Helping save new-born lives in Armenia

70% of child mortality is among newborns. Why?

Zhanna Ulikhanyan
A new born baby in an incubator in Republican maternity Ward, Yerevan, Armenia.
UNICEF Armenia/2018/Osipova
16 October 2018

A new member of Amrakits community, Shushanik, was born this May in Armenia’s northern Lori marz. What she needs first and foremost, are the trustworthy hands of her doctor, the nurses and her mother. Like all other children who live in rural communities in Armenia, Shushanik is at a disadvantage, including children whose mothers have only basic education. In Armenian villages, 40 children are born on average everyday. Together, they face a higher risk of not making it to their first birthday.

 

New-borns account for 70% of child mortality is Armenia. Why?

In the course of the last 20 years, Armenia registered significant achievements by halving the child mortality rate. However, progress has slowed down during the last five years. Data shows that 70% of child mortality cases occur among new-born babies. The main causes of this are premature delivery, congenital disease, pneumonia, and suffocation.

In 2017, UNICEF partnered with the Ministry of Health and the AUA Center for Health Services Research and Development to assess level, access, and quality of care provided to newborns in maternity hospitals, children’s hospitals and clinics across the country. This research confirmed that high-quality neonatal and infant care services are limited and at a decline in Armenia. There is unequal distribution or absence of a quality workforce in the marzes, coupled by a low capacity of intensive care services and an ineffective system of referral for special treatment for pregnant women and new-borns. Although a system of home visits by medical staff functions in the country, its effectiveness is decreased by the insufficient knowledge and skills of medical staff, unsatisfactory level of monitoring and other factors. The picture was of concern, especially that the majority of new-born babies (60%) in Armenia reside in the marzes.

 

The Every Single New-born Action Plan

Based on the survey results and the revealed gaps, in 2017-2018 UNICEF and the Ministry of Health worked to develop a strategy that will offer short and long-term solutions to reducing new-born mortality, including an action plan to strengthen the system of home visits. A number of documents were developed to cover these gaps, such as a clinical manual and guidelines on the monitoring of neonatal illnesses in communities, a manual and toolset for maternity nurses, and another manual for doctors and social workers on home visits.

The results of the survey also helped define the main targets for a comprehensive set of capacity building training that UNICEF and the Ministry of Health continued to deliver throughout 2018. “I do not even remember when I last participated in a training focusing on the needs of 0-2-month-olds. It seems that we always discuss treatment and care of children under 5, but the 0-2-month age group is always left out. And this is when a small mistake can have critical consequences,” says paediatrician Sakanyan of the training organized by UNICEF. Dr. Sakanyan has worked in polyclinics in Stepanavan and Lori marz for 36 years now.

General check-ups including growth monitoring and immunization for babies and children.
UNICEF Armenia/2018/Osipova
General check-ups including growth monitoring and immunization for babies and children. Routine activities/immunization session UNICEF supports Government of Armenia to introduce new vaccines and to sustain very high vaccination coverage.

. “I do not even remember when I last participated in a training focusing on the needs of 0-2-month-olds. It seems that we always discuss treatment and care of children under 5, but the 0-2-month age group is always left out. And this is when a small mistake can have critical consequences.”

Mrs. Sakanyan

 

Over 650 paediatricians, family doctors and nurses from across Armenia have already participated in the week-long training organized by UNICEF this year, developing their knowledge and skills in on-site treatment of neonatal diseases, the basic principles of timely hospitalization, and correct evaluation of the infant’s health status and development after they leave the hospital. The training is now included in the educational programme of the National Health Institute and is also a part of the licensing requirements for medical staff.

Even with her considerable experience, Dr. Sakanyan considers the training to be quite helpful having developed her knowledge in disease management. “A local family that I know brought in their 1,5-month-old infant last month for an examination. He had already been prescribed long-term hospital treatment and they wanted a second opinion. I instantly recalled from the training to take account of the full picture, instead of concentrating on just one symptom. And the whole picture was totally different. I prescribed him treatment that helped the child to recover without being hospitalized,” she told us proudly. “This is how important good trainings are – not only do they provide you with knowledge, but also with confidence to make decisions in your work.”

Baby in his mother's arms during the general check-ups in the polyclinic.
UNICEF Armenia/2018/Osipova
General check-ups including growth monitoring and immunization for babies and children. Routine activities/immunization session UNICEF supports Government of Armenia to introduce new vaccines and to sustain very high vaccination coverage.

Parents, being an important side to ensuring proper neonatal care for their children, also took part in a series of parental education training organized by UNICEF and the Ministry. Around 5000 pregnant women, parents and caretakers from Armenia’s different marzes learned about basic neonatal care, what signs to look out for during the first weeks and when to seek specialist care and advice.

Shushanik’s mother and paediatrician from her community also participated in these trainings. Thanks to the skilful hands of her doctor and her mom, Shushanik will successfully transition through her first year, the one considered to be the most dangerous for infants in Armenia.