POPLINE Document Number: 281924
Author(s):
Darmstadt GL
Bhutta ZA
Cousens S
Adam T
Walker N
Source citation:
Lancet, 2005 Mar 12;365:977-988.
Abstract:
In this second article of the neonatal survival series, we identify 16 interventions with proven efficacy (implementation under ideal conditions) for neonatal survival and combine them into packages for scaling up in health systems, according to three service delivery modes (outreach, family-community, and facility-based clinical care). All the packages of care are cost effective compared with single interventions. Universal (99%) coverage of these interventions could avert an estimated 41–72% of neonatal deaths worldwide. At 90% coverage, intrapartum and postnatal packages have similar effects on neonatal mortality—two-fold to three-fold greater than that of antenatal care. However, running costs are two-fold higher for intrapartum than for postnatal care. A combination of universal—ie, for all settings—outreach and family-community care at 90% coverage averts 18–37% of neonatal deaths. Most of this benefit is derived from family-community care, and greater effect is seen in settings with very high neonatal mortality. Reductions in neonatal mortality that exceed 50% can be achieved with an integrated, high-coverage programme of universal outreach and family-community care, consisting of 12% and 26%, respectively, of total running costs, plus universal facility-based clinical services, which make up 62% of the total cost. Early success in averting neonatal deaths is possible in settings with high mortality and weak health systems through outreach and family-community care, including health education to improve home-care practices, to create demand for skilled care, and to improve care seeking. Simultaneous expansion of clinical care for babies and mothers is essential to achieve the reduction in neonatal deaths needed to meet the Millennium Development Goal for child survival. (author's)
Keywords:
Developing CountriesIndex page
Research Report
Research Methodology
Infant
Neonatal Mortality
Child Survival
Maternal-Child Health Services
Antenatal Care
Interventions
Needs Assessment
Cost Effectiveness
Health Education
Youth
Age Factors
Population Characteristics
Demographic Factors
Population
Infant Mortality
Mortality
Population Dynamics
Survivorship
Length of Life
Primary Health Care
Health Services
Delivery of Health Care
Health
Maternal Health Services
Programs
Organization and Administration
Evaluation
Evaluation Indexes
Quantitative Evaluation
Education