WORLD PREMATURITY DAY: LOW-COST INTERVENTIONS EFFECTIVE TO PREVENT DEATHS RELATED TO PREMATURITY IN TANZANIA, SAY UNICEF AND PARTNERS

© UNICEF Tanzania/2014/HoltDar es Salaam, 17 November 2014 – In Tanzania, each year, around 213,000 babies are born too soon – or prematurely - over 9,000 of whom will die from complications of preterm birth. This is almost a quarter of the approximately 40,000 newborn babies dying every year in the country. Complications of preterm births are the second leading cause of death in newborns in Tanzania.
Tanzania has made big progress in the past few decades in child survival, with a decline in under-five mortality rate from 166 (1990) to 54 (2012). But the rate of reduction in neonatal mortality has been much slower, from 43 per 1,000 live births in 1990 to 21 in 2012. Deaths from preterm birth complications have also been slow to decline and represent a growing proportion of all under-five deaths.

In Tanzania, every day, more than 100 newborns die, mainly from infections, delivery-related complications like asphyxia (difficulty of breathing), and complications of prematurity (born too soon) 1. Newborn deaths now contribute up to 40 per cent of the total mortality of children under-five in Tanzania. Crucially most of these newborn deaths could be averted through cost-effective interventions. These figures call for increased attention and action for newborn babies and their mothers. According to the Every Newborn Action Plan, a global action plan to end preventable deaths, the critical period to save thousands of mothers and newborns lives is around the time of birth and in the first 24 hours of a newborn’s life, which is when 40 per cent of all stillbirths and newborn deaths, and 48 per cent of maternal deaths, occur.
In 2014, the Ministry of Health and Social Welfare (MoHSW), with support from various partners, developed the “Sharpened” One Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania 2014-15. This plan highlights the little progresses made for newborns and their mothers and the need to specifically address family planning, care around the time of birth and commodity security to reduce preventable deaths. If this plan is acted on nationally, we will be able to save the lives of 1,400 mothers, 9,400 newborn babies, and avert an additional 2,500 stillbirths by the end of 2015.
Babies born prematurely have an increased risk of dying and developing disabilities
Preterm babies are at greater risk of dying and of respiratory, gastrointestinal and neurological diseases when compared with babies born after 37 weeks of gestation. Preterm birth is also a risk for lifelong visual, hearing, cognitive and cardiovascular impairments 2. Furthermore, babies born prematurely in low-income countries are 10 times more likely to die than those born in high-income countries.
We can reduce the number of preterm births
In Tanzania and in many low-income countries, the main risk factors for preterm birth include infections during pregnancy, malaria, HIV, being underweight, short birth spacing and adolescent pregnancy. Appropriate care before, between, and during pregnancy (including family planning and antenatal care) are important to reduce preterm birth rates. However, a big proportion of preterm births remains unexplained 3. Hence we need further research to better understand and prevent their causes.
We can reduce the number of newborn babies dying from complications of prematurity
A baby born preterm does not necessarily need intensive care and high technology to survive. Cost-effective interventions which increase the chance of a newborn baby to survive and decrease the risk of developing disabilities later in life include:

1. Antenatal steroids, injected to mothers in premature labour, help develop immature foetal lungs and prevent respiratory problems of newborn babies.
2. Kangaroo Mother Care, a technique where the newborn baby is held skin-to-skin on the mother's chest helps to keep the baby warm and facilitates breastfeeding. Keeping preterm babies warm is especially important because their tiny bodies lose heat rapidly, making these babies highly vulnerable to illness, infection and death. It is estimated that Kangaroo Mother Care (KMC) could prevent 5,000 deaths annually in Tanzania 4.
3. Resuscitation with bag and mask and continuous positive airways pressure helps preterm babies with breathing difficulties. If simple resuscitation was available for 90% of the babies that needed it, at least 2,000 newborn lives would be saved per year 5. Helping Babies Breathe, a program launched by MoHSW in 2009 to train health workers at all levels of the health system on newborn resuscitation skills, aims to reduce deaths from asphyxia. Various partners have supported the MoHSW in this initiative.
4. Assisting the mother with initiation of breastfeeding within the first hour after birth, such as helping the mother express breast milk for feeding the baby from a cup if necessary.
5. Prevention, early detection and treatment of infections: hygienic practices around the time of birth (e.g. hand washing, hygienic cord and skin care) are important to prevent infections of both mother and baby. Antibiotics, such as amoxicillin, can be used to treat pneumonia, and gentamicin to fight serious infections in newborn babies.

In addition, all newborns need post-natal check-ups within 24 hours and after 3 days to prevent complications and later disabilities.
Better care needed at birth and especially for sick and small newborn babies
“Special care is needed for all newborns and especially important for babies born too soon,” says Dr. Jama Gulaid, the UNICEF Representative in Tanzania. “This means drying them, keeping them warm and clean, initiating breastfeeding within an hour of birth, and ensuring that babies who have difficulty breathing get immediate attention. There is a golden minute after birth that counts for every newborn.”
There is a well-established evidence that such essential care practices during pregnancy, childbirth, and postnatal period, without expensive, high-tech intensive care will save a significant number of preterm babies from death and most of these pre-term infants can grow up healthy and without lifelong disabilities.
As highlighted in the Every Newborn Action Plan as well as Tanzania’s sharpened One Plan, we need to strengthen and invest in care during labour, birth and the first week of life. Improving the quality of maternal and newborn care at health facilities as well as in the community, along the continuum of care; reduce inequalities and reach every woman and newborn; harness the power of parents, families and communities; and count every newborn through measurement, programme-tracking and accountability; this globally and in Tanzania. Every citizen has a role to play by demanding the quality service and holding the health.
"Of note, we need to increase training and support for all those who are delivering and attending the babies -- from obstetricians and paediatricians to midwives and nurses," adds Dr. Jama Gulaid.
Partners including UNICEF support the ministries to assess the situation of newborn, identify major bottlenecks and solutions to improve newborn health both in mainland and Zanzibar. The key support are upon capacity building of service providers in key maternal, neonatal and child health packages including the Helping Babies Breathe approach, Kangaroo Mother Care, Basic Emergency Obstetric and Newborn Care, and Essential Newborn Care as well as providing essential equipment and supplies and raising awareness and demand of women for quality MNCH care.
Partners are coming together to commemorate the World Prematurity Day and renew our promise to eliminate preventable child deaths. Improving newborn health including prematurity prevention and the quality of newborn care is a key part of this drive.
###
For further information, including interviews, please contact:
Sandra Bisin, UNICEF Tanzania, Mobile: +255 787 600079, sbisin@unicef.org
Jacqueline Namfua, UNICEF Tanzania, Phone: +255 754711073, jnamfua@unicef.org

______
1 Source: Levels & Trends in Child Mortality. 2014
2 Source: Born too soon report, 2012
3 Source: Born too soon report, 2012
4 Source: Situation analysis of Newborn Health in Tanzania 2009
5 Source: Situation analysis of Newborn Health in Tanzania 2009
http://www.unicef.org/tanzania/media_15695.html

UJAMAA ORPHANAGE FOUNDATION - PRIDE IN THE COMMUNITY 
Follow us on Facebook: www.facebook.com/ujamaa orphanage foundation