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Strengthening newborn health and prevention of birth defects PDF

81 Pages·2014·1.64 MB·English
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(cid:2)(cid:3)(cid:4)(cid:5)(cid:6)(cid:7)(cid:3)(cid:8)(cid:5)(cid:6)(cid:9)(cid:6)(cid:7)(cid:10)(cid:11)(cid:5)(cid:12)(cid:13)(cid:14)(cid:4)(cid:6)(cid:10)(cid:15)(cid:5)(cid:16)(cid:17)(cid:3)(cid:8)(cid:10) (cid:16)(cid:6)(cid:18)(cid:10)(cid:19)(cid:4)(cid:5)(cid:20)(cid:5)(cid:6)(cid:3)(cid:9)(cid:14)(cid:6)(cid:10)(cid:14)(cid:21)(cid:10)(cid:22)(cid:9)(cid:4)(cid:3)(cid:8)(cid:10)(cid:23)(cid:5)(cid:21)(cid:5)(cid:24)(cid:3)(cid:25) (cid:2)(cid:3)(cid:4)(cid:5)(cid:6)(cid:7)(cid:8)(cid:5)(cid:9)(cid:8)(cid:7)(cid:10)(cid:3)(cid:8)(cid:11)(cid:5)(cid:12)(cid:7)(cid:10)(cid:13)(cid:14)(cid:15)(cid:16)(cid:7)(cid:8)(cid:17)(cid:16)(cid:18)(cid:15)(cid:8)(cid:6)(cid:3)(cid:19)(cid:18)(cid:5)(cid:20)(cid:15)(cid:21)(cid:8)(cid:20)(cid:3)(cid:7)(cid:22)(cid:5)(cid:6)(cid:23)(cid:8)(cid:24)(cid:3)(cid:3)(cid:7)(cid:18)(cid:20)(cid:19) (cid:25)(cid:26)(cid:27)(cid:25)(cid:28)(cid:8)(cid:17)(cid:4)(cid:6)(cid:18)(cid:21)(cid:8)(cid:25)(cid:29)(cid:30)(cid:26)(cid:31)(cid:8)(cid:32)(cid:3)(cid:22)(cid:8)(cid:33)(cid:3)(cid:21)(cid:10)(cid:18)(cid:31)(cid:8)(cid:34)(cid:20)(cid:35)(cid:18)(cid:15) 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 All rights reserved. Requests for publications, or for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – can be obtained from Bookshop, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India (fax: +91 11 23370197; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. This publication does not necessarily represent the decisions or policies of the World Health Organization. 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 SEA Regional Network Meeting on Strengthening Newborn Health and Prevention of Birth Defects iii 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 SEA Regional Network Meeting on Strengthening Newborn Health and Prevention of Birth Defects vii 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 (cid:54)(cid:87)(cid:85)(cid:68)(cid:87)(cid:72)(cid:74)(cid:92)(cid:3)(cid:73)(cid:82)(cid:85)(cid:3)(cid:51)(cid:85)(cid:72)(cid:89)(cid:72)(cid:81)(cid:87)(cid:76)(cid:82)(cid:81)(cid:3)(cid:68)(cid:81)(cid:71)(cid:3)(cid:38)(cid:82)(cid:81)(cid:87)(cid:85)(cid:82)(cid:79)(cid:3)(cid:82)(cid:73)(cid:3)(cid:37)(cid:76)(cid:85)(cid:87)(cid:75)(cid:3)(cid:39)(cid:72)(cid:73)(cid:72)(cid:70)(cid:87)(cid:86)(cid:3)(cid:11)(cid:21)(cid:19)(cid:20)(cid:22)(cid:239)(cid:21)(cid:19)(cid:20)(cid:26)(cid:12)(cid:3)(cid:76)(cid:81)(cid:3)(cid:70)(cid:82)(cid:79)(cid:79)(cid:68)(cid:69)(cid:82)(cid:85)(cid:68)(cid:87)(cid:76)(cid:82)(cid:81)(cid:3)(cid:90)(cid:76)(cid:87)(cid:75)(cid:3) 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. SEA Regional Network Meeting on Strengthening Newborn Health and Prevention of Birth Defects 1

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4.2 Prevention and control of birth defects in the SEAR: .. United Nations agencies, partner organizations, AIIMS, CDC and WHO Regional and . and reported that a birth defects surveillance manual, atlas and training package . like computers; irregular updates of the database due to the clinical
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