LAO PEOPLE’S DEMOCRATIC REPUBLIC NEONATAL MORTALITY RATE 1 1990 2011 2015 2020 55 32 30 20 Neonatal deaths (per 1000 live births) Target in national EENC 5-year action plan CAUSES OF NEONATAL DEATH, 20152 Preterm 26% Sepsis/ Pneumonia 24% Asphyxia 29% Congenital anomalies 10% Other 10% Diarrhoea 1% PROGRAMME READINESS FOR EENC SCALE-UP 20173 Detailed 12-month EENC implementation plan developed and funded EENC technical working group formed 1. Level and Trends in Child Mortality: Report 2015. UNICEF, 2015. Lao Social Indicator Survey (LSIS) 2011–2012. 2. WHO Global Health Observatory Data, 2015. 3. Ministry of Health, Lao People’s Democratic Republic, 2017. 4. Assessment of 18 randomly selected hospitals that have introduced EENC, 2016. 5. Adequate handwashing facilities defined as having at least one sink in the room, and all sinks in the room having running water, soap, and single-use towels/re-usable sterile towels/hand dryers available. 6. Adequate hand hygiene comprises washing hands twice before gloving and using sterile gloves to cut the umbilical cord. 7. LSIS 2011–2012. 8. Quality improvement approach consists of: (1) regular and documented meetings of the EENC team, (2) at least two EENC assessments per year, and (3) developing and updating an EENC hospital action plan at least quarterly. 9. Data from observations of 13 deliveries at 3 national hospitals and 8 deliveries at 6 subnational hospitals. PARTIAL EENC included in pre-service curricula (medical, midwifery and nursing) EENC 5-year action plan developed, costed and adopted Clinical intra-partum and newborn care protocol adapted, reviewed and endorsed YES NO STOCK-OUTS OF KEY MEDICINES AND COMMODITIES FOR EENC IN THE PAST 12 MONTHS, 20164 Antibiotics for sepsis Vitamin K Corticosteroids Magnesium sulfate Oxytocin Functional bag and mask within 2 m of delivery beds Hepatitis B vaccine 0 1 2–4 > 4 Number of stock-outs across 18 hospitals (4 national hospitals and 14 subnational hospitals) 0 20 40 60 80 100 Percentage of preterm babies Data from interviews and chart reviews of postpartum mothers: – 8 at national hospitals (n = 2), and – 9 at subnational hospitals (n = 7) Data from observations in 18 hospitals (4 national hospitals and 14 subnational hospitals) 88 33 Pregnant women* at risk of preterm labour receiving corticosteroids 50 56Immediate skin-to-skin contact 22 13Prolonged (≥ 90 min) skin-to-skin contact 33 13Sustained skin-to-skin contact until first breastfeed national hospital subnational hospital Pregnant women < 32 weeks of gestational age receiving MgSO4 0 Received Kangaroo Mother Care 0 22 Received early and exclusive breastfeeding 0 ENVIRONMENTAL HYGIENE, 20164 KEY POINTS • 42% of all under-5 deaths in Lao PDR occur in the newborn period. • EENC coaching has been done in 4/7 (57%) of national hospitals, 17/17 (100%) of provincial hospitals, and 32/137 (23%) of district, military and police hospitals. • A high proportion of maternity and paediatric staff have been coached in EENC, including 69% of staff in national hospitals and 76% of staff in provincial hospitals. • Syphilis testing is recorded for a low proportion of pregnant women. • Seventy percent of partographs are completed correctly. • Preterm newborns are less likely to receive EENC, which puts them at higher risk of poor health outcomes. • The majority of essential medicines and commodities are available in national and provincial hospitals. • A low proportion of hospitals has adequate sink handwashing facilities and alcohol gel/hand rub available in all maternity and neonatal care rooms. Adequate hand hygiene6 practised in 70% of deliveries 17% of hospitals have alcohol gel/hand rub available in all delivery, recovery, postnatal and neonatal care rooms 6% of hospitals have adequate sink handwashing facilities5 in all delivery, recovery, postnatal and neonatal care rooms 67% of hospitals have clean and dry newborn resuscitation areas PRETERM BABIES, 20164 * Women of 24–34 weeks of gestational age 0 20 40 60 80 100 Percentage of term babies Data from interviews with postpartum mothers: – 42 at national hospitals (n = 4), and – 147 at subnational hospitals (n = 14) Prolonged (≥ 90 min) skin-to-skin contact Immediate skin-to-skin contact Sustained skin-to-skin contact until first breastfeed Received early and exclusive breastfeeding Bathed in > 24 hours 0 Skin-to-skin contact applied in C-section deliveries national hospital subnational hospital TERM BABIES, 20164 NEWBORN CARE PRACTICES 52 41 71 66 57 43 48 48 62 89 0 20 40 60 80 100 Percentage of postpartum mothers Data from interviews and chart reviews of postpartum mothers: – 42 at national hospitals (n = 4) and – 146 at subnational hospitals (n = 14) Encouraged to eat and drink during labour Syphilis testing recorded With companion during childbirth Episiotomy Oxytocin injected within 1 min of birth9 Partographs completed correctly national hospital subnational hospital Not in supine position during active labour ANTENATAL CARE AND DELIVERY PRACTICES, 20164 Percentage COVERAGE OF KEY INTERVENTIONS, 20127 0 20 40 60 80 100 42Skilled attendance at birth 38Facility delivery rate 4Births delivered by caesarean section 39Breastfeeding initiated within ≤ 1 hour of birth 40Women who received PNC* in ≤ 2 days of birth 41Newborns who received PNC* in ≤ 2 days of birth introduced in 18% of health facilities (53/299) 74% of staff coached (568/769) 94% have EENC teams 6% have established a quality improvement approach8 * postnatal care EENC 74% 94% 6% Of the facilities that have introduced EENC4: EENC IMPLEMENTATION, 20173 Skin-to-skin contact no data Exclusive breastfeeding from 0 to 1 month 64 50 28 12 1 5 30 36 100 100 59 76 5 0 no data Early EssEntial nEwborn CarE (EEnC) 2017 0 10 20 30 40 50 60 W PR /2 01 7/ DN H/ 00 7 – © W or ld H ea lth O rg an iza tio n 20 17 – S om e rig ht s re se rv ed . T hi s w or k is av ai la bl e un de r t he C C BY -N C- SA 3 .0 IG O li ce ns e.
PHILIPPINES NEONATAL MORTALITY RATE 1 2003 2013 2020 17 13 10 Neonatal deaths (per 1000 live births) Target in regional action plan CAUSES OF NEONATAL DEATH, 20152 Preterm 33% Sepsis/ Pneumonia 18% Asphyxia 23% Congenital anomalies 17% Other 8% Diarrhoea 1% PROGRAMME READINESS FOR EENC SCALE-UP 20173 Detailed 12-month EENC implementation plan developed and funded EENC technical working group formed 1. National Demographic and Health Survey Philippines, 2003 and 2013. 2. WHO Global Health Observatory, 2015. 3. Department of Health of the Philippines, 2017. 4. Based on data from assessments of 28 randomly selected hospitals that have introduced EINC, 2017. 5. Adequate handwashing facilities defined as having at least one sink in the room, and all sinks in the room having running water, soap, and single-use towels/re-usable sterile towels/hand dryers available. 6. Adequate hand hygiene comprises washing hands twice before gloving and using sterile gloves to cut the umbilical cord. 7. National Demographic and Health Survey Philippines, 2013. 8. Quality improvement approach consists of: (1) regular and documented meetings of the EENC team, (2) at least two EENC assessments per year, and (3) developing and updating an EENC hospital action plan at least quarterly. 9. Data from observations of 78 deliveries at 13 national hospitals and 52 deliveries at 14 subnational hospitals. PARTIAL EENC included in pre-service curricula (medical, midwifery and nursing) EENC 5-year action plan developed, costed and adopted Clinical intra-partum and newborn care protocol adapted, reviewed and endorsed YES NO STOCK-OUTS OF KEY MEDICINES AND COMMODITIES FOR EENC IN THE PAST 12 MONTHS, 20164 Antibiotics for sepsis Vitamin K Corticosteroids 0 1 2–4 > 4 Number of stock-outs across 28 hospitals (13 national hospitals and 15 subnational hospitals) 0 20 40 60 80 100 Percentage of preterm babies Data from interviews and chart reviews of postpartum mothers: – 102 at national hospitals (n = 13), and – 42 at subnational hospitals (n = 12) Data from observations in 28 hospitals (13 national hospitals and 15 subnational hospitals) 70 64 Pregnant women* at risk of preterm labour receiving corticosteroids 59 60Immediate skin-to-skin contact 4Prolonged (≥ 90 min) skin-to-skin contact 17 18Sustained skin-to-skin contact until first breastfeed national hospital subnational hospital Pregnant women < 32 weeks of gestational age receiving MgSO4 Received Kangaroo Mother Care Received early and exclusive breastfeeding 17 ENVIRONMENTAL HYGIENE, 20174 KEY POINTS • 45% of all under-5 deaths in Philippines now occur in the newborn period. • Essential intrapartum and newborn care (EINC) was rolled out in 2010. Since, at least 39 national and regional and 175 first-level referral hospitals have introduced EINC. • The majority of pregnant women are encouraged to assume a non- supine position during active labour. Other globally recommended intrapartum care practices are practiced for around half or less of pregnant women. • Preterms are less likely to receive EENC, which puts them at higher risk of poor health outcomes. • Stock-outs of key medicines and commodities are observed more frequently in national and regional hospitals. • A low proportion of hospitals has adequate sink handwashing facilities in all maternal and neonatal care rooms. Appropriate hand hygiene is practised in one out of two deliveries. Adequate hand hygiene6 practised in 48% of deliveries 21% of hospitals have alcohol gel/hand rub available in all delivery, recovery, postnatal and neonatal care rooms 7% of hospitals have adequate sink handwashing facilities5 in all delivery, recovery, postnatal and neonatal care rooms 93% of hospitals have clean and dry newborn resuscitation areas PRETERM BABIES, 20174 NEWBORN CARE PRACTICES * Women of 24–34 weeks of gestational age 14 57 Magnesium sulfate Oxytocin Functional bag and mask within 2 m of delivery beds Hepatitis B vaccine 33 13 21 45 0 20 40 60 80 100 Percentage of postpartum mothers Data from interviews and chart reviews of postpartum mothers: – 113 at national hospitals (n = 13) and – 141 at subnational hospitals (n = 15) 45 76 59 Encouraged to eat and drink during labour 31 18Syphilis testing recorded 43With companion during childbirth 29 29Episiotomy 27 68Oxytocin injected within 1 min of birth9 24 24Partographs completed correctly national hospital subnational hospital 73 Not in supine position during active labour ANTENATAL CARE AND DELIVERY PRACTICES, 20174 76 24 Percentage COVERAGE OF KEY INTERVENTIONS, 20157 0 20 40 60 80 100 73Skilled attendance at birth 61Facility delivery rate 9Births delivered by caesarean section 50Breastfeeding initiated within ≤ 1 hour of birth 72Women who received PNC* in ≤ 2 days of birth 53Newborns who received PNC* in ≤ 2 days of birth introduced in 78% of health facilities (1093/1401) 43% of staff coached (1676/3934) 75% have EENC teams4 36% have established a quality improvement approach8 * postnatal care EENC 43% 75% 36% Of the facilities that have introduced EENC4: EENC IMPLEMENTATION, 20173 Skin-to-skin contact Exclusive breastfeeding from 0 to 1 month 90 64 0 20 40 60 80 100 Percentage of term babies Data from interviews with postpartum mothers: – 131 at national hospitals (n = 13), and – 141 at subnational hospitals (n = 15) Prolonged (≥ 90 min) skin-to-skin contact Immediate skin-to-skin contact Sustained skin-to-skin contact until first breastfeed Received early and exclusive breastfeeding Bathed in > 24 hours 48 6Skin-to-skin contact applied in C-section deliveries national hospital subnational hospital TERM BABIES, 20174 35 29 69 65 59 36 62 55 47 92 Early EssEntial nEwborn CarE (EEnC) 2017 0 10 20 30 40 50 60 W PR /2 01 7/ DN H/ 00 8 – © W or ld H ea lth O rg an iza tio n 20 17 – S om e rig ht s re se rv ed . T hi s w or k is av ai la bl e un de r t he C C BY -N C- SA 3 .0 IG O li ce ns e.
0 20 40 60 80 100 Percentage of term babies Data from interviews with postpartum mothers: – 34 at national hospitals (n = 3), and – 118 at subnational health facilities (n = 17) 9 10 Prolonged (≥ 90 min) skin-to-skin contact 65 77Immediate skin-to-skin contact 50 49 Sustained skin-to-skin contact until first breastfeed 32 64 Received early and exclusive breastfeeding 81 85Bathed in > 24 hours 21 64Skin-to-skin contact applied in C-section deliveries national hospital subnational hospital TERM BABIES, 20174 CAMBODIA NEONATAL MORTALITY RATE 1 1990 2014 2020 37 18 14 Neonatal deaths (per 1000 live births) Target in national EENC 5-year action plan CAUSES OF NEONATAL DEATH, 20152 Preterm 29% Sepsis/ Pneumonia 22% Asphyxia 24% Congenital anomalies 17% Other 8% Detailed 12-month EENC implementation plan developed and funded EENC technical working group formed 1. Cambodia Demographic and Health Surveys, 2000 and 2014. 2. WHO Global Health Observatory Data, 2015. 3. Ministry of Health, Cambodia, 2017. 4. Assessments of 20 randomly select health facilities that have introduced immediate newborn care (INC), 2017. 5. Adequate handwashing facilities defined as having at least one sink in the room, and all sinks in the room having running water, soap, and single-use towels/re-usable sterile towels/hand dryers available. 6. Adequate hand hygiene comprises washing hands twice before gloving and using sterile gloves to cut the umbilical cord. 7. Does not include staff coached at national hospitals, n = 254. Data on denominator not available from national hospitals. 8. Data from assessments of 15 randomly selected hospitals that have introduced INC, 2017. 9. Quality improvement approach consists of: (1) regular and documented meetings of the EENC team, (2) at least two EENC assessments per year, and (3) developing and updating an EENC hospital action plan at least quarterly. Data from 15 national, regional, and first-level referral hospitals. 10. Data from observations of 5 deliveries at 2 national hospitals and 7 deliveries at 6 subnational health facilities. PARTIAL EENC included in pre-service curricula (medical, midwifery and nursing) EENC 5-year action plan developed, costed and adopted Clinical intra-partum and newborn care protocol adapted, reviewed and endorsed YES NO STOCK-OUTS OF KEY MEDICINES AND COMMODITIES FOR EENC IN THE PAST 12 MONTHS, 20174 Antibiotics for sepsis Vitamin K Corticosteroids Magnesium sulfate Oxytocin Functional bag and mask within 2 m of delivery beds Hepatitis B vaccine 0 1 2–4 > 4 Number of stock-outs across 20 health facilities (3 national hospitals and 17 subnational health facilities) 0 20 40 60 80 100 0 20 40 60 80 100 Percentage of postpartum mothers Percentage of preterm babies Data from interviews and chart reviews of postpartum mothers: – 38 at national hospitals (n = 3), and – 126 at subnational health facilities (n = 17) Data from interviews and chart reviews of postpartum mothers: – 4 at national hospitals (n = 3), and – 8 at subnational health facilities (n = 7) Data from observations in 20 health facilities (3 national hospitals and 17 subnational health facilities) 76 76 97 Encouraged to eat and drink during labour 15 4Syphilis testing recorded 33 33 Pregnant women* at risk of preterm labour receiving corticosteroids 50 75Immediate skin-to-skin contact 81With companion during childbirth Prolonged (≥ 90 min) skin-to-skin contact 26 3Episiotomy 86 80Oxytocin injected within 1 min of birth10 82 88Partographs completed correctly 38 Sustained skin-to-skin contact until first breastfeed national hospital national hospital subnational hospital subnational hospital 95 Not in supine position during active labour Pregnant women < 32 weeks of gestational age receiving MgSO4 0 no sample 0 0 Received Kangaroo Mother Care 0 63 Received early and exclusive breastfeeding 0 ANTENATAL CARE AND DELIVERY PRACTICES, 20174 ENVIRONMENTAL HYGIENE, 20174 KEY POINTS • 50% of all under-5 deaths in Cambodia occur in the newborn period. • Immediate newborn care (INC) is implemented in Cambodia. INC coaching has been done in 5/6 national hospitals – all provincial hospitals – and over 90% operational district hospitals and first- level health facilities. • A high proportion of maternity and paediatric staff have been coached in EENC, including 80% in provincial hospitals and close to 70% in operational district hospitals. • Around 80% of pregnant women have a correctly completed parto- graph in their patient chart, are encouraged to assume a position of choice and have a companion during childbirth. • Preterm newborns are less likely to receive EENC, which puts them at higher risk of poor health outcomes. • Stock-outs of essential medicines and commodities are experienced mostly in subnational health facilities. • No health facilities assessed have adequate sink handwashing facilities, whilst 1 in 3 have alcohol gel/hand rub available in all maternity and neonatal care rooms. Adequate hand hygiene6 practised in 73% of deliveries 35% of health facilities have alcohol gel/hand rub available in all delivery, recovery, postnatal and neonatal care rooms 0% of health facilities have adequate sink handwashing facilities5 in all delivery, recovery, postnatal and neonatal care rooms 75% of health facilities have clean and dry newborn resuscitation areas PRETERM BABIES, 20174 NEWBORN CARE PRACTICES * Women of 24–34 weeks of gestational age no data 82 Percentage COVERAGE OF KEY INTERVENTIONS, 20141 0 20 40 60 80 100 89Skilled attendance at birth 83Facility delivery rate 6Births delivered by caesarean section 63Breastfeeding initiated within ≤ 1 hour of birth 90Women who received PNC* in ≤ 2 days of birth 77Newborns who received PNC* in ≤ 2 days of birth introduced in 90% of health facilities (1139/1272) 71% of staff coached7 (3803/5347) 27% have EENC teams8 13% have established a quality improvement approach8,9 * postnatal care EENC 71% 27% 13% Of the facilities that have introduced EENC: EENC IMPLEMENTATION, 20173 Skin-to-skin contact no data Exclusive breastfeeding from 0 to 1 month 80 PROGRAMME READINESS FOR EENC SCALE-UP 20173 Early EssEntial nEwborn CarE (EEnC) 2017 0 10 20 30 40 50 60 W PR /2 01 7/ DN H/ 00 9 – © W or ld H ea lth O rg an iza tio n 20 17 – S om e rig ht s re se rv ed . T hi s w or k is av ai la bl e un de r t he C C BY -N C- SA 3 .0 IG O li ce ns e.
Early EssEntial nEwborn CarE (EEnC) 2017 CHINA NEONATAL MORTALITY RATE 1 1990 2016 2020 30 5 10 Neonatal deaths (per 1000 live births) Target in regional action plan CAUSES OF NEONATAL DEATH, 20152 Preterm 34% Sepsis/ Pneumonia 9% Asphyxia 27% Congenital anomalies 18% Other 11% Diarrhoea 1% Detailed 12-month EENC implementation plan developed and funded EENC technical working group formed 1. Level and Trends in Child Mortality: Report 2015. UNICEF, 2015. China Maternal and Child Mortality Surveillance Report, 2016. 2. WHO Global Health Observatory, 2015. 3. Ministry of Health, 2017. 4. Assessments of the 6 hospitals that have introduced EENC, 2016. 5. Adequate handwashing facilities defined as having at least one sink in the room, and all sinks in the room having running water, soap, and single-use towels/re-usable sterile towels/hand dryers available. 6. Adequate hand hygiene comprises washing hands twice before gloving and using sterile gloves to cut the umbilical cord. 7. China National Health Statistics Annual Report, 2016. China Maternal and Child Surveillance Report, 2016. 8. Quality improvement approach consists of: (1) regular and documented meetings of the EENC team, (2) at least two EENC assessments per year, and (3) developing and updating an EENC hospital action plan at least quarterly. 9. Data from observations of 8 deliveries at 3 national hospitals and 8 deliveries at 3 subnational hospitals. PARTIAL EENC included in pre-service curricula (medical, midwifery and nursing) EENC 5-year action plan developed, costed and adopted Clinical intra-partum and newborn care protocol adapted, reviewed and endorsed YES NO STOCK-OUTS OF KEY MEDICINES AND COMMODITIES FOR EENC IN THE PAST 12 MONTHS, 20164 Antibiotics for sepsis Vitamin K Corticosteroids Magnesium sulfate Oxytocin Functional bag and mask within 2 m of delivery beds Hepatitis B vaccine 0 1 2–4 > 4 Number of stock-outs across 6 hospitals (3 national hospitals and 3 subnational hospitals) 0 20 40 60 80 100 Percentage of preterm babies Data from interviews and chart reviews of postpartum mothers: – 13 at national hospitals (n = 3), and – 3 at subnational hospitals (n = 3) Data from observations in 6 hospitals (3 national hospitals and 3 subnational hospitals) 100 100 Pregnant women* at risk of preterm labour receiving corticosteroids 38 33Immediate skin-to-skin contact 23Prolonged (≥ 90 min) skin-to-skin contact 33 23Sustained skin-to-skin contact until first breastfeed national hospital subnational hospital Pregnant women < 32 weeks of gestational age receiving MgSO4 Received Kangaroo Mother Care Received early and exclusive breastfeeding 0 ENVIRONMENTAL HYGIENE, 20164 KEY POINTS • 51% of all under-5 deaths in China now occur in the newborn period. • A national EENC technical working group has been formed, whilst work on funding an annual implementation plan and endorsing a clinical protocol is on-going. • Six health facilities introduced EENC in 2016, and 84% of staff pro- viding childbirth and newborn care have been coached. • The majority of women have syphilis testing recorded in their patient charts, are encouraged to eat and drink during labour, and have correctly completed partographs. However, few women assume a non-supine position during the active stage of labour or have a companion during childbirth. • Preterm newborns are less likely to receive EENC, which puts them at higher risk of poor health outcomes. • All key medicines and commodities for EENC are available in hospi- tals. One in three hospitals have adequate hand sink handwashing facilities in all maternal and neonatal care rooms. Adequate hand hygiene6 practised in 94% of deliveries 17% of hospitals have alcohol gel/hand rub available in all delivery, recovery, postnatal and neonatal care rooms 33% of hospitals have adequate sink handwashing facilities5 in all delivery, recovery, postnatal and neonatal care rooms 100% of hospitals have clean and dry newborn resuscitation areas PRETERM BABIES, 20174 * Women of 24–34 weeks of gestational age 8 8 0 0 0 20 40 60 80 100 Percentage of postpartum mothers Data from interviews and chart reviews of postpartum mothers: – 26 at national hospitals (n = 3) and – 28 at subnational hospitals (n = 3) 92 76 71 Encouraged to eat and drink during labour 84 100Syphilis testing recorded 21With companion during childbirth 25 27Episiotomy 63 50Oxytocin injected within 1 min of birth9 96 100Partographs completed correctly national hospital subnational hospital 50 Not in supine position during active labour ANTENATAL CARE AND DELIVERY PRACTICES, 20164 50 7 Percentage COVERAGE OF KEY INTERVENTIONS, 20157 0 20 40 60 80 100 99.9Skilled attendance at birth 99.7Facility delivery rate 34.0Births delivered by caesarean section Breastfeeding initiated within ≤ 1 hour of birth 95.0Women who received PNC* in ≤ 2 days of birth 94.0Newborns who received PNC* in ≤ 2 days of birth introduced in 0.02% of health facilities (6/25 860) 84% of staff coached (981/1167) 100% have EENC teams 50% have established a quality improvement approach8 * postnatal care EENC 84% 100% 50% Of the facilities that have introduced EENC: EENC IMPLEMENTATION, 20173 Skin-to-skin contact no data no data Exclusive breastfeeding from 0 to 1 month no data 0 20 40 60 80 100 Percentage of term babies Data from interviews with postpartum mothers: – 26 at national hospitals (n = 3), and – 28 at subnational hospitals (n = 3) 73 79 Prolonged (≥ 90 min) skin-to-skin contact 88 86Immediate skin-to-skin contact 85 61 Sustained skin-to-skin contact until first breastfeed 46 57 Received early and exclusive breastfeeding 100 100Bathed in > 24 hours 0Skin-to-skin contact applied in C-section deliveries national hospital TERM BABIES, 20174 NEWBORN CARE PRACTICES no data 100 100 PROGRAMME READINESS FOR EENC SCALE-UP 20173 subnational hospital 0 10 20 30 40 50 60 W PR /2 01 7/ DN H/ 01 0 – © W or ld H ea lth O rg an iza tio n 20 17 – S om e rig ht s re se rv ed . T hi s w or k is av ai la bl e un de r t he C C BY -N C- SA 3 .0 IG O li ce ns e.
MONGOLIA NEONATAL MORTALITY RATE 1 1990 2015 2020 32 10 5 Neonatal deaths (per 1000 live births) Target in national EENC 5-year action plan CAUSES OF NEONATAL DEATH, 20152 Preterm 33% Sepsis/ Pneumonia 17% Asphyxia 22% Congenital anomalies 22% Other 6% Detailed 12-month EENC implementation plan developed and funded EENC technical working group formed 1. Level and Trends in Child Mortality: Report 2015. UNICEF, 2015. Mongolia Health Indicators, 2015. 2. WHO Global Health Observatory Data, 2015. 3. Ministry of Health of Mongolia, 2017. 4. Based on data from assessments of the 25 national and first-level referral hospitals that have introduced EENC. 5. Adequate handwashing facilities defined as having at least one sink in the room, and all sinks in the room having running water, soap, and single-use towels available. 6. Adequate hand hygiene comprises washing hands twice before gloving and using sterile gloves to cut the umbilical cord. 7. Mongolia Health Indicators, 2015. Social Indicator Sample Survey. National Statistics Office of Mongolia, UNFPA, UNICEF, 2013. 8. Quality improvement approach consists of: (1) regular and documented meetings of the EENC team, (2) at least two EENC assessments per year, and (3) developing and updating an EENC hospital action plan at least quarterly. 9. Data from observations of 24 deliveries in 4 national hospitals and 85 deliveries in 18 subnational hospitals. PARTIAL EENC included in pre-service curricula (medical, midwifery and nursing) EENC 5-year action plan developed, costed and adopted Clinical intra-partum and newborn care protocol adapted, reviewed and endorsed YES NO STOCK-OUTS OF KEY MEDICINES AND COMMODITIES FOR EENC IN THE PAST 12 MONTHS, 20164 Antibiotics for sepsis Vitamin K Corticosteroids Oxytocin Functional bag and mask within 2 m of delivery beds Hepatitis B vaccine 0 1 2–4 > 4 Number of stock-outs across 25 hospitals (4 national hospitals and 21 subnational hospitals) 0 20 40 60 80 100 Percentage of preterm babies Data from interviews and chart reviews of postpartum mothers: – 27 at national hospitals (n = 4), and – 45 at subnational hospitals (n = 19) Data from observations in 25 hospitals (4 national hospitals and 21 subnational hospitals) 60 88 Pregnant women* at risk of preterm labour receiving corticosteroids 48 40Immediate skin-to-skin contact 11Prolonged (≥ 90 min) skin-to-skin contact 53 44Sustained skin-to-skin contact until first breastfeed national hospital subnational hospital Pregnant women < 32 weeks of gestational age receiving MgSO4 Received Kangaroo Mother Care Received early and exclusive breastfeeding ENVIRONMENTAL HYGIENE, 20164 KEY POINTS • 50% of all under-5 deaths in Mongolia now occur in the newborn period. • EENC coaching has begun in 4/4 national and 21/21 first-level referral government hospitals and in 23/113 first-level facilities. • Seventy-four percent of staff at national and 84% at first-level referral hospitals have been coached in EENC. • The majority of pregnant women have syphilis testing recorded, are encouraged to eat and drink, assume a non-supine position during the active stage of labour, and are injected with oxytocin within 1 minute of birth. However, less than 10% have a companion at childbirth. • Preterm newborns are less likely to receive EENC, which puts them at higher risk of poor health outcomes. • Most key medicines and commodities for EENC are available in hospitals. Only one in five hospitals has adequate sink handwashing facilities. Adequate hand hygiene6 practised in 82% of deliveries 48% of hospitals have alcohol gel/hand rub available in all delivery, recovery, postnatal and neonatal care rooms 20% of hospitals have adequate sink handwashing facilities5 in all delivery, recovery, postnatal and neonatal care rooms 72% of hospitals have clean and dry newborn resuscitation areas PRETERM BABIES, 20164 NEWBORN CARE PRACTICES * Women of 24–34 weeks of gestational age 11 11 Magnesium sulfate 100 60 33 23 10 0 20 40 60 80 100 Percentage of postpartum mothers Data from interviews and chart reviews of postpartum mothers: – 38 at national hospitals (n = 4) and – 173 at subnational hospitals (n = 21) 84 84 Encouraged to eat and drink during labour 89 73Syphilis testing recorded 6With companion during childbirth 11 11Episiotomy 95 100Oxytocin injected within 1 min of birth9 61 60Partographs completed correctly national hospital subnational hospital 91 Not in supine position during active labour ANTENATAL CARE AND DELIVERY PRACTICES, 20164 97 11 Percentage COVERAGE OF KEY INTERVENTIONS, 20157 0 20 40 60 80 100 99.6Skilled attendance at birth 99.6Facility delivery rate 24.8Births delivered by caesarean section 94.8Breastfeeding initiated within ≤ 1 hour of birth 95.4Women who received PNC* in ≤ 2 days of birth 98.4Newborns who received PNC* in ≤ 2 days of birth introduced in 34% of health facilities3 (48/142) 80% of staff coached (760/947) 92% have EENC teams 36% have established a quality improvement approach8 * postnatal care EENC 80% 92% 36% Of the facilities that have introduced EENC4: EENC IMPLEMENTATION, 20173 Skin-to-skin contact no data Exclusive breastfeeding from 0 to 1 month no data 0 20 40 60 80 100 Percentage of term babies Data from interviews with postpartum mothers: – 40 at national hospitals (n = 4), and – 173 at subnational hospitals (n = 21) Prolonged (≥ 90 min) skin-to-skin contact Immediate skin-to-skin contact Sustained skin-to-skin contact until first breastfeed Received early and exclusive breastfeeding Bathed in > 24 hours 52 0Skin-to-skin contact applied in C-section deliveries national hospital subnational hospital TERM BABIES, 20164 68 58 63 62 88 81 38 48 77 56 Early EssEntial nEwborn CarE (EEnC) 2017 PROGRAMME READINESS FOR EENC SCALE-UP 20173 0 10 20 30 40 50 60 W PR /2 01 7/ DN H/ 01 1 – © W or ld H ea lth O rg an iza tio n 20 17 – S om e rig ht s re se rv ed . T hi s w or k is av ai la bl e un de r t he C C BY -N C- SA 3 .0 IG O li ce ns e.
0 20 40 60 80 100 Percentage of term babies Data from interviews with postpartum mothers: – 10 at national hospital (n = 1), and – 39 at subnational hospitals (n = 5) 0 3 Prolonged (≥ 90 min) skin-to-skin contact 10 44Immediate skin-to-skin contact 40 46 Sustained skin-to-skin contact until first breastfeed 90 62 Received early and exclusive breastfeeding 8 no data Bathed in > 24 hours 50 no dataSkin-to-skin contact applied in C-section deliveries national hospital subnational hospital TERM BABIES, 20164 PAPUA NEW GUINEA NEONATAL MORTALITY RATE 1 1990 2006 2020 32 29 10 Neonatal deaths (per 1000 live births) Target in regional action plan CAUSES OF NEONATAL DEATH, 20152 Preterm 31% Sepsis/ Pneumonia 22% Asphyxia 27% Congenital anomalies 11% Other 8% Diarrhoea 1% PROGRAMME READINESS FOR EENC SCALE-UP 20173 Detailed 12-month EENC implementation plan developed and funded EENC technical working group formed 1. Level and Trends in Child Mortality: Report 2015. UNICEF, 2015. Papua New Guinea Demographic and Health Survey, 2006. 2. WHO Global Health Observatory Data, 2015. 3. National Department of Health, 2017. 4. Assessments of 6 hospitals that have introduced EENC, 2016. 5. Adequate handwashing facilities defined as having at least one sink in the room, and all sinks in the room having running water, soap, and single-use towels/re-usable sterile towels/hand dryers available. 6. Adequate hand hygiene comprises washing hands twice before gloving and using sterile gloves to cut the umbilical cord. 7. Papua New Guinea Demographic and Health Survey, 2006. 8. Data from the national hospital. An additional 579 staff have been coached in subnational health facilities. 9. Applies to national and first-level referral hospitals only. 10. Quality improvement approach consists of: (1) regular and documented meetings of the EENC team, (2) at least two EENC assessments per year, and (3) developing and updating an EENC hospital action plan at least quarterly. 11. Data from observations of 5 deliveries at the national hospital and 9 deliveries at 4 subnational hospitals. PARTIAL EENC included in pre-service curricula (medical, midwifery and nursing) EENC 5-year action plan developed, costed and adopted Clinical intra-partum and newborn care protocol adapted, reviewed and endorsed YES NO STOCK-OUTS OF KEY MEDICINES AND COMMODITIES FOR EENC IN THE PAST 12 MONTHS, 20164 Antibiotics for sepsis Vitamin K Corticosteroids Magnesium sulfate Oxytocin 0 1 2–4 > 4 Number of stock-outs across 6 hospitals (1 national hospital and 5 subnational hospitals) 0 20 40 60 80 100 Percentage of preterm babies No data from interviews and chart reviews of postpartum mothers Data from observations in 6 hospitals (1 national hospital and 5 subnational hospitals) Pregnant women* at risk of preterm labour receiving corticosteroids Immediate skin-to-skin contact Prolonged (≥ 90 min) skin-to-skin contact Sustained skin-to-skin contact until first breastfeed national hospital subnational hospital Pregnant women < 32 weeks of gestational age receiving MgSO4 Received Kangaroo Mother Care Received early and exclusive breastfeeding ENVIRONMENTAL HYGIENE, 20164 KEY POINTS • 42% of all under-5 deaths in PNG now occur in the newborn period. • EENC has been introduced in the national hospital, 18/31 (58%) first level referral hospitals and 173/717 (24%) first-level facilities. • Seventy percent of staff at the national hospital have been coached in EENC. • All women receive oxytocin within 1 minute of birth at the national hospital, where episiotomies are also not routinely performed. Sub- national hospitals perform relatively higher than the national hospital for other antenatal and delivery practices. • Data on care for preterm babies are not available. • Most key medicines and commodities for EENC are available at na- tional and subnational hospitals. However, no hospital has adequate sink handwashing facilities. Adequate hand hygiene6 practised in 7% of deliveries Hospitals have alcohol gel/hand rub available in all delivery, recovery, postnatal and neonatal care rooms: no data 0% of hospitals have adequate sink handwashing facilities5 in all delivery, recovery, postnatal and neonatal care rooms 100% of hospitals have clean and dry newborn resuscitation areas PRETERM BABIES, 20164 NEWBORN CARE PRACTICES * Women of 24–34 weeks of gestational age Functional bag and mask within 2 m of delivery beds Hepatitis B vaccine no data no data no data no data no data no data no data introduced in 26% of health facilities (192/749) 70% of staff coached8 (135/192) 3% have EENC teams9 3% have established a quality improvement approach9,10 EENC 70% 3% 3% Of the facilities that have introduced EENC: EENC IMPLEMENTATION, 20173 0 20 40 60 80 100 Percentage of postpartum mothers Data from interviews and chart reviews of postpartum mothers: – 10 at national hospital (n = 1) and – 39 at subnational hospitals (n = 5) Encouraged to eat and drink during labour Syphilis testing recorded With companion during childbirth Episiotomy Oxytocin injected within 1 min of birth11 Partographs completed correctly national hospital subnational hospital Not in supine position during active labour ANTENATAL CARE AND DELIVERY PRACTICES, 20164 40 68 50 64 71 20 23 0 67 100 55 30 68 60 Percentage COVERAGE OF KEY INTERVENTIONS, 20147 0 20 40 60 80 100 53Skilled attendance at birth 0 0 0 Facility delivery rate Births delivered by caesarean section Breastfeeding initiated within ≤ 1 hour of birth Women who received PNC* in ≤ 2 days of birth Newborns who received PNC* in ≤ 2 days of birth * postnatal care Skin-to-skin contact no data Exclusive breastfeeding from 0 to 1 month 80 0 Early EssEntial nEwborn CarE (EEnC) 2017 52 0 10 20 30 40 50 60 W PR /2 01 7/ DN H/ 01 2 – © W or ld H ea lth O rg an iza tio n 20 17 – S om e rig ht s re se rv ed . T hi s w or k is av ai la bl e un de r t he C C BY -N C- SA 3 .0 IG O li ce ns e.
SOLOMON ISLANDS NEONATAL MORTALITY RATE 1 1990 2007 2015 2020 16 15 9 10 Neonatal deaths (per 1000 live births) Target in regional action plan CAUSES OF NEONATAL DEATH, 20152 Preterm 29% Sepsis/ Pneumonia 19% Asphyxia 25% Congenital anomalies 19% Other 8% PROGRAMME READINESS FOR EENC SCALE-UP 20173 Detailed 12-month EENC implementation plan developed and funded EENC technical working group formed 1. Level and Trends in Child Mortality: Report 2015. UNICEF, 2015. Solomon Islands Demographic and Health Surveys, 2007 and 2015. 2. WHO Global Health Observatory Data, 2015. 3. Ministry of Health and Medical Services, 2017. 4. Assessments of 10 health facilities that have introduced EENC, 2017. 5. Adequate handwashing facilities defined as having at least one sink in the room, and all sinks in the room having running water, soap, and single-use towels/re-usable sterile towels/hand dryers available. 6. Adequate hand hygiene comprises washing hands twice before gloving and using sterile gloves to cut the umbilical cord. 7. Solomon Islands Demographic and Health Survey, 2015. 8. Applies to national and first-level referral hospitals only. 9. Quality improvement approach consists of: regular and documented meetings of the EENC team, (2) at least two EENC assessments per year, and (3) developing and updating an EENC hospital action plan at least quarterly. 10. Data from observations of 2 deliveries at 2 subnational hospitals. PARTIAL EENC included in pre-service curricula (medical, midwifery and nursing) EENC 5-year action plan developed, costed and adopted Clinical intra-partum and newborn care protocol adapted, reviewed and endorsed YES NO STOCK-OUTS OF KEY MEDICINES AND COMMODITIES FOR EENC IN THE PAST 12 MONTHS, 20174 Antibiotics for sepsis Vitamin K Corticosteroids Magnesium sulfate Oxytocin Hepatitis B vaccine 0 1 2–4 > 4 Number of stock-outs across 10 health facilities (1 national hospital and 9 subnational health facilities) 0 20 40 60 80 100 Percentage of preterm babies Data from interviews and chart reviews of postpartum mothers: – 7 at national hospitals (n = 1), and – 2 at subnational hospitals (n = 2) Data from observations in 10 health facilities (1 national hospital and 9 subnational health facilities) Pregnant women* at risk of preterm labour receiving corticosteroids 86 100Immediate skin-to-skin contact 100 14Prolonged (≥ 90 min) skin-to-skin contact 100 14Sustained skin-to-skin contact until first breastfeed national hospital subnational hospital Pregnant women < 32 weeks of gestational age receiving MgSO4 0 0 Received Kangaroo Mother Care 0 50 Received early and exclusive breastfeeding ENVIRONMENTAL HYGIENE, 20174 KEY POINTS • 43% of all under-5 deaths in the Solomon Islands now occur in the newborn period. • EENC has been introduced in the national hospital, 6/9 (67%) provincial hospitals, and 138/292 (47%) first level health facilities. Almost all staff providing childbirth and newborn at the national hospital have been coached in EENC. Coaching coverage at provincial hospitals is 41% and in first level facilities, 54%. • Most mothers are encouraged to eat and drink and assume a non- supine position during active labour, and have a companion at the time of childbirth. Injection of oxytocin within 1 minute of birth however, is only done for half of the mothers in subnational health facilities. • Preterm babies are less likely to receive EENC, which places them at higher risk of poor health outcomes. • Stock-outs of key medicines and commodities for EENC are more frequently experienced in subnational health facilities. • No health facility has adequate sink handwashing facilities in mater- nal and neonatal care rooms. Adequate hand hygiene6 practised in deliveries: no data 20% of health facilities have alcohol gel/hand rub available in all delivery, recovery, postnatal and neonatal care rooms 0% of health facilities have adequate sink handwashing facilities5 in all delivery, recovery, postnatal and neonatal care rooms 100% of health facilities have clean and dry newborn resuscitation areas PRETERM BABIES, 20174 NEWBORN CARE PRACTICES * Women of 24–34 weeks of gestational age Functional bag and mask within 2 m of delivery beds 0 20 40 60 80 100 Percentage of postpartum mothers Data from interviews and chart reviews of postpartum mothers: – 10 at national hospitals (n = 1) and – 33 at subnational health facilities (n = 9) 70 76 82 Encouraged to eat and drink during labour 30 15Syphilis testing recorded 91With companion during childbirth 27 0Episiotomy 50 no dataOxytocin injected within 1 min of birth10 42 100Partographs completed correctly national hospital subnational hospital 94 Not in supine position during active labour ANTENATAL CARE AND DELIVERY PRACTICES, 20174 80 60 Percentage COVERAGE OF KEY INTERVENTIONS, 20157 0 20 40 60 80 100 86Skilled attendance at birth 85Facility delivery rate 6Births delivered by caesarean section 79Breastfeeding initiated within ≤ 1 hour of birth 69Women who received PNC* in ≤ 2 days of birth 16Newborns who received PNC* in ≤ 2 days of birth introduced in 48% of health facilities (145/302) 58% of staff coached (412/710) 13% have EENC teams8 0% have established a quality improvement approach8,9 * postnatal care EENC 58% 13% 0% Of the facilities that have introduced EENC: EENC IMPLEMENTATION, 20173 Skin-to-skin contact no data Exclusive breastfeeding from 0 to 1 month 87 0 20 40 60 80 100 Percentage of term babies Data from interviews with postpartum mothers: – 10 at national hospital (n = 1), and – 33 at subnational health facilities (n = 9) 80 64 Prolonged (≥ 90 min) skin-to-skin contact 70 70Immediate skin-to-skin contact 80 70 Sustained skin-to-skin contact until first breastfeed 90 55 Received early and exclusive breastfeeding 50 67Bathed in > 24 hours 67 0Skin-to-skin contact applied in C-section deliveries national hospital subnational hospital TERM BABIES, 20174 I 14 no data Early EssEntial nEwborn CarE (EEnC) 2017 0 10 20 30 40 50 60 W PR /2 01 7/ DN H/ 01 3 – © W or ld H ea lth O rg an iza tio n 20 17 – S om e rig ht s re se rv ed . T hi s w or k is av ai la bl e un de r t he C C BY -N C- SA 3 .0 IG O li ce ns e.
VIET NAM NEONATAL MORTALITY RATE 1 1990 2014 2020 24 12 7 Neonatal deaths (per 1000 live births) Percentage Target in national EENC 5-year action plan CAUSES OF NEONATAL DEATH, 20152 Preterm 41% Sepsis/ Pneumonia 16% Asphyxia 14% Congenital anomalies 22% Other 7% COVERAGE OF KEY INTERVENTIONS, 20167 0 20 40 60 80 100 98Skilled attendance at birth 97Facility delivery rate Detailed 12-month EENC implementation plan developed and funded EENC technical working group formed 28Births delivered by caesarean section 73Breastfeeding initiated within ≤ 1 hour of birth 90Women who received PNC* in ≤ 2 days of birth 89Newborns who received PNC* in ≤ 2 days of birth introduced in 88% of hospitals (687/784) 61% of staff coached (2484/4054) 63% have EENC teams 13% have established a quality improvement approach8 * postnatal care 1. Level and Trends in Child Mortality: Report 2015. UNICEF, 2015. Multiple Indicator Cluster Survey Viet Nam, 2014. 2. WHO Global Health Observatory, 2015. 3. Ministry of Health, 2007. 4. Based on data from assessments of 48 randomly selected hospitals that have introduced EENC, 2017. 5. Adequate handwashing facilities defined as having at least one sink in the room, and all sinks in the room having running water, soap, and single-use towels/re-usable sterile towels/hand dryers available. 6. Adequate hand hygiene comprises washing hands twice before gloving and using sterile gloves to cut the umbilical cord. 7. Viet Nam Reproductive Health Annual Report, 2016. Multiple Indicator Cluster Surveys Viet Nam, 2014 (births delivered by caesarean section, and indicators on postnatal care) and 2011 (exclusive breastfeeding 0–1 month). 8. Quality improvement approach consists of: (1) regular and documented meetings of the EENC team, (2) at least two EENC assessments per year, and (3) developing and updating an EENC hospital action plan at least quarterly. 9. Data from observations of 21 deliveries at 3 national hospitals and 55 deliveries at 24 subnational hospitals. EENC 61% PARTIAL 63% 13% EENC included in pre-service curricula (medical, midwifery and nursing) EENC 5-year action plan developed, costed and adopted Clinical intra-partum and newborn care protocol adapted, reviewed and endorsed YES NO STOCK-OUTS OF KEY MEDICINES AND COMMODITIES FOR EENC IN THE PAST 12 MONTHS, 20174 Antibiotics for sepsis Vitamin K Corticosteroids Magnesium sulfate Oxytocin Functional bag and mask within 2 m of delivery beds 0 1 2–4 > 4 Number of stock-outs across 48 hospitals (3 national hospitals and 45 subnational hospitals) 0 20 40 60 80 100 0 0 20 20 40 40 60 60 80 80 100 100 Percentage of postpartum mothers Percentage of preterm babies Percentage of term babies Data from interviews and chart reviews of postpartum mothers: – 38 at national hospitals (n = 3) and – 389 at subnational hospitals (n = 45) Of the facilities that have introduced EENC4: Data from interviews and chart reviews of postpartum mothers: – 29 at national hospitals (n = 3), and – 45 at subnational hospitals (n = 15) Data from observations in 48 hospitals (3 national hospitals and 45 subnational hospitals) Data from interviews with postpartum mothers: – 38 at national hospitals (n = 3), and – 389 at subnational hospitals (n = 45) 71 69 Encouraged to eat and drink during labour 76 25 Prolonged (≥ 90 min) skin-to-skin contact 85 3Syphilis testing recorded 38 45 Pregnant women* at risk of preterm labour receiving corticosteroids 82 96Immediate skin-to-skin contact 83 44Immediate skin-to-skin contact 100 53 Sustained skin-to-skin contact until first breastfeed 1 4With companion during childbirth 4 62Prolonged (≥ 90 min) skin-to-skin contact 68 61 Received early and exclusive breastfeeding 70 71Episiotomy 98 100Oxytocin injected within 1 min of birth9 77 100Bathed in > 24 hours 14 67Skin-to-skin contact applied in C-section deliveries 68 68Partographs completed correctly Sustained skin-to-skin contact until first breastfeed national hospital national hospital national hospital subnational hospital subnational hospital subnational hospital 12 Not in supine position during active labour 0 Pregnant women < 32 weeks of gestational age receiving MgSO4 Received Kangaroo Mother Care 35 Received early and exclusive breastfeeding ANTENATAL CARE AND DELIVERY PRACTICES, 20174 ENVIRONMENTAL HYGIENE, 20174 KEY POINTS • 53% of all under-5 deaths in Viet Nam now occur in the newborn period. • Around 60% of hospital staff providing chidlbirth and newborn care have been coached in EENC at each level. • Almost all women are injected with oxytocin within 1 minute of child- birth. However, very few pregnant women have a companion during childbirth and encouraged to assume a non-supine positive during active labour. • Preterm newborns are less likely to receive EENC, which places them at higher risk of poor health outcomes. • Stock-outs of key medicines and commodities are more frequently reported in district hospitals than in provincial and national hospitals. • No hospital has adequate sink handwashing facilities in all maternal and neonatal care rooms. Adequate hand hygiene is practised in 4 out of 5 deliveries. Adequate hand hygiene6 practised in 79% of deliveries 19% of hospitals have alcohol gel/hand rub available in all delivery, recovery, postnatal and neonatal care rooms 0% of hospitals have adequate sink handwashing facilities5 in all delivery, recovery, postnatal and neonatal care rooms 90% of hospitals have clean and dry newborn resuscitation areas PRETERM BABIES, 20174 TERM BABIES, 20174 NEWBORN CARE PRACTICES * Women of 24–34 weeks of gestational age EENC IMPLEMENTATION, 20174 Hepatitis B vaccine no data 10 25 62 62 11 9 31 Skin-to-skin contact Exclusive breastfeeding from 0 to 1 month 27 PROGRAMME READINESS FOR EENC SCALE-UP 20173 Early EssEntial nEwborn CarE (EEnC) 2017 59 0 10 20 30 40 50 60 W PR /2 01 7/ DN H/ 01 4 – © W or ld H ea lth O rg an iza tio n 20 17 – S om e rig ht s re se rv ed . T hi s w or k is av ai la bl e un de r t he C C BY -N C- SA 3 .0 IG O li ce ns e.