Newborn Health in Humanitarian Settings - Field Guide

192 Pages·2017·16.37 MB·English

Newborn Health in
Humanitarian Settings
FIELD GUIDE
Baby Ismil* is comforted by his mother Azida* and grandmother Fatima*.
Four week-old Ismil* was born in a makeshift settlement for displaced
Rohingya people in Cox’s Bazar, Bangladesh.
Cover Photographer’s Credit:
© Hanna Adcock/Save the Children
Date:
23 November 17

*Names have been changed to protect identities.
Newborn Health in
Humanitarian Settings
FIELD GUIDE
UNICEF - Programme Division
3 United Nations Plaza
New York, NY 10017 USA
www.unicef.org
© United Nations Children’s Fund (UNICEF), and Save the Children
All rights reserved, revised January 2018.

This compendium is based on country-level documentation and data.
While carefully reviewed, it is not edited or fact checked to offcial UN
publication standards. Statements in the case studies do not imply or
constitute offcial opinions or policy positions of either The United Nations,
UNICEF or Save the Children
Table of Contents
ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
ABBREVIATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1. INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.1 W hat is the Purpose of this Field Guide? . . . . . . . . . . . . . . . . . . . 13
1.2. W ho is the Field Guide Intended For? . . . . . . . . . . . . . . . . . . . . . 14
1.3. H ow is the Field Guide Organized? . . . . . . . . . . . . . . . . . . . . . . . . 16
2. BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.1. H umanitarian Settings Across the Globe . . . . . . . . . . . . . . . . . 19
2.1.a. C hallenges to newborn health service delivery . . . . . . . . . . . . . . . . 22
2.2. N ewborn Health: Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.2.a. G lobal burden of newborn mortality . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.2.b. P rincipal causes of neonatal deaths . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3. NEWBORN HEALTH SERVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
3.1. G eneral Principles and Considerations . . . . . . . . . . . . . . . . . . . . . 39
3.1.a. T he continuum of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.1.b. L evels of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.2 E ssential Newborn Care (ENC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.2.a. E NC at the household level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
3.2.b. E NC in primary care facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
3.2.c. Essential newborn care in hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
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.3.3 erP utam ir w oL/yt iB ht r eW i thg )W BL( . . . . . . . . . . . . . . . . . . . . . . 15
3.3.a. M anaging prematurity at the household level . . . . . . . . . . . . . . . . . 65
3.3.b. Managing prematurity in primary care facilities . . . . . . . . . . . . . . . 75
3.3.c. M anaging prematurity in hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
.4.3 eN n robw efnI itc sno . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.4.a. M anaging infections at the household level . . . . . . . . . . . . . . . . . . . 56
3.4.b. M anaging infections in primary care facilities . . . . . . . . . . . . . . . . . 86
3.4.c. M anaging infections in hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 07
.5.3 utrapa rtnI m lpmoC iitac sno . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3.5.a. M anaging intrapartum complications at the household level . . . . 37
3.5.b. M anaging intrapartum-related complications in
primary care facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
3.5.c. M anaging intrapartum-related complications in hospital . . . . . . . 57
.4 GET ART S CI SNOIT AREDISNOC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
1.4 iaM ertsn ima gn eN n robw eH la ht i n uH inam irat na
droC iitan no . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.4 dnoC uitc gn a iS ut ita no lanA isy s . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
4.2.a. E xamine national policies and protocols . . . . . . . . . . . . . . . . . . . . . . 48
4.2.b. E xamine existing clinical guidelines, key messages/
BCC materials, tools and training materials . . . . . . . . . . . . . . . . . . . 58
4.2.c. I ncorporate questions about newborn health services
within a rapid health assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
4.2.d. A ssess resource availability: facilities, supplies and staff . . . . . . 68
Newborn Health in Humanitarian Settings: Field Guide 3
Newborn Strategic Program Implementation
1 Introduction 2 Background 3 Health Services 4 Considerations 5 Considerations 6 Annexes
4.3 Developing a Response Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
4.3.a. P rioritizing newborn interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
4.3.b. A ddress staff competency gaps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
4.3.c. P rocure essential medicines and supplies . . . . . . . . . . . . . . . . . . . . 93
4.3.d. U pdate and distribute clinical guidelines, protocols
and other essential materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
4.3.e. D istribute supply kits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
4.3.f. E stablish partnerships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
4.3.g. P romote quality improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
4.3.h. D evelop proposals to secure additional funding . . . . . . . . . . . . . . 95
4.4 Developing and Implementing a Monitoring
and Evaluation (M&E) Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
5. PROGRAM IMPLEMENTATION CONSIDERATIONS . . . . .100
5.1 D eveloping and Disseminating Key
Messages/BCC Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
5.2 Developing a Referral System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .102
5.2.a. W hen referral is not possible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104
5.3 H ome Visits for Mothers and Babies . . . . . . . . . . . . . . . . . . . . . .106
5.4. P rocuring Newborn Care Supply Kits . . . . . . . . . . . . . . . . . . . . . .108
5.5. N ewborn Deaths in Crisis Settings . . . . . . . . . . . . . . . . . . . . . . . .109
5.3.a. S upport for neonatal loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109
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.6 SEXENA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 1
enA x :1 Newborn Health Services Summary Tables,
by Level of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 1
A1 Essential Newborn Care (ENC) Services for all Newborns . . .31 1
B1 Services to Prevent and Manage Prematurity/LBW . . . . . . . . 121
C1 Services to Prevent and Manage Newborn
Infections and Sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .621
enA x :2 Doses of Common Drugs for Neonates . . . . . . . . . . . . . . . . . .50 1
enA x :3 Advanced Care for Very Sick Newborns . . . . . . . . . . . . . . . . . 041
A3 Requirements for Advanced Newborn Care . . . . . . . . . . . . . . . . 141
B3 S urveillance and Monitoring Form for Inpatient Newborns . . . 241
C3 Resources for Advanced Newborn Care . . . . . . . . . . . . . . . . . . . . 341
enA x :4 Tools to Support Neonatal Referrals . . . . . . . . . . . . . . . . . . . . 41
A4 Job Aid: When to Refer a Newborn to the Hospital . . . . . . . . . 541
B4 Job Aid: Transferring the Sick Newborn . . . . . . . . . . . . . . . . . . . . 051
C4 Sample Referral Note . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
ennA x :5 Newborn Care Supply Kits for Humanitarian Settings . . . . 251
A5 C ommunity Newborn Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
B5 Clinic or Primary Health Facility Newborn Kit . . . . . . . . . . . . . . 651
C5 Hospital Newborn Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
enA x :6 Indicators and Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . 861
A6 List of Indicators Collected Through Routine Systems . . . . . . 961
B6 List of Indicators and Questions to Measure Facility
Capacity to Provide Newborn Health Services . . . . . . . . . . . . . .87 1
Newborn Health in Humanitarian Settings: Field Guide 5
Newborn Strategic Program Implementation
1 Introduction 2 Background 3 Health Services 4 Considerations 5 Considerations 6 Annexes
ACKNOWLEDGEMENTS
Save the Children and the United Nations Children’s Fund (UNICEF)
led the development of the Newborn Health in Humanitarian Settings:
Field Guide with many thanks to Heather Papowitz and Ribka Amsalu,
in collaboration with representatives from Columbia University,
The ELMA Relief Foundation, International Medical Corps (IMC),
International Rescue Committee (IRC), Jhpiego, Johns Hopkins
University (JHU), London School of Hygiene and Tropical Medicine
(LSHTM), Offce of U.S. Foreign Disaster Assistance (OFDA), SickKids
Centre for Global Health, Stanford University, United Nations High
Commissioner for Refugees (UNHCR), United Nations Population
Fund (UNFPA), University of Alberta, U.S. Agency for International
Development (USAID), U.S. Centers for Disease Control and
Prevention (CDC), Women’s Refugee Commission (WRC), World Health
Organization (WHO) and World Vision International.
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Newborn Health in Humanitarian Settings: Field Guide 7
ABOUT
This Field Guide is a companion to the Inter-agency Field Manual
on Sexual and Reproductive Health in Humanitarian Settings (2018),
providing information related specifcally to newborn care during the
neonatal period (days 0-28). The interim Field Guide was originally
published in 2015. After feld-testing in two humanitarian crises
(South Sudan and Somalia) and soliciting extensive feedback from
practitioners, it was revised in 2017 and published in January 2018.
The Field Guide has been designed as an enhancement to national
strategies and programs aimed at improving the lives of newborns and
their mothers, and to strategies such as the Every Newborn Action
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