Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health

Joint press Release: PMNCH, WHO and Aga Khan University

Three-year study identifies key interventions to reduce maternal, newborn and child deaths

15 December 2011 | Geneva - A new global consensus has been agreed on the key evidence-based interventions that will sharply reduce the 358,000 women who still die each year during pregnancy and childbirth and the 7.6 million children who die before the age of five, according to a massive, three-year global study. The study, Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health, is designed to facilitate decision-making in low- and middle-income countries about how to allocate limited resources for maximum impact on the health of women and children.

The study reviewed more than 50,000 scientific papers to determine the proven effectiveness of interventions and impact on survival, identifying 56 essential interventions that when implemented in "packages" relevant to local settings, are most likely to save lives. The study is released today by the World Health Organization (WHO), the Aga Khan University and The Partnership for Maternal, Newborn & Child Health (PMNCH).

Some of the interventions include:

• Manage maternal anaemia with iron;
• Prevent and manage post-partum haemorrhage;
• Immediate thermal care for newborns;
• Extra support for feeding small and preterm babies;
• Antibiotics for the treatment of pneumonia in children.

"What is new," says Dr Elizabeth Mason, Director of WHO’s department of Maternal, Newborn, Child and Adolescent Health, and an author of the study, "is putting together information in a different way and building consensus among physicians, scientists and professional organizations to lay out an evidence-based path to help women before, during and after birth and their children. Everyone now agrees on the 56 essential interventions."

Suitability for low- and middle-income countries

The first step was a global landscape analysis of what countries and the 440 PMNCH partners were doing to reduce maternal and newborn deaths.

"What came back was a hodge-podge," says Dr Zulfiqar Bhutta, Founding Chair of Women and Child Health at the Aga Khan University, Pakistan, who headed the study team. “PMNCH partners had very different ideas of what should be undertaken.”

In all, 142 interventions were assessed for their effectiveness and impact on survival by addressing the main causes of maternal, newborn, and child mortality. Drs Bhutta and Mason and their team also studied the intervention suitability for use in low- and middle-income countries.

They asked what health and outreach workers with limited training could handle at the community level where specialized care is not available. They identified what could be handled in community settings by nurses, midwives and workers with more training. They also identified which patients need to be referred to hospitals where physicians and emergency care are available.

After very extensive consultation and review by a wide group of experts, the list was honed down to 56 essential interventions, accompanied by brief guidelines and reference materials.

We now have a clear consensus, critical for the survival of women, their infants and children," says Dr Carole Presern, Director, of The Partnership for Maternal, Newborn & Child Health. "This was a meticulous effort involving many partners. It is truly a landmark moment in advancing the health of women and children."

Maternal and child deaths still a problem

Though considerable progress has been made toward reducing maternal, infant and child deaths, many countries in Africa and India will fall short of the United Nation's Millennium Development Goals 4 & 5, which aim to reduce child deaths and improve maternal health.

Sub-Saharan Africa and south Asia, which have the highest maternal and child death rates, have made some progress, but not enough to meet the Millennium Development Goals by 2015.

More than half of maternal deaths are caused by excessive bleeding (35%) and hypertension (18%).

A child's greatest risk of dying is during the first 28 days of life, accounting for 40% of all deaths among children under the age of 5. Half of newborn deaths occur during the first 24 hours and 75% during the first week of life, with preterm birth, severe infections and asphyxia being the main causes.

A link to the essential interventions summary table and other information can be found on: http://www.who.int/pmnch/topics/part_ publications/201112_essential_interventions/en/index. html