Non-Environmental Cost-Benefit News

Each year 4 million babies around the world die in the first month of life. More than half the deaths could be avoided with simple measures such as cutting umbilical cords with sterile blades, prescribing antibiotics for pneumonia and keeping newborns warm.

Those are among the findings of a group of studies released yesterday that seek to direct the world's attention to the large number of infants in poor countries who die soon after birth, usually at home and often unnamed.

The high mortality arises from poverty, ignorance and disorganization in poor countries, and is exacerbated by fatalism on the part of many parents, a lack of political will in governments and the inattention of global health experts, the researchers concluded.

"This disaster has to end," said Vinod Paul, an Indian physician and expert in the care of newborns, yesterday at a launch of the initiative in Washington. "We believe the vast majority of these deaths can be prevented by the knowledge we have today. We do not need new knowledge."

"In West Africa, one of every three mothers will lose a newborn," said Anne Tinker of the charity Save the Children, calling that evidence of "an unacceptable disparity between the haves and the have-nots."

Four studies reviewing the magnitude of "neonatal" mortality around the world, strategies for reducing it, a roadmap for improving newborn care in poor countries and an estimate of costs were published online yesterday by the Lancet, a European medical journal.

Much of the data have appeared elsewhere in recent years. What is new is gathering in one place the "evidence base" for action by donor nations, charities and the developing countries themselves.

Among the new information was the calculation that at least 41 percent of the 4 million deaths, and possibly as much as 72 percent, could be prevented if current knowledge were put to use.

The Lancet Neonatal Survival Steering Team, composed of researchers at many universities and charitable organizations, also estimated that to cut neonatal deaths in half would cost $4.1 billion per year on top of the $2 billion now being spent on the problem by poor countries and outsiders.

The 4 million deaths occur among the 130 million babies born worldwide each year. Deaths in industrialized countries account for 1 percent of the total. Two-thirds occur in 10 countries: India, China, Pakistan, Nigeria, Bangladesh, Ethiopia, Congo, Indonesia, Afghanistan (news - web sites) and Tanzania.

Programs to improve health in developing countries traditionally target pregnant women and young children. Newborns have been relatively overlooked, even though they are the most vulnerable -- especially in the first few days of life. Of children who die before age 5, 38 percent die in their first month. Of them, three-quarters die in the first week.

One cheap intervention that could eliminate the 7 percent of deaths caused by tetanus is giving pregnant women two tetanus shots, if they have not had any. The mothers pass their immunity to their babies, who can become infected if the umbilical cord is cut with a contaminated instrument.

Teaching mothers and health workers to recognize infection in very young babies -- and get them to a doctor or provide antibiotics themselves if that is not possible -- could reduce the 26 percent of deaths caused by pneumonia and sepsis (bloodstream infections).

Making those improvements, however, will require training many more midwives and other health care workers -- a huge undertaking. In south Asia and sub-Saharan Africa, only about one-third of women deliver with the aid of a "skilled birth attendant."

However, some interventions cost nothing.

One of the authors of the Lancet series, Gary L. Darmstadt, described successful efforts by a team of U.S. and Indian researchers to change behavior in a region of 300 villages and 100,000 people in the state of Uttar Pradesh in northern India.

Traditionally, women who have just delivered consult a Hindu holy man called a pandit on when to start breast-feeding. After checking astrological tables and other sources, the pandit generally advises that feeding begin two or three days after birth. Until then, the baby is given tea or sugar water.

Many new mothers also squeeze out of their breasts and discard the thick, antibody-filled, disease-preventing first milk, known as colostrum, because it is mistakenly considered old and dirty.

One of the pandits in the area was a physician. After gaining his trust, the researchers asked him to consider changing his advice.

"We just leveled with him and said: You're a medically trained person; you know that breast-feeding is critically important," recounted Darmstadt, of the Johns Hopkins University's Bloomberg School of Public Health.

The man agreed, and he persuaded five other pandits serving the area to change their advice, too.

"I think, in essence, he took an evidence-based approach," Darmstadt said.

By David Brown
The Washington Post www.washingtonpost.com
http://www.washingtonpost.com/wp-dyn/articles/A4799-2005Mar3.html?sub=AR