SeriesCan available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?
Introduction
This Lancet Every Newborn Series shows that despite a halving of under-5 child deaths in the past two decades, progress in reducing newborn deaths has been slower, with about 3 million neonates still dying every year.1 Reductions in neonatal mortality have averaged 2·0% annually since the Millennium Development Goals (MDG) baseline in 1990, which is much slower than corresponding reductions in maternal mortality (2·6%) or mortality in children 1–59 months of age (3·4%). Additionally, 2·6 million stillbirths (≥28 weeks or ≥1000 g) occur every year, including 1·2 million during labour.2 These stillbirths were not counted in the MDGs and progress has been substantially slower than even that for reductions in newborn mortality.1 Achievement of the proposed Every Newborn targets of ten or fewer neonatal deaths and stillbirths per 1000 births in every country1, 2 would need a doubling of present rates of change at a global average, and more in some high-burden countries. Such progress needs focus on the most effective interventions and intentional investment and implementation, which has been insufficient so far.3 In this third paper of the Series, we provide an update of the evidence base for interventions since the Lancet 2005 Neonatal Series and 2011 Stillbirth Series, and other relevant reviews.4, 5, 6, 7 We estimate the potential lives saved and the running costs of implementation, and make recommendations for prioritisation linked to the Every Newborn Action Plan.
Section snippets
Review of interventions and delivery platforms
We identified specific interventions across the continuum of care (preconception, antenatal, intrapartum, immediate postnatal period, and thereafter), building on previous evidence reviews4, 5, 6, 7, 8 (appendix pp 3–4), which could affect stillbirths and newborn outcomes (figure 1). We also reviewed delivery platforms that could augment the uptake of these interventions and methods to improve quality of care. We searched all major databases to identify available quality systematic reviews in
Methods
We selected interventions from those reviewed, based on evidence of benefits as described here and extensively in previous publications. The cause-specific effects of these interventions on stillbirths and neonatal mortality are presented in table 2 and appendix pp 50–64. We used the Lives Saved Tool (LiST) to model the effect of these interventions within the health systems of 75 Countdown countries that together account for more than 95% of maternal, neonatal, and child deaths worldwide. LiST
Discussion
Our review is the first comprehensive analysis of the evidence base and strategies to address global newborn health and survival and delivery strategies since our analyses in 2005, and has the additional strength of considering maternal and stillbirth outcomes.5, 136 During the past decade, notable advances have been made in the breadth and depth of the evidence base for newborn interventions,1 especially in the context of essential interventions and packages of care.137 Some highlights include
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