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Funders and Their Role
Results The overview included 61 reproductive (n=3), maternal (pregnancy: n=15; childbirth: n=11; postpartum: n=4), newborn (n=12) and child (n=16) health interventions to assess their impact on neonatal and child survival (Panel 1). A total of 148 systematic reviews were identified for these 61 RMNCH interventions, of which 92 were Cochrane reviews, 55 were non-Cochrane reviews and one was a WHO guideline on management of unintended pregnancy. Of these 148 reviews, only 57 reviews reported mortality outcomes (Panel 2). We identified 11 promising interventions for reducing neonatal, infant, child or perinatal mortality (antenatal care; tetanus immunization in pregnancy; prophylactic antimalarial during pregnancy; induction of labour for prolonged pregnancy; case management of neonatal sepsis, meningitis and pneumonia; prophylactic and therapeutic use of surfactant; continuous positive airway pressure; case management of childhood malaria; case management of childhood pneumonia; vitamin A as part of treatment for measles associated pneumonia for children above 6months; and home visits across the continuum of care) and a further four interventions were rated as promising for reducing stillbirths (prophylactic antimalarial during pregnancy; provision and promotion of ITNs during pregnancy; induction of labour for prolonged pregnancy; and home visits across the continuum of care). Eighteen interventions showed insufficient evidence of benefit in one or more of the mortality categories (Table 1).
Discussion There have been many great successes in reducing neonatal mortality as part of the MDGs, however, the current rates are still too high since each year 2.9 million newborns do not live to their first month of life (Berkley et al., 2014). In order to accelerate the progress towards reaching the targets set for 2015, this overview aimed to identify key interventions for neonatal and later survival. Review of all the recent Cochrane and other reviews on pre-pregnancy, pregnancy, neonatal and child health interventions which have reported perinatal or neonatal and child mortality identified six highly effective and 11 promising interventions which are likely to improve health and survival among babies. During the past decade, notable advances have been made in reviewing the evidence pop over to this site for newborn interventions (Bhutta et al., 2013, 2014), especially in the context of essential interventions, packages of care and their interconnections (Lassi et al., 2013a). The key effective interventions for improving the survival identified in this overview include antenatal corticosteroids for preventing neonatal RDS in preterm infants; early initiation of breastfeeding; hygienic cord care; KMC for preterm infants; provision and promotion of use of ITNs for children; and vitamin A supplementation for infants from six months of age. Among these, four are particularly effective for neonates, while two had clear implications for improving the survival among infants and children. Most of the interventions identified are very effective for premature infants, as deaths from preterm births complications are the leading cause for neonatal deaths (Bhutta et al., 2013). Every year, an estimated 15 million babies are born preterm. Of these over one million die. The common cause of neonatal mortality is RDS which is related to prematurity. The incidence of mortality due to prematurity is highest in LMIC (Blencowe et al., 2012) where even moderately preterm babies strive for survival. Preventing deaths from preterm births, is therefore of the utmost importance. Administration of antenatal corticosteroids to women at risk of preterm birth can prevent deaths among babies related to RDS. This overview further suggests that the risk of deaths among those who are born too soon can be halved (50%) by encouraging KMC which not only ensures skin-to-skin contact, but promotes breastfeeding and early recognition of danger signs and illnesses in newborns. Similarly, the benefits of breastfeeding have been well documented; with studies suggesting much greater benefits of early vs. late feeding (Debes et al., 2013). Early initiation of breastfeeding can reduce neonatal deaths by 44%. At the same time hygienic cord care can further reduces mortality by 23%. For children under the age of five years, infections accounts for a large number of deaths. Prevention of malaria particularly in malaria endemic countries can ensure 18% reduction in mortality. Provision of vitamin A for children above 6months of age, which decreases the susceptibility towards infection, can also improve survival and health.