiotics for baby infections.

In Sweden, the introduction of midwives for home deliveries at the end of the 19th century slashed the death rate by up to 32 percent. Midwives in those days focused on keeping the baby warm, daily umbilical cord care, resuscitation of the infant, early breast-feeding and general hygiene.

And it's not only nations with a high GDP that have succeeded in reducing neonatal deaths. Countries such as Honduras, Indonesia, Moldova, Nicaragua, Sri Lanka and Vietnam have done it, despite being quite poor.

While it may take a decade to bolster hospital services in some of the poorest areas so that the target of saving 3 million babies a year can be reached, experts say much of the reduction in deaths can be achieved even in the absence of fully developed health systems.

Community programs that offer basic services and educate families about safer home birth and baby care, and encourage mothers to seek help if there are complications, can go a long way and can be rolled out quickly and cheaply.

"We needn't hold our breath and wait until the pot is full of money. We can move now," said UNICEF Executive Director Carol Bellamy. "We can actually save as many as a million newborns with much less expensive interventions based on family care and community outreach programs."

Skilled help during delivery is a major factor, experts say. In sub-Saharan Africa, more than 60 percent of women give birth at home alone, and in South Asia, that figure is higher than 70 percent. About half of newborn deaths happen after a home birth where there is no midwife or other birth attendant.

The research was produced by academics and health economists from several countries, as well as experts from international health and development agencies such as the World Health Organization and the United Nations Children's Fund and the World Bank. The project was funded by the Bill & Melinda Gates Foundation and USAID, the American international aid agency.

"The problem is not too big, the obstacles are solvable and the resources are simply a matter of how seriously you take those lives," said the Lancet's editor, Dr. Richard Horton.