Reducing newborn mortality in the Asia–Pacific region: Quality hospital services and community-based care

Authors

  • Kate M Milner,

    Corresponding author
    1. Murdoch Childrens Research Institute
    2. Royal Children's Hospital, Melbourne, Victoria, Australia
    • Centre for International Child Health, Department of Paediatrics, University of Melbourne
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  • Trevor Duke,

    1. Centre for International Child Health, Department of Paediatrics, University of Melbourne
    2. Murdoch Childrens Research Institute
    3. Royal Children's Hospital, Melbourne, Victoria, Australia
    4. Discipline of Child Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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  • Ingrid Bucens

    1. National Hospital of Dili, Dili, Timor-Leste
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  • Conflict of interest: None declared.

Correspondence: Dr Kate Milner, Centre for International Child Health, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Flemington Rd, Parkville, Vic. 3052, Australia. Fax: +613 9345 4977; email: kate.m.milner@rch.org.au

Abstract

Improving newborn health and survival is an essential part of progression toward Millennium Development Goal 4 in the World Health Organization Western Pacific and South East Asian regions. Both community and facility-based services are required. Strategies to improve the quality of care provided for newborns in health clinics and district- and referral-level hospitals have been relatively neglected in most countries in the region and in the published literature. Indirect historical evidence suggests that improving facility-based care will be an increasing priority for improving newborn survival in Asia and the Pacific as newborn mortality rates decrease and health systems contexts change. There are deficiencies in many aspects of newborn care, including immediate care and care for seriously ill newborns, which contribute substantially to regional newborn morbidity and mortality. We propose a practical quality improvement approach, based on models and standards of newborn care for primary-, district- and referral-level heath facilities and incorporated within existing maternal, newborn and child health programmes. There are examples where such approaches are being used effectively. There is a need to produce more nurses, community health workers and doctors with skills in care of the well and the sick newborn, and there are World Health Organization models of training to support this, including guidelines on emergency obstetric and newborn care and the Pocket Book of Hospital Care for Children. There are also simple data collection and analysis programmes that can assist in auditing outcomes, problem identification and health services planning. Finally, with increased survival rates there are gaps in follow-up care for newborns at high risk of long-term health and developmental impairments, and addressing this will be necessary to ensure optimal developmental and health outcomes for these children.

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