Dhaka, Friday, March 23, 2018


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Nutritional supplements help improve maternal and newborn health

DHAKA, Feb 22, 2018 (BSS) - Bangladesh has achieved major gains in maternal and newborn survival, facility childbirth and skilled birth attendance till now and this trend could be further improved by providing nutritional supplements to pregnant mothers, their newborn babies and young children.

A critical component of optimal maternal nutrition and health is micronutrient intake. Mounting evidence suggests that micronutrient supplements, in place of the current recommendation of iron-folic acid supplements, offers greater benefits for both mother and baby.

High-quality maternal health care is necessary to address this burden and implementation of WHO Safe Childbirth Checklist (SCC), whose items address the major causes of maternal deaths, is hypothesized to improve adherence of providers to essential childbirth practices.

The SCC was adapted for the local context through expert consultation meetings, creating a total of 27 checklist items. WHO conducted a study as a pre-post evaluation of SCC implementation and collected data of over 8 months at the Magura District Hospital.

The WHO experts analyzed 468 direct observations of birth, main analysis using 310 complete observations and sensitivity analysis with the additional 158 incomplete observations, from admission to discharge.

The primary outcome of interest was the number of essential childbirth practices performed before compared to after SCC implementation. The change was assessed using adjusted Poisson regression models accounting for clustering by nurse-midwives.

After checklist introduction, significant improvements were observed: on average, around 70% more of these safe childbirth practices were performed in the follow-up period compared to baseline from 11 to 19 out of 27 practices.

Substantial increases were seen in communication between nurse-midwives and mothers (counseling), and in management of complications including rational use of medicines. In multivariable models that included characteristics of the mothers and of the nurse-midwives, the rate of delivering the essential childbirth practices was 1.71 times greater in the follow-up compared to baseline.

Implementation of SCC has the potential to improve essential childbirth practice in resource-poor settings like Bangladesh. This study emphasizes the need for health system strengthening in order to achieve the full advantages of SCC implementation.

As the end of MDGs era offers an opportunity to examine successes and failures in the global health and to identify priorities for the future, the world achieved overall major gains in maternal and child survival and in coverage of facility-based childbirth and skilled birth attendance.

Many women and newborns, however, continue to die during and shortly after childbirth, and disparities persist across countries as well as across groups within countries. This suggests that the global strategy, which has focused on increasing coverage of skilled birth attendance, did not eliminate all excess burden.

WHO says high-quality maternal health care is essential for reducing excess mortality. Mirroring global trends, Bangladesh made a great progress towards MDG 4 and 5 targets and now stepped into fulfilling the challenges of SDG targets.

While the current neonatal mortality rate of 28 per 1000 live births has been lower than the target of 48 deaths per 1000 live births, its maternal mortality ratio (MMR) decreased from 574 maternal deaths per 100,000 live births in 1991 to 176 deaths per 100,000 live births in 2015.

The good news is that use of facility delivery has been increased in this period and much more facilities are being provided now to ensure safe childbirth and sound maternal health by the Ministry of Hearth and Family Welfare. High-quality childbirth care requires facility and availability of human resources with skills and capacity to effectively manage uncomplicated and complicated childbirth events.

"When it comes to newborn deaths, the global trends are alarmingly high, particularly among the world's poorest countries. Global data indicates that 2.6 million newborn babies die every year and the average newborn mortality rate in low-income countries are way higher compared to high-income countries. Newborns from low-income countries are 50 times more likely to die," said Edouard Beigbeder, the UNICEF Chief in Bangladesh.

Compared to any other low-income countries, he said, no doubt, Bangladesh has done quite well in relation to many development indicators, including its progress in neonatal mortality. A sharp decline is evident from the data: 241,000 newborns died in 1990 and then this data went down to 62,000 in 2016.

But the question is, the UNICEF Chief sought to know, whether this progress has been made in all the regions of country. Has its impact reached out to every newborn? A recent UNICEF report reveals that despite well- performing public health programmes, Bangladesh is still among the 10 countries with the highest number of newborn deaths in 2016, and newborn mortality rates.

WHO suggests the health professionals to advise healthy pregnant women that the duration of labour varies greatly from one woman to another. While most women want a natural labour and birth, they also acknowledge that birth can be an unpredictable and risky event and that close monitoring and sometimes medical interventions may be necessary.