Strengthening newborn health and prevention of birth defects

81 Pages·2014·1.64 MB·English

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SEA-CAH-14
Strengthening Newborn Health
and Prevention of Birth Defects
Report of the South-East Asia regional network meeting
23–25 April 2013, New Delhi, India
© World Health Organization 2014
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Printed in India
Contents
Acronyms ...............................................................................................................v
Executive summary ...............................................................................................vii
1. Introduction ...................................................................................................1
1.1 Objectives ........................................................................................................2
2. Inaugural session ............................................................................................3
3. Setting the stage .............................................................................................5
3.1 Emerging paradigm of newborn health ..............................................................5
3.2 Addressing preterm births: global movement .....................................................6
3.4 Regional initiatives to strengthen newborn health and prevent birth defects .......9
4. Strategies for prevention and control of birth defects ....................................11
4.1 Prevention of birth defects and maternal risk factors ........................................11
4.2 Prevention and control of birth defects in the SEAR:
Strategic Framework (2013–2017) ...................................................................12
5. Regional and national networks ....................................................................14
5.1 Progress of the Regional Network on Newborn Health.....................................14
5.2 Progress of national networks on newborn health ............................................15
5.3 Perspectives for the future ...............................................................................18
6. Database for newborn health and birth defects .............................................19
6.1 Surveillance for birth defects: principles ...........................................................19
6.2 Regional–national networks for birth defects: conceptual framework ...............21
6.3 Neonatal-perinatal database: available models ................................................22
6.4 Group work on variables for an integrated database on
newborn health and birth defects ....................................................................26
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7. Initiatives on strengthening newborn health and preventing birth defects ......27
7.1 National Birth Defects Registry and Birth Defects Prevention
Programme: Thailand ......................................................................................27
7.2 National child health screening and early interventions: India ..........................28
7.3 Integrating birth defects surveillance in the existing system: Sri Lanka ...............29
7.4 Strengthening facility-based newborn care in countries of the South Asian
Association for Regional Corporation ...............................................................30
8. Capacity-building .........................................................................................31
8.1 Birth Defects Surveillance Manual: overview ...................................................31
8.2 Communication strategy for birth defects prevention .......................................32
8.3 E-training for newborn health care ...................................................................32
8.4 Standard treatment protocols to manage newborn conditions in
small hospitals .................................................................................................33
9. Technical updates and guidelines ..................................................................35
9.1 Elimination of congenital syphilis ....................................................................35
9.2 Newborn screening: India ...............................................................................36
9.3 Newborn screening: Thailand ..........................................................................37
9.4 Coordinated approaches to address preterm births and birth defects ...............38
9.5 Evidence for the prevention of neural tube defects ..........................................40
9.6 Prevention of congenital rubella syndrome ......................................................42
9.7 Prevention and control of haemoglobinopathies ..............................................43
10. Action plan to establish/strengthen networks for newborn health and
birth defects .................................................................................................45
11. Panel discussion: reflections and commitments by partners ...........................46
12. Conclusions and recommendations ..............................................................48
Annexes
1. List of participants ........................................................................................51
2. Agenda .........................................................................................................56
3. Country action plan ......................................................................................58
iv SEA Regional Network Meeting on Strengthening Newborn Health and Prevention of Birth Defects
Acronyms
AIIMS All India Institute for Medical Sciences
apps application
ASHA Accredited Social Health Activist
CDC Centers for Disease Control and Prevention, Atlanta, USA
CRS congenital rubella syndrome
FFI Food Fortification Initiative
HMIS Health Management Information System
ICD International Statistical Classification of Diseases and Related Health
Problems, Tenth Revision
ICDDR,B International Centre for Diarrhoeal Disease Research, Bangladesh
MDG Millennium Development Goal
MMR measles, mumps and rubella (vaccine)
MR measles and rubella (vaccine)
NNPD neonatal–perinatal database
NTD neural tube defect
RCH reproductive and child health
RMNCH+A reproductive, maternal, neonatal, child health and adolescent health
SAARC South Asian Association for Regional Corporation
SEAR WHO South-East Asia Region
SEA Regional Network Meeting on Strengthening Newborn Health and Prevention of Birth Defects v
SNCU special newborn care unit
STP standard treatment protocol
UNICEF United Nations Children’s Fund
WHO World Health Organization
YLD years without a disability
vi SEA Regional Network Meeting on Strengthening Newborn Health and Prevention of Birth Defects
Executive summary
Although there has been significant progress in the reduction of child mortality in
the World Health Organization Office for South-East Asia Region over the past two
decades, neonatal mortality remains high. One million newborns die every year in the
Region, that is one third of the global burden. In response, the WHO Regional Office
has taken several initiatives to support Member States to strengthen national newborn
health programmes. One of the most significant of these has been to establish a regional
network of institutions for newborn health. The network has been instrumental in
developing training materials and tools for strengthening newborn health care in the
Region. Corresponding national networks for newborn health have since been initiated
in Bangladesh, Myanmar and Nepal. Furthermore, a regional neonatal-perinatal databse
has been developed in order to generate epidemiological information.
The South-East Asia Regional Strategic Framework on the Prevention and Control
of Birth Defects was published in 2013. To support implementation of this strategy, it
is planned to establish a Regional Network on Birth Defects to function along similar
lines to, and in close collaboration with the Regional Network on Newborn Health. In
addition, birth defects would be integrated in the existing neonatal–perinatal database
to be used by member institutions of the two networks. Capacity-building tools would
also be developed by the Regional Birth Defects Network to support the development
and implementation of birth defects programmes in the countries.
In this context, a regional network meeting on strengthening newborn health and
prevention of birth defects was held on 23–25 April 2013 in New Delhi, India. The
meeting aimed to review progress in the establishment of national neonatal-perinatal
networks; to disseminate educational and training tools on newborn health; to discuss
the Regional Strategic Framework on the Prevention and Control of Birth Defects; to
establish regional and national networks on the prevention of birth defects; and to
identify linkages with the regional network on newborn health. Participants included
national programme managers for newborn health and birth defects from 10 of the 11
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Member States of the Region, members of the Regional Network on Newborn Health,
WHO staff from the Regional and Country Offices, birth defects experts, the United
States Centers for Disease Control and Prevention (CDC), and representatives from
United Nations agencies and other partner organizations.
The participants agreed that, while implementation of existing evidence-based
interventions to reduce newborn mortality remained important, prevention of birth
defects needed to be recognized as a public health priority to achieve Millennium
Development Goal 4 and to sustain progress beyond 2015. Based on the progress and
role of the Regional Network on Newborn Health, it was recommended to establish
a Regional Network on Birth Defects which would be coordinated by the WHO
Collaborating Centre for Genetics at the All India Institue for Medical Sciences, New
Delhi, India. This Network would work in close collaboration with the existing Regional
Network on Newborn Health being coordinated by the WHO Collaborating Centre
on newborn health at the same institute.
Recommendations were developed for Member States as well as for WHO, CDC
and other partners. In addition, proposed action plans for the next few years were
developed by each participating country.
viii SEA Regional Network Meeting on Strengthening Newborn Health and Prevention of Birth Defects
1. Introduction
Every year, 1 million of the 3 million global neonatal deaths occur in the South-East Asia
Region (SEAR). An equal number of stillbirths also take place annually in the Region. High
coverage of an evidence-based intervention could avert the majority of these deaths.
Among the approaches taken by the World Health Organization (WHO) South-East
Asia Regional Office to promote newborn health has the provision of capacity building
and catalytic support to centres of excellence in Member States to create a regional
resource. Through regional meetings held in 1998, 2002 and 2011, WHO Regional
Office for South-East Asia has brought the newborn health leadership of the Region
together to form the Regional Network on Newborn Health. The Network has been
instrumental in developing a neonatal-perinatal database, learning resource materials
and packages for newborn care, and standard treatment protocols to manage common
newborn conditions in small hospitals that have contributed to strengthen newborn
health care in the Region.
The regional neonatal-perinatal database generates prospective information on
neonatal/perinatal morbidity and mortality using standardized tools for data collection
and analysis. New insights into the profile of neonatal and perinatal epidemiology were
also generated. Subsequently, the establishment of corresponding national networks
for newborn health has been initiated in Bangladesh, Myanmar and Nepal.
WHO Regional Office for South-East Asia has recently published the Regional
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Member States. To support implementation of the strategy, it is proposed to establish a
Regional Network on Birth Defects for surveillance and prevention. This Network will
be established based on the experience of the Regional Network on Newborn Health,
and with which it will function in close collaboration. A common database is to be
developed for use among the member institutions of the two networks. In addition,
capacity-building tools are planned to support the development and implementation
of birth defects programmes in the countries.
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