Simple Measures Help Curb Infant Mortality

06 July 2007 -- The World Health Organization and its partners say up to half a million African infants die the day they are born. Health experts say nearly a million babies could be saved in sub-Saharan Africa with a few low-cost interventions.

Among the devices that can save lives are kits that help provide a clean environment for childbirth, a dose of the AIDS drug nevirapine to an infant within three days of birth and resuscitators to help clear a newborn’s lungs and promote breathing.

One group that’s helping support these interventions, and connecting their manufacturers with governments and NGOs seeking them, is PATH, the Program for Appropriate Technology in Health.

Patricia Coffrey is a program officer for PATH based in Seattle, Washington.

She said infants’ inability to begin breathing accounts for 24 percent of the over one and half million deaths during delivery in sub-Saharan Africa each year.

She describes how a simple resuscitator can solve the problem:

"The most typical design," she said, "is bag made of plastic or silicon substance with a mask over child’s nose and mouth. Then you manually compress the bag, and it provides a breath of air into the child. You do that at a steady rate, and that allows the child to begin breathing or clear their airway. It helps their lungs expand, and they can begin breathing on their own."

One problem is the cost. Coffrey says many of the resuscitators sell for $100. However, PATH has produced a buyer’s guide of what it says are 10 of the least expensive and easy-to-use devices – some costing less than $30. The guide, called “A Practical Selection of Neonatal Resuscitators,” can be found on its web page: (http://www.path.org/files/TS_nnr_guide.pdf ).

The booklet helps individuals or NGOs to make direct contact with manufacturers. PATH is also negotiating to have the devices included in UNICEF’s supply catalog, used by governments and NGOs in Africa.

PATH is also working in three districts of South Africa’s Kwazulu-Natal Province to help train the health care providers in resuscitation and in the management of women in the third trimester.

PATH also promotes the use of another potential lifesaver: clean delivery kits, which help prevent infection during childbirth. PATH says worldwide, infections from unhygienic deliveries kill about 1,600 women a day and almost a million newborns every year.

Each kit includes a clean piece of plastic for the mother to lie on, a clean string and single-edged razor blade for tying and cutting the umbilical cord, and a bar of soap for anyone helping with the delivery.

Coffrey said a PATH study in Tanzania confirmed that women who used the kits were substantially less likely to develop genital tract infections, and infants were less likely to develop infections of the umbilical cord after delivery.

Where kits are not available, women may purchase some of the items separately.

She said, "You certainly can go and purchase each piece individually, and often in places before birth, a provider or clinic will tell a woman or her family she needs to purchase different elements in preparation for her deliver. The benefit of the kit is its ease. You just purchase it all in one piece and when you have a child there are other kids you have to take care of as well and other household duties. The convenience factor is appreciated. And all of the elements are appropriate ones – like a single edged razor blade…which is the safest way to cut the cord, rather than a double-edged one."

A third live-saving intervention supported by PATH is an infant-sized dose of the AIDS medication nevirapine. It helps inhibit the spread of HIV / AIDS from an infected mother to her newborn. But the drug, which is given to the infant in the form of syrup, must be administered within 72 hours of delivery.

Coffrey said many mothers go to a clinic only one or two times before delivery. For that reason, she says it’s essential for the drug to be packaged in a way that’s easy for the mother to take home and store until the child’s birth.

PATH has done just that, with the syrup sealed in a dosing syringe that can be given to the mother two months before delivery.

"So what (PATH) created," she said, "was an infant-dose pouch of nevirapine, which is an oral dosing syringe is filled with [the syrup] and given it to woman during antenatal care visit. It is capped securely and sealed in a foil pouch (with a self-sealing strip) and the (illustrated) instructions for use are written right on the pouch, and you send it home with the mom prior to birthing."

PATH says 57 million women around the world give birth at home without a traditional birth attendant. It says adopting some of these low-cost interventions can help bring about a decline in the staggering mortalities associated with childbirth – including one million stillborn children and 250,000 mothers who die each year.

Source: WHO

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