Where we stand ?
Mohamed Khashaba,MD
Professor of Pediatrics/Neonatology
Head of NICU, MUCH
Mansoura, Egypt
A healthy newborn infant is the best
promise for the future
The Millennium Development Goals
(MDG)
120
100
Rateper 1000
80
60
Infant Mortality
40
Neonatal Mortality
20
1975 1980 1985 1990 1995
Year
Comparison of Infant and
Neonatal Mortality Decline in
Egypt 1975 -1995
140
120
100
Rateper 1000
80
60
Infant Mortality
40
Neonatal Mortality
20
1975 1980 1985 1990 1995
Year
Medium-Term Trends in Neonatal Mortality
in the Middle East and North Africa
75
Neonatal Mortality Rate
50
Yemen
Morocco
Egypt
25 Tunisia
Jordan
0
1975 1980 1985 1990 1995
Year
Many neonatal deaths are unseen and
undocumented
Most epidemiological and other research
focuses on 1% of deaths
Direct Causes of Neonatal Mortality
Neonatal
Tetanus
Pneumonia
14%
19%
Diarrhea
2%
Asphyxia Other
21% 5%
Prematurity
10%
Injuries Sepsis
11% Congential 7%
abnormalities
11%
WHO Mother and Baby Package, 1993
Causes of perinatal death in Egypt
Asphyxial conditions
developing in labor
Conditions associated 28%
w ith preterm birth or
immaturity
21%
Intranatal
(↓ 10-20%)
Intrapartum: Postnatal:
Skilled care (20-30%) Extracare for LBWT(20-40%)
Antibiotics for PROM Management of serious neonatal
(↓infection 15-45%)
Antenatal steroids(25-50%) illeness (↓ 10-50%)
Tackling the problems
Antenatal Care
The general lack of antenatal care is
responsible not only for most maternal
deaths but also for high neonatal morbidity
and mortality rates (Dünser et al, 2006)
• Improvements in transportation
services for referral.
• Education campaigns specifically
targeted at newly married couples
and their families, and the general
public through television and
radio messages.
• Institution of perinatal and
neonatal audits at hospitals and
health centers
Crucial to the success of programs
is:
• national ownership, and
• public-private partnerships to
ensure long-term funding.
Research Priorities for
Community-Based
Health Services
• Community-based studies to determine
existing obstetric practices, neonatal
care, and health-seeking behavior for
perinatal asphyxia.
• Training of traditional birth attendants
and community health workers to
implement the package of basic
neonatal care resuscitation.
• Strategies to improve access to
emergency obstetric care, and methods
to increase referral rates for
complicated pregnancies, and
•
• An ongoing dialogue must be
established between government
and researchers to combat
perinatal asphyxia.