A key strategy to save newborn

A health worker is seen providing home-based newborn care intervention at a house in a remote village of Jokigonj, Sylhet in Bangladesh. Photo:TAREQ SALAHUDDIN

Although Bangladesh has made a commendable success in reducing child mortality, the number of newborn deaths in Bangladesh is still very high. In Bangladesh, more than 113,884 newborns died in 2008 , most of those could be prevented by ensuring home based Essential Newborn Care (ENC) by a health worker at or within two days of birth.
Providing ENC that comprises a set of basic measures including hygienic cord care, thermal control, early and exclusive breastfeeding, and immunisation can make a big difference in preventing these needless deaths. Despite having a vital role, this simple but lifesaving strategy is yet to be fully implemented in Bangladesh.
In Bangladesh, about half of the neonatal deaths (death within 28 days of birth) occur in the first day of life and about three quarters in the first week, often at home and without any contact of a healthcare professionals. Studies have shown that home-based newborn care interventions can prevent 30–60 percent of newborn deaths in high mortality settings under controlled conditions. Therefore, experts recommend that any health worker trained in ENC should pay a visit at the baby's home within the first two days of birth to improve newborn survival.
ENC is based on certain preventive messages and encourages healthy practice. As infection is one of the major killers, ENC started with the focus on cleanliness during delivery such as ensuring clean place, clean and sterile instrument. Immediate drying thoroughly using a clean, dry cloth and making uninterrupted skin-to-skin contact are important. Proper cord clamping and cutting after waiting for up to three minutes or until the pulsations stop is found to reduce to chances of anemia in full term and pre-term babies. Initiating breastfeeding within 1 hour contributes to a host of medical benefits. Washing or bathing within 3 days of birth may be harmful for baby and hence it is not recommended.
Although ENC has been included in the National Neonatal Health Strategy, and integrated into Bangladesh's recent Health Population and Nutrition Sector Development Programme 2011–2016, a number of issues are lacking and under-recognised to translate the policy into action. Experts identified lack of specification --- what kind of health worker will provide ENC, inadequate and unequal distribution of health workers trained in ENC, lack of monitoring tools, lack of large scale training and awareness programme are the challenges to implement ENC fully.
Dr Syed Rubayet, Programme Manager, Save the Children explained that there are several types of health workers in government sector and also involve in NGO's programmes. The Government should specify one from those different types of health workers who will be responsible for home visit at delivery or within 2 days of birth. He pointed out that currently there is no available form to collect data on ENC from government set up and thus, monitoring and evaluation becomes very difficult. He underscored the need of adequate community health worker and increase of training facility for them to save thousands of newborn.

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