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Advancing Newborn Health and Survival in Developing Countries: A Conceptual Framework

Abstract

Four million newborns die every year at home, often without skilled care at delivery or any other contact with the formal health system. Improved household practices and use of services, often in the community, should improve survival. We developed a conceptual framework for household and community newborn and maternal care that acknowledges the inseparability of the mother and neonate, yet stresses elements relating to the newborn, heretofore underemphasized in safe motherhood and child-survival programs. The framework identifies five paths that, if implemented well, would generally improve newborn outcomes: (1) use of routine maternal and newborn care and good-quality services; (2) response to maternal danger signs; (3) response to the nonbreathing newborn; (4) care for the low birth weight baby; and (5) response to newborn danger signs, particularly those of infection. This model, balancing preventive (19 routine behaviors) and curative care (14 special behaviors), is rooted in the community, bridges safe motherhood and child survival, and provides a framework for newborn health research, programmatic, and advocacy agendas for developing countries.

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References

  1. Stoll BJ . The global impact of neonatal infection Clin Perinatol 1997 24: 1–2

    Article  CAS  Google Scholar 

  2. World Health Organization (WHO). Perinatal Mortality — A Listing of Available Information. Maternal Health and Safe Motherhood Programme Geneva: World Health Organization (WHO) 1996 (WHO/FRM/MSM/96.7)

  3. World Health Organization (WHO). Mother–Baby Package: Implementing Safe Motherhood in Countries. Maternal Health and Safe Motherhood Programme Geneva: World Health Organization (WHO) 1994 (WHO/FHE/MSM/94.11)

  4. Goldenberg RL, Rouse DJ . Prevention of premature birth N Engl J Med 1998 339: 313–20

    Article  CAS  Google Scholar 

  5. Jewkes R, Wood K . Competing discourses of vital registration and personhood: perspectives from rural South Africa Soc Sci Med 1998 46: 1043–56

    Article  CAS  Google Scholar 

  6. Ahmed S, Sobham F, Islam A, e-Khuda B . Neonatal morbidity and care-seeking behaviour in rural Bangladesh J Trop Pediatr 2001 47: 98–105

    Article  CAS  Google Scholar 

  7. Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD . Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India Lancet 1999 354: 1955–61

    Article  CAS  Google Scholar 

  8. Bang AT, Bang RA, Morankar VP, Sontakke PG, Solanki JM . Pneumonia in neonates: can it be managed in the community? Arch Dis Child 1993 68: 550–6

    Article  CAS  Google Scholar 

  9. Bartlett AV, Paz de Bocaletti ME, Bocaletti MA . Neonatal and early postnatal morbidity and mortality in a rural Guatemalan community: the importance of infectious diseases and their management Pediatr Infect Dis J 1991 10: 752–7

    Article  CAS  Google Scholar 

  10. World Health Organization (WHO). Essential Newborn Care. Report of a Technical Working Group Geneva: World Health Organization (WHO) 1996 (WHO/FRH/MSM/96.13)

  11. Murray J, Adeyi GN, Graeff J et al. Emphasis behaviors in maternal and child health: focusing on caretaker behaviors to develop maternal and child health programs in communities Arlington, VA: BASICS 1997 http://www.basics.org/publications/Emphais/Emphasis.htm

    Google Scholar 

  12. UNICEF. International Workshop on Improving Children's Health and Nutrition in Communities, 20–23, June 2000, Durban, South Africa New York: UNICEF 2000 p 3–4

  13. McCarthy J, Maine D . A framework for analyzing the determinants of maternal mortality Stud Fam Plann 1992 21: 1 23–33

    Article  Google Scholar 

  14. Tinker A, Koblinsky MA, Daly P et al. Making motherhood safe Washington, DC: World Bank 1993 p 11

    Book  Google Scholar 

  15. Koblinsky M . On the pathway to maternal health — results from Indonesia MotherCare Matters 1995 5: 1 1–2

    Google Scholar 

  16. UNICEF. UNICEF Programming for Safe Motherhood New York: UNICEF 1999 p 17

  17. Save the Children. Saving newborn lives strategic planning workshop — summary report, June 11–12, 2000, Shepherdstown, WV Washington, DC: Save the Children 2000 (Annex G and I)

  18. Marsh DR, Sternin M, Khadduri R et al. Identification of model newborn care practices through a positive deviance inquiry to guide behavior change interventions in Haripur, Pakistan Food Nutr Bull in press

  19. Darmstadt GL, Black RE, Santosham M . Research priorities and postpartum care strategies for the prevention and optimal management of neonatal infections in less developed countries Pediatr Infect Dis J 2000 19: 739–50

    Article  CAS  Google Scholar 

  20. Waldman RJ, Bartlett AV, Campbell CC, Steketee RW . Overcoming Remaining Barriers: The Pathway to Child Survival Arlington, VA: United States Agency for International Development, the BASICS Project 1996

    Google Scholar 

  21. Claeson M, Waldman RJ . The evolution of child health programmes in developing countries: from targeting diseases to targeting people Bull WHO 2000 78: 10 1234–45

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by Save the Children Federation — US through a grant from the Bill & Melinda Gates Foundation.

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Marsh, D., Darmstadt, G., Moore, J. et al. Advancing Newborn Health and Survival in Developing Countries: A Conceptual Framework. J Perinatol 22, 572–576 (2002). https://doi.org/10.1038/sj.jp.7210793

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