New strategy to cut three million baby deaths

Behind closed doors in Mangochi district hospital, Malawi, Lukia Idrusi was told that 32 hours previously she had given birth to a stillborn baby. Although she had been anxiously asking about the baby since coming round from her operation, her grandmother had felt she was too ill to be given the tragic news.

Behind closed doors in Mangochi district hospital, Malawi, Lukia Idrusi was told that 32 hours previously she had given birth to a stillborn baby. Although she had been anxiously asking about the baby since coming round from her operation, her grandmother had felt she was too ill to be given the tragic news.

Lukia had realised something was wrong almost as soon as her labour began. "It went on for hours and hours and then I felt something burning inside me. Then I stopped feeling labour pains," she said. A clinical examination confirmed that her uterus had ruptured and the foetal heartbeat had stopped.

Lukia lost her baby, and nearly her life, for want of basic obstetric care. Each year four million babies die in the first four weeks of life, 99 per cent of them in developing countries.

Today, a panel of public health experts assembled by The Lancet medical journal sets out a strategy based on 16 simple, cheap measures which they say could save three million of these lives. By treating infections, delaying premature birth and improving care at delivery they believe the global death toll could be cut by 70 per cent.

The cost, $4.1bn (£2.15bn) on top of the $2bn already being spent, amounts to less than $1 a day per inhabitant of the 75 countries with the highest mortality, they say. Most of the deaths occur in 10 countries in Asia and sub-Saharan Africa.

Richard Horton, the editor of The Lancet, which publishes the research today, said: "The annual death toll is equivalent to all the babies born in Western Europe each year being wiped out. Although 99 per cent of these deaths occur in poor countries, almost all published research relates to the 1 per cent of newborn deaths in rich countries. The deaths of 10,000 newborn children every day, largely ignored in global policy, demands immediate and sustained action from international agencies, professional organisations and governments in rich and poor countries."

The main causes of newborn death are prematurity, severe infections, diarrhoea and suffocation. Tetanus and labour complications are also important causes. Another four million babies are stillborn, and most of those die during labour, the researchers found.

Success is possible without high technology, such as intensive care units and ventilators, and even without massive hospital building programmes or the overhauling of health systems, say the experts. Tetanus vaccine is safe and cheap - 40 cents for the two shots required. Yet 250,000 babies die each year from the infection. Major programmes are in place to prevent mother-to-child transmission of HIV, yet this costs $20 per patient.

Cheap antibiotics can treat infections, delay premature birth and improve birth weight. A shortage of skilled staff is the main problem, but the authors argue that outreach campaigns to provide vaccination, promote home care of babies and community schemes to treat babies with pneumonia can save lives.

Zulfiqar Bhutta of the Aga Khan University, Pakistan, one of the authors, said 50 measures were considered and the 16 most effective selected. "Delivering these simple low-cost interventions would save three out of every four deaths," he said.

Carol Bellamy, the executive director of Unicef, said: "This is where Unicef will be placing its emphasis in the next few years." The authors tackled the myth that only rich nations had reduced neonatal deaths, pointing to successes in Honduras, Indonesia, Moldova, Nicaragua, Sri Lanka and Vietnam.

16 LIFE-SAVING STEPS

1: FOLIC ACID SUPPLEMENTS

Cost: £93m

Cuts the incidence of spina bifida by 72 per cent. Has small impact on mortality but good in preventing disability

2: TETANUS VACCINATION

Cost: £64m

Tetanus accounts for 500,000 deaths a year. Universal immunisation would wipe that out

3: SYPHILIS SCREENING

Cost: £1.6m

Syphilis is one of the most important causes of stillbirth and babies can be born infected. One shot of penicillin treats it

4: PRE-ECLAMPSIA (HIGH BLOOD PRESSURE) IN PREGNANCY

Cost: £263m

More common in Africa than Europe and threatens life of mother and baby. Treatment with magnesium sulphate can help

5: MALARIA

Cost: £17m

Many pregnant women have malaria, slowing growth of the baby. Treat every woman with one dose of Fansidar a month

6: BACTERIURIA

Cost: £11m

A common infection of the urine which causes premature birth. Screen and treat women with antibiotics

7: PREMATURE LABOUR

Cost: £12m

Early rupture of the membranes caused by infection. Birth can be delayed with the use of antibiotics

8: STEROID TREATMENT

Cost: £226m

Two injections given to women in premature labour reduces breathing difficulties in the baby and cuts deaths by 40 per cent

9: EMERGENCY OBSTETRIC CARE

Cost: £1.4bn

Skilled midwives and equipment to deal with breech deliveries and other emergencies

10: LABOUR SURVEILLANCE

Cost: included in no. 9

Tracking progress of labour - how the cervix is dilating - allows early intervention to prevent problems such as asphyxia

11: CLEAN DELIVERY

Cost: £27m

Clean hands, clean surface, clean blade to cut the cord and a clean tie to tie it, reduces infection and can cut deaths

12: RESUSCITATION

Cost: £27m

Immediate assistance from midwives or birth attendants to revive the baby after birth can cut deaths by up to 42 per cent

13: BREASTFEEDING

Cost: £395m

Promoting exclusive breast-feeding for four to six months ensures the gut is lined with protective bacteria

14: PREVENTING HYPOTHERMIA

Cost: £50m

Keep the baby warm by drying it straight after birth. No early bathing saves lives

15: KANGAROO MOTHER CARE

Cost: Included in No9

Promoting skin to skin contact for smaller babies is better for them than an incubator, reduces infections and promotes breast-feeding

16: PNEUMONIA TREATMENT

Cost: £15m

Checks for infected babies by counting their breathing rate and treating with antibiotics cuts deaths by 27 per cent

Total: $6.1bn (including $2bn being spent)

Extra spending required: $4.1bn