Time to focus on more than 350,000 preterm births in the Philippines every year
© UNICEF Philippines/2012/Palasi
A newborn baby in Taguig City benefits from a breastfeeding friendly culture being promoted by its local leaders.
World Prematurity Day highlights effective, low-cost care and DOH announces new commitments to address the problem
Manila, 16th November 2012. Preterm birth is the world’s largest killer of babies, causing more than 1 million deaths each year worldwide, yet 75 per cent could be saved without high technology care. The Philippines ranks 8th out of 184 countries for the number of babies born prematurely, and ranks 17th for the total number of deaths due to complications from preterm birth.
World Prematurity Day, November 17 2012, is part of a global effort to raise awareness of the deaths and disabilities due to prematurity and the simple, proven, cost-effective measures that could prevent them. World Prematurity Day is building momentum by showing how countries can reduce preterm births and better care for babies born too soon.
Today in the Philippines, 48% of children who die under the age of 5 years are newborns, and 39% of these die from preterm complications, making this the leading cause of newborn mortality. In 2011, 11,290 deaths were attributed to preterm complications – the equivalent of 31 newborn deaths every day.
294,000 moderate to late preterm babies
Late preterm babies, those born between 32 and 37 weeks of pregnancy, have a good chance of survival if the basic, low cost interventions are in place. Around 84% of the 350,000 preterm babies that are born annually in the Philippines fall into this category. Babies born between 32 and 37 weeks should be able to survive with access to simple and affordable care.
Essential newborn care
‘What is crucial for preterm babies is that they receive appropriate newborn care,’ said Dr Mariella Castillo, UNICEF’s Mother and Child Health specialist. “ This means ensuring that babies who have difficulty breathing get quick attention, and that all newborns are breastfed and kept warm, dry and clean.’
Recognizing the problem of prematurity, the Department of Health (DOH) is strengthening its newborn care program by ensuring that critical policy gaps and access to lifesaving drugs and medicine that will improve neonatal outcomes are developed and implemented. The National Maternal, Newborn, Child Health and Nutrition (MNCHN) Strategy has interventions during the pre-pregnancy period, prenatal, birth and delivery up to the postpartum period that will ensure improved health outcomes for mothers and newborns and their survival through functional service delivery across the country.
Among these interventions is the essential intrapartum and newborn care (EINC) protocol fondly called “Unang Yakap” (The First Embrace). It contains guidelines for quality and safe birthing services that are mother and newborn friendly, ensuring success of breastfeeding initiation at the health facility. In addition, the recently published DOH-WHO Guidelines on Intrapartum and Immediate Postpartum Care, developed together with the Philippine Obstetrical and Gynecological Society (POGS), aims to complement the essential newborn care (ENC) protocol guidelines, to ensure safer and more effective labor procedures.
This goes hand in hand with the advocacy of minimum of four (4) prenatal care visits, facility-based delivery, deliveries that will be attended by skilled and competent health professionals, and postnatal care to mothers and newborns as they return to their barangays and communities.
On World Prematurity Day the Philippines will be named a ‘champion’ country for having already adopted packages of interventions to care for premature babies and will serve as a regional and global centre of excellence.
“In the Philippines, efforts are currently being made to further strengthen such interventions and to make such services available for all mothers and newborns in the country,” Dr Anthony Calibo from the Department of Health stated.
Progress is already being seen, with a recent reduction in neonatal sepsis rates and neonatal death rates in government hospitals that were part of the 11-hospital EINC scale-up initiative under the DOH-AusAID-UN Joint Programme on Maternal and Neonatal Health (JPMNH). Interventions that were proven to work included improving emergency obstetric and newborn care in the hospitals; heightened awareness of the use of antenatal steroids during preterm labour with imminent delivery of the baby; health facility infection control measures such as hand washing; kangaroo mother care and breastfeeding initiation practices.
It is worth highlighting three low-cost interventions that are known to be especially effective for preterm babies, but are still not widely used despite documented success:
• Steroid injections. When given to mothers in preterm labour, dexamethasone, a steroid also used to treat asthma, helps speed up the development of the baby’s lungs while inside the uterus enabling the baby to breath once it is born. At a cost of about US$1, four shots of this drug stop premature babies from going into respiratory distress when they are born and, in many cases, prevent death.
• Kangaroo Mother Care. Using this technique, the tiny infant is placed skin-to-skin upright between the mother’s breasts and then tied to the mothers chest with a cloth. This keeps the preterm baby warm and facilitates breastfeeding. Keeping preterm babies warm is especially important because their tiny bodies lose heat rapidly, making them highly vulnerable to illness, infection and even death.
• In addition, while all newborns are more vulnerable to life-threatening infection than older infants and children, preterm babies are especially at risk. Good hygiene and care can help prevent these infections, and basic antibiotics to fight infections when they occur, can save lives.
There is also good news ahead for the Philippines, as premature babies with respiratory distress syndrome and who are from the poorest families will be given a chance to survive as DOH prepares to procure medicine
that assists premature babies with breathing difficulties.
The Philippine Society of Newborn Medicine (PSNbM) in collaboration with PhilHealth is now on the final stage of completing the “Prematurity Package” for PhilHealth members, including supplies of medicines for infants with breathing difficulties. The PSNbM is also working with the Kangaroo Mother Care Foundation to establish KMC units in hospitals around the country.
“We in the PSNbM believe that the low cost care consisting of complete prenatal care, antenatal steroids, essential intrapartum and newborn care, breastfeeding and Kangaroo Mother Care should be strengthened so that the high cost of management of preterm neonates can be minimized or eliminated” said Dr Wilfredo Santos, head of the PSNbM.
Having committed to the Millennium Development Goal for child survival and pledging support to A Promise Renewed (a renewed commitment to reduce under 5 deaths), the Philippines is using World Prematurity Day to take actions to address preterm birth, in the hope of taking a step forward in achieving these goals for child survival.
“Whilst the final frontier of preventing premature birth, by learning more about factors that influence it, is still a long way off, there are encouraging signs for mothers in the Philippines, that more effective treatment for premature babies is on the way” said Dr Willibald Zeck, UNICEF Chief of Health and Nutrition.
Notes to Editors
Country by country statistics are available in Born Too Soon, published in May 2012. Report is available free at http://www.healthynewbornnetwork.org/resource/born-too-soon-global-action-report-preterm-birth
For more information on families affected by premature birth, information and data on preterm birth, go to facebook.com/WorldPrematurityDay
DOH : Anthony Calibo, MD, DPPS, Medical Specialist IV (Pediatrics and Child Health), National Center for Disease Prevention and Control(NCDPC), firstname.lastname@example.org, +63 2 6517800 local 1730
UNICEF Philippines: Angela Travis, Communication Specialist, email@example.com, +632 9010176