Low cost measures could save lives of three million babies a year

BMJ 2005; 330 doi: (Published 10 March 2005) Cite this as: BMJ 2005;330:557
  1. Rebecca Coombes
  1. London

The lives of nearly three million of the four million newborn babies who die worldwide each year could be saved by low cost, low tech interventions, a series of articles published by the Lancet shows.

Ninety nine per cent of the four million deaths occur in poor countries, although almost all published research relates to the 1% in rich countries.

The first paper in the series of articles, all published in the 3 March issue (, looks at when, where, and why newborn babies are dying and finds that 75% of neonatal deaths occur in the first week of life, with the highest risk of death on the first day of life. Two thirds of deaths occur in 10 countries, which include Afghanistan, Ethiopia, and Pakistan.

The main causes of neonatal deaths are infections (36%), premature birth (28%), and asphyxia (23%). Neonatal tetanus, a preventable illness that is virtually unknown in the developed world, kills half a million babies each year.

A key message of the Lancet series is that interim approaches are already available in the community that would save newborns. For example, between 60% and 80% of neonatal deaths are in babies with a low birth weight, and many could be saved with simple support such as keeping them warm and breast feeding.

Researchers estimate that a package of 16 low tech interventions could be provided to 90% of women and babies in poor countries at a cost of just $1 (£0.5; €0.8) extra per inhabitant per year.

The 16 interventions set out in the papers include tetanus vaccinations for pregnant women, promoting clean delivery, prompt and exclusive breast feeding, extra care for low weight babies, and antibiotics for neonatal infection. None of the interventions involves expensive drugs or complex technology.

Dr Zulfiqar Bhutta, professor of paediatrics and child health at Aga Khan University, Karachi, said it was vital to improve care practices in the home, where most neonatal deaths occur. More than half of women in Africa and south Asia give birth at home without a skilled attendant.

“We know the interventions are simple, so how come they are not there? You have to look at where the deaths occur. At home there is a sense of fatalism around newborns that nothing can be done. We need to get the message across that small babies can be saved. Health systems may be bad, but families are not mobilised sufficiently to go out and seek help,” he said.

A major barrier to progress in reducing mortality among newborns has been the false belief that expensive, high tech solutions are needed to bring death rates down, he said.

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