Cheap, simple care could save lives of thousands of newborns

LONDON -- More than 10,000 newborns die every day in poor countries, and more than 7,000 of them could be saved by simple, cheap -- and deliverable -- care, according to research announced Thursday.

While global attention has focused on improving the health of mothers and children in the developing world, the fate of the newborn has fallen through the gap, according to analysis papers to be published in coming weeks in The Lancet medical journal.

Almost 40 percent -- 4 million -- of the annual 10 million deaths of children under age 5 occur in the first month of life.

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

"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.

Success is possible without intensive care units stocked with incubators and ventilators. Many lives can be saved without hospital building programs or the overhaul of health care systems, according to a panel of public health experts who did the analysis.

The main causes of newborn death are premature birth, infection, diarrhea and suffocation. Tetanus and labor complications are also important causes.

Rich countries have newborn death rates of four per 1,000 live births on average. By contrast, the rate in poorer countries, where 99 percent of all neonatal deaths occur, is 33 deaths per 1,000 live births. The highest rates are seen in sub-Saharan Africa.

It's not high-tech care that has 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 babies. And in Sweden, the introduction of midwives for home deliveries at the end of the 19th century slashed the death rate by a third.

And it's not only wealthy nations 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 without 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, the figure is above 70 percent. About half of newborn deaths happen after a home birth where there is no midwife or other attendant.

The research was produced by experts from several countries, as well as international agencies such as the World Health Organization, UNICEF and the World Bank. The project was funded by the Bill & Melinda Gates Foundation and USAID.