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Pledge to cut child deaths down to zero in Bangladesh
The health minister has promised to make it a campaign pledge to bring down the child deaths to zero in Bangladesh at a roundtable where bdnews24.com gathered top policymakers of the health sector to discuss ways to keep ‘every child alive’.
Published : 25 April 2018, 04:48 PM
Updated : 26 April 2018, 04:05 AM
The decision-makers are optimistic as the rate of child deaths going down is faster in Bangladesh than in many other countries in the world.
Bangladesh has also helped the world to change policies for newborn care with its own research findings.
Minister Mohammed Nasim said on Wednesday the Awami League will adopt the reduction of child mortality rate to zero as a new election pledge.
“This will be our election pledge. I want to make this political commitment that we will keep it in the election manifesto,” he said as the Unicef launched a global campaign in February to keep ‘every child alive’.
Bangladesh is acclaimed globally for cutting under-5 deaths. But an estimated 170 children die every day before completing one month of their life here largely due to preventable causes. There are cheaper ways to prevent those deaths.
The roundtable before the general election due in December was seen as a way to push the politicians to make newborn care a promise in their pre-election manifesto.
The discussion highlighted the troubling numbers of newborn deaths.
bdnews24.com Editor-in-Chief Toufique Imrose Khalidi moderated the roundtable that addressed almost all aspects of newborn care, including the quality of care.
They also stressed making a booklet to make mothers and families aware of child births.
The experts deliberated on the disconnect between the two wings of the health ministry—Directorate General of Health Services and Directorate General of Family Planning.
The rising trend of caesarian deliveries was also discussed as the keynote speaker President of Bangladesh Paediatric Association Mohammad Shahidullah pointed at the fact that those are mostly done at private facilities. Child marriage is also seen as a factor behind the newborn deaths.
Director General for Health Abul Kalam Azad, Director General for Family Planning Kazi Mustafa Sarwar, UNFPA Representative in Bangladesh Asa Torkelsson, Save the Children’s Deputy Country Director Ishtiaq Mannan, Unicef Bangladesh’s Deputy Representative Sheema Sengupta, Chief of the health section Maya Vandenet and Health Manager Md Ziaul Matin were the speakers.
The health minister stressed awareness- building measures for the mothers and family members and sought more funds for the health sector in the budget.
Focus on first eight days
The absolute number of newborn deaths has declined from 241,000 in 1990 to 62,000 in 2016. But premature births, failure to breathe at birth and infections kill a large number of newborns on the first day of birth, according to the UN.
Eighty-eight percent of the newborn babies die from preventable causes such as preterm complications (45 percent), perinatal asphyxia (23 percent) and severe infections (20 percent).
“If you look at the data further, you will see most of those deaths take place in the first eight days of a child’s life,” said Shahidullah, who introduced neonatology in Bangladesh in early 1990s.
“Of the total newborn deaths, 50 percent happen within 24 hours, and 31 percent between the second day and the eighth day,” he said, citing the reasons of prematurity, breathing difficulties and infections.
Global studies say universal access to products that cost between $0.13 and $6 each could save those babies.
Steroid injections for women in preterm labour to reduce deaths due to premature babies’ breathing problems, resuscitation devices to save babies who do not breathe at birth, chlorhexidine umbilical cord cleansing to prevent infections and injectable antibiotics to treat newborn sepsis and pneumonia are recommended.
Premature babies are also recommended to give ‘kangaroo care’ in which they are put on skin-to-skin contact with their parents.
Shahidullah said teenage pregnancy is also a “dangerous” cause of both maternal and newborn deaths in Bangladesh.
Investments needed
He emphasised political leadership and said investments should be made to improve the facility. “Budgetary allocations [for the health sector] should be increased as in the long run it is a greater investment.”
The Unicef, which is a major partner in maternal and neonatal health efforts in Bangladesh, agrees on the need of investment.
The UN agency is supporting the government in upgrading facilities such as creating newborn care units in some hospitals and some other units in Upazila health complexes.
“Investment in facilities is absolutely critical,” said Maya Vandenent, Chief of the Health section of Unicef Bangladesh.
About 30 percent of newborn deaths can be reduced with the well-managed special newborn care units being set up in hospitals, she said.
Md Ziaul Matin, health manager of the health section of Unicef, praised Bangladesh for its own effort to reduce the newborn deaths.
Bangladesh kicked off the newborn campaign even before the global launch, he said. “We launched it in February, but Bangladesh (had already) started its own national campaign.”
“Bangladesh is well ahead of other countries,” he said, adding that the government has allocated Tk 3 billion for this special newborn care.
Sheema Sengupta, Deputy Representative of Unicef Bangladesh, said she was confident that the campaign will push politicians into greater accountability.
But she said there is a lot to be done, replying to the moderator Khalidi.
The new Health Sector Programme (2017-2022), for the first time, has incorporated a national newborn health programme in the operational plans to scale up newborn care, taking evidence and lessons from existing programmes supported by development partners.
Midwives can save newborn
The new Bangladesh chief of the UNFPA said a trained midwife can provide the essential maternal and newborn care.
Citing medical journal The Lancet, Torkelsson said they can actually provide 87 percent of the essential care in and around the delivery.
The government launched midwifery as a separate profession with the help of UNFPA in 2010 when Prime Minister Sheikh Hasina made this commitment at the UN General Assembly. Currently, there are 34 midwifery training centres in Bangladesh.
Last hundred miles matter
Save the Children’s Deputy Country Director Ishtiaq Mannan said Bangladesh has helped the world change its policy towards newborn care.
“Bangladesh has done two famous researches in the last decades—randomised control trials of Projonmo and chlorhexidine. Both have influenced global policy. This is a big success,” he said.
“Research evidence generated from Bangladesh changed the global policy.”
But he cautioned that Bangladesh is at the final hundred metre of the race as it cut down the absolute number of newborn deaths from 241,000 in 1990 to 62,000 in 2016.
For the last mile of the journey, business as usual will not work, Mannan warned.
Coordination matters
Ensuring that the two wings of the Ministry Health and Family Welfare matters work in a coordinated manner remains a key challenge.
The health directorate of the health ministry is in charge of delivering the services to the right people at the right time in right quality.
Family Planning programme intends to bring down the Total Fertility Rate (TFR) and unwanted pregnancies which will ultimately reduce the risks of both maternal and newborn deaths and diseases.
The family planning directorate also has extensive programme and network at the primary care level focusing on pregnancy and childbirth.
But very often it is heard that there is a lack of coordination between the DGFP and DGHS staff on the ground.
The two directors general also acknowledged that and said they worked on it and improved the situation.
The health minister said they are more aware of their works now. “I had instructed them [two wings] before. They are now working as brothers,” he quipped.
The two directors-general also signed a same circular to close the coordination gap.
The roundtable styled “Let's Save Every Newborn-Election Pledge needed”, held at the National Press Club in partnership with the Unicef, is part of the UN agency’s every child alive campaign.
It has been organised to inform decision-makers on the importance of investing in newborn programme, advocacy to boost national newborn campaign with the global campaign, and discuss necessary policy changes.
This will reinforce the national newborn campaign in Bangladesh and will engage political and opinion leaders to promote newborn health as a priority, as the future of the country.
The deputy representative of Unicef was confident that the campaign will push politicians into greater accountability.
Sengupta said their focus is to get political commitments.
“It does not matter which party is in power. This has to be the commitment from the government of Bangladesh and for the government of Bangladesh. It’s simple. It’s what we need,” she said.
Apart from Bangladesh, Ethiopia, Guinea-Bissau, India, Indonesia, Malawi, Mali, Nigeria, Pakistan and Tanzania are the other nine countries focused for this global campaign. Together, these countries account for more than half of the world’s newborn deaths.
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