make them count using the best data for maximum impact

Newborn Indicators Marketplace

Kate KerberJune 30, 2010

Make them count: using the best data for maximum impact

Outline

• Numbers, Rates and Causes • UN vs IHME?

• Countdown• Coverage of service use and behaviours• Equity, Policy, Finance

• Making an impact: presenting results• Using and improving your own programme data

(Tanya)

Definitions for reference• Neonatal: death within 0-28 days of life. (Early: day 0-7, Late: day 8-

28)– Neonatal Mortality Rate: deaths / annual births * 1000

• Infant – birth to one year• Child – deaths after 1 year and before 5 years• Under 5 – deaths from birth to age 5• Maternal mortality: death due to pregnancy-related causes

– Maternal Mortality Ratio: deaths / annual births * 100,000• Stillbirth: babies born dead after 28 weeks gestation

– Stillbirth rate: deaths / total births * 1000• Perinatal: Stillborn babies of 22+ wks plus deaths in the first 7 days

of life but definition varies. – Perinatal mortality rates: confusing!

Numbers – neonatal deaths

• NMR = number of deaths / number of annual births * 1000

• Number of deaths = NMR * annual births / 1,000

• Annual births?– Number of deaths will change if annual births change– Birth registration range: 4% Uganda to 87% Vietnam– UN Population Division estimates for consistency (e.g.

SOWC)

Progress to MDG 4 – child survival (global)

MDG 4 target (32)

Ref: Lawn, Kerber et al BJOG 2009 updated with data for 2008 from UN Child Mortality Group, WHO//CHERG and IHME (Rajaratnam J eta l 2010)

3.6 million neonatal deaths41% of under 5 deaths: Links closely with MDG 5

We are at a tipping point regardless of the estimates used

USA NMR is 4

Progress towards MDG 4 in 2008

On track: under-five mortality rate (U5MR) is less than 40, or U5MR is 40 or more and the average annual rate of reduction (AARR) in the U5MR observed for 1990-2008 is 4.0 percent or more

No Progress: U5MR is 40 or more and AARR is less than 1.0 per cent

Insufficient Progress: U5MR is 40 or more and AARR is less than 4.0 percent but equal to or greater than 1.0 percent

Data not available

Source: UNICEF, The State of Africa’s Children. Celebrating 20 Years of the Convention on the Rights of the Child. New York, 2010 (Table 10. The rate of progress)

Global progress to MDG 5 – maternal survival (Africa)

Ref: Kinney et al, PLoS 2010. Data from Hill et al 2007, Hogan et al 2010.

Overlapping estimatesStill not enough progress

IHME projects for 2010 on modeled data whereas the UN estimates for 2008 on existing data

Consistency and comparing like with like where possible

Not enough opportunity to review IHME methods

Other UN partners and bodies, including Countdown, are continuing to use UN numbers which have been through “country validation”

Reality: many countries aren’t using either of the UN or IHME numbers

We should continue to the use UN numbers because (25 June):

Everyone’s a critic but they are not very critical

Know the mortality rates in your country: UN, IHME, DHS, MICS - and when to use them

MMR in particular subject to very high uncertainty so do not use to show trends over time

Know how many deaths your estimate is based on (beware of small numbers) and where they come from

Encourage vital registration and strong HMIS in your countries

Source: CHERG/WHO 2010. Estimates for 193 countries for 2008. Black R et al Lancet 2010

New estimates of causes of newborn deaths

New from 2003 “Real” data used

for China and India Multi-cause model

used for all U5 Uncertainty

bounds

Neonatal messages 3 causes = 81% Tetanus declining National profiles

differ greatly

Countdown to 2015 for MNCH

68 countries accounting for 95% of deaths Multi-agency effort to analyze, summarize,

synthesize and disseminate data Contraceptive use Antenatal care Skilled attendance at delivery Postnatal care Child health Financial investment Equity of access Health systems and policy

Released at Women Deliver: Decade report with data profiles for 68 countries

SC representation through Joy Lawn as technical co-chair

Countdown to 2015: Coverage

20 coverage indicators tracked over time – increase is possible!

PNC database – advancing the indicator

SC representation through Allisyn Moran

Download the Countdown to 2015 meeting presentations:www.countdown2015mnch.org/conferences/2010conference/2010-session-reports

http://www.countdown2015mnch.org/conferences/2010conference/2010-session-reports


Countdown to 2015: Finance





Critical determinants of coverage across the continuum of care

SC representation through UK – Simon Wright/Nouria Brikci

Countdown to 2015: Policy

CCMTask shiftin

g

IMNCI

Costed

plans




Poorest compared to richest across 8 interventions

Validity? Usability? SC representation – Kate Kerber

If all families in Nigeria got the same care as the richest families:NMR would be halved and 127,000 newborn deaths would be prevented

Countdown to 2015: Equity

Gap between poorest and richest households along the continuum of care in Uganda

0%

20%

40%

60%

80%

100%

Antenatal care(1+ visit)

Skilledattendant atchildbirth

Postnatal carewithin 2 days

DPT1

P oorest fifth householdsRichest fifth households

Uganda DHS 2006

Locally owned and Locally owned and led data for actionled data for action Country data Country data

profilesprofiles

Translating data into policy and programmatic action

Newborn Indicators Marketplace

Indicators for Newborn Health Programs

Tanya GuentherJune 30, 2010

Outline

• Newborn Indicator TWG Updates• Indicators for Kangaroo Mother Care• Resources • Discussion

Newborn Indicator TWG

Rationale:• Growing interest in newborn health

– Millennium Development Goals (MDGs 4 and 5)– WHO/UNICEF Joint Statement on Home Visits – Global Health Initiative

• Data gaps in monitoring and tracking newborn health– Countdown 2015 profiles and tracking process– LiST review of evidence

• Opportunities exist– DHS, MICS, SPA revision– SNL and partners’ sub-national surveys


Progress to date:• April 2008 Consultative Meeting convened by SNL• Inter-agency Working group formed • Research conducted to address gaps

– PNC/PPC data analysis for home/facility births (Bangladesh and Egypt using DHS data)

– Qualitative study on recall and practices (Bangladesh, Malawi by Macro and Ghana by ICH)

– MICS4 pre-test in Kenya

• Follow-up TWG meetings: January & June 2010


Areas of Focus:• PNC indicator

– Timing and place of visit, care provider– Content of visit – how much can we expect in large surveys?– Denominator – all births

• Newborn behaviors/practices – What to measure, how to ask questions, timing

• Newborn services at facilities– Ensure key drugs/equipment and staff competency measured: eg ANC

and PNC visits, EmOC, resuscitation, KMC, sepsis• Other areas

– Pregnancy vs birth histories, recognition of danger signs, care seeking, referral, KMC, HMIS, verbal autopsy, perinatal audit, policy and finance benchmarks


Progress and Recommendations:

PNC contact – Consensus on:

• timing of visit (within 2 days)• denominator should include all births • data must be comparable for the mother and baby• place of visit/provider may vary• there are issues with the numerator as it is currently measured


PNC (con’t):– MICS4 being finalized

– DHS will include all births– Outstanding issues:

• Content of PNC check • Cut-off for PNC to distinguish between intra-partum check and

postnatal check (i.e. 1 hr? 2 hrs?)

Facility Birth Home birth w/ attendant Home birth w/o attendant Duration of stay NA NA Check in facility Check with provider post

birth NA

Check post facility Check with provider Check with provider Who was the provider, where was the check, when was the check


Newborn care practices/behaviors:– Consensus on questions considered robust for use in population-based

surveys• Baby’s weight and size• Time of first breastfeed

– Consensus on areas that require more testing and validation– Measurement a work in progress– Effect of immediate newborn care practices is also under study and

will hopefully make the next LiST iteration


Newborn care practices/behaviors:Indicator Description Comments

1. Thermal care: Drying

Percent of newborns dried as soon as baby is born

No easy way to ask about timing; delivery of placenta not a good reference point due to variation

2. Thermal care: Wrapping

Percent of newborns wrapped as soon as baby is born

Analysis of SNL datasets to explore correlation between drying and wrapping; if high, will remove wrapping

3. Thermal care: Delayed bath

Percent of newborns with first bath delayed at least 6 hours after birth

Question should be open so different cut-offs can be used

4. Cord care: Clean instrument

Percent of newborns with cord cut with a clean instrument

Only home births where new instrument not used should be asked about boiling

5. Cord care: Dry cord care

Percent of newborns with nothing ever applied to the cord

Earlier questions ask about what was applied after cutting cord and did not cover entire period


Newborn care practices/behaviors (con’t):– Other areas identified for study:

• Clean delivery kits• Skin-to-skin• Care of small newborns (extra visits; facility-based KMC)• Care-seeking

– Draft questionnaire for newborn care practices developed – More work needed to refine questions– Need to analyze existing data sets (13 SNL baseline studies, with lots

of variation)


• Newborn services at facilities– Much less work in this area– Lack standard indicators for newborn services– Consensus on expanding SPA to include observations of delivery and

newborn care– Consensus that many tools exist that can be reviewed and built upon

(DHS SPA, MCHIP pilot SPA in Kenya; Rapid Health Services Assessment)

– Group meeting in July to begin drafting indicators and questions


Next Steps:• Continue work in small groups (PNC, NB practices; NB

services)• Analyze baseline datasets from SNL• Learn from MICS 4 roll-out and Kenya SPA• Next meeting in November 2010

Indicators for KMC

• Focus on facility-based KMC • High impact-low resource intervention• No standard indicators exist• SNL has developed some indicators to test• Tools are being developed to support these

indicators

Indicators for KMC

Core indicators:1. % of LBW babies on admission who received KMC2. % of facilities where KMC is operational3. # of health providers trained in KMC4. % of LBW babies on admission who received KMC

and survived to discharge5. % of LBW babies on admission who received KMC

lost to follow-up

Indicators for KMC

Supplemental indicators:6. % of health providers trained in KMC7. # of health facility staff oriented to KMC8. Average length of stay in KMC services (in days)9. Average number of follow-up visits among KMC babies

discharged from facility10. % of LBW babies on admission who graduated KMC

Resources

• List of helpful websites (handout)

• Sharepoint (coming soon: M&E page)– https://savenet2.savechildren.org/op/snl/Pages/snl_welcome.aspx – https://savenet2.savechildren.org/op/snl/Pages/Technical.aspx

• Technical assistance

Discussion

• Questions for us?• Discussion points:

– What are you measuring in your programs? – What information would you like to have? – What statistics do you see used incorrectly? – Are you planning to collect data on newborn health?– Have you been involved in DHS/MICS?

Be in touch for more information:

[email protected]@savechildren.org

Thank you!

make them count using the best data for maximum impact

Health & Medicine

mortality rate u5mr

mortality rate ununder

deaths annual births

perinatal mortality

child mortality group

deaths total births

yearchild deaths

data profiles