Community-based antenatal and perinatal interventions and newborn survival.
BACKGROUND
As part of the millennium development goal (MDG) 4 to reduce by two-thirds the mortality rate among children under five, neonatal mortality rate (NMR) needs to be reduced by half. This is a selective review of the literature of the morbidity and mortality patterns among newborns as well as cost-effective interventions and community aspects of newborn care.


METHODS
Documented causes of morbidity and mortality among newborns were examined in the overall context of developing and developed countries. Cost-effective interventions that have been proven to be inexpensive with evidence or potential to save newborns' lives by international agencies concerned with health, journals and other publications were reviewed. Community aspects of newborn care and what is required at the individual, household and community levels to reduce neonatal morbidity and mortality were also reviewed.


RESULTS
A score of recent publications by the World Health Organization (WHO), Save-the-Children, United Nations Children's Fund (UNICEF), journals, and other scientific publications reported consistently that neonatal mortality constitute 40-70% of deaths in infancy and that 99% of these deaths occurred in developing countries, with highest neonatal mortality rates (NMRs) in sub-Saharan Africa. The global burden of newborn illness shows that a disparity of up to 30-folds exists between countries with highest and lowest NMRs. Four million babies die in developing countries and about 42% of these deaths are due to infections. Other major causes include perinatal asphyxia (21%), birth injuries (11%), prematurity and low birth weight (10%) and congenital abnormalities (11%). It was also observed that two-thirds of the deaths in the neonatal period occur in the first week; among these deaths, two-thirds occurred within the first 24 hours. Review findings also revealed that an integrated, proven and cost-effective intervention such as the mother-baby packages incorporated into a functional and sustainable healthcare delivery system and improved household practices will save newborns' lives. Reports showed that to achieve meaningful development, neonatal mortality will need to be reduced in developing countries.


CONCLUSIONS
Programmes that are necessary for the reduction in neonatal morbidity and mortality rates are for countries to employ rational mix of quality clinical services, effective public health measures and inexpensive community-based interventions in public and private sectors and to scale-up known cost-effective interventions.
Sule
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Department of Community Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
Onayade
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D003362:Cost-Benefit Analysis; D019049:Developed Countries / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007224:Infant Care / Q000191:economics / Q000592:standards*; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000191:economics / Q000592:standards*; D018743:Perinatal Care / Q000191:economics / Q000592:standards*; D011247:Pregnancy; D011635:Public Health Administration; D012111:Residence Characteristics