Harare, 18 February 2004 -- Neonatal morbidity and mortality rates in the African Region, currently estimated at 45 deaths per 1,000 live births, are among the highest in the world, and contribute about 50% of the infant mortality rate in the Region, according to a WHO-sponsored study made available at a regional workshop on improving maternal and neonatal health in Harare, Zimbabwe.

The findings of the study, presented by Dr Office Chidede, a Consultant Neonatologist at the University of Zimbabwe, also show that stillbirths and deaths within the first seven days of life in the Region was estimated at 76 per 1,000 live births.

He also indicated that 70% of deliveries take place in the community where maternal and newborn births are usually not recorded.

Eight countries were covered by the study conducted between February 2001 and August 2002. Its goal was to develop or recommend evidence-based strategic interventions and establish sustainability in the institutionalization and implementation of identified remedial measures.

The study documents some of the causes of death as provided by health providers and facility records. These include: birth asphyxia (suffocation during birth), 40%; prematurity and low birth weight, 25%; infections, 20%; congenital defects, 10%, and acute surgical conditions, 3%.

Other findings relate to unavailability of basic supplies and equipment, staff shortages and low morale, bad roads and long distances between referral points, continued use of traditional birth attendants (who are still popular and highly regarded) and preference of mothers to deliver in health facilities, although these are still largely perceived as not user-friendly. 1

Among suggestions contained in the study for remedying the situation are accessibility by all women and newborns to: well-organized and functioning services; user-friendly health facilities; care by skilled attendants, appropriate drugs and functioning referral facilities.

In a presentation to the meeting, the UNFPA Maternal Health Adviser, Dr Vincent Fauveau, outlined some of the reasons why African countries have failed to reduce maternal mortality. These include: lack of national commitment, financial support, coordination and partnership; increasing poverty and the low status of women; the adverse effects of HIV/AIDS, tuberculosis and malaria, and the use of inappropriate strategies to stem the growing tide of maternal mortality.

Dr Fauveau stated that UNFPA's vision and strategy for maternal mortality reduction was based on three pillars: family planning, skilled attendance at all births and the availability of, and accessibility to, emergency obstetric care.

In his presentation, Dr Issakha Diallo of Advance Africa, a Non- Governmental Organization, presented the results of a recent study which shows that 40-50% of infant deaths in developing countries are neonatal, and that spacing births by three years or more could reduce neonatal deaths by 50%.

Some conclusions of the study are that:

• birth intervals of three years or longer can substantially decrease the risk of newborn death 
• infants are twice as likely to survive if the previous birth interval is at least two years 
• family planning can reduce maternal maternity by 20% 
• avoiding short birth intervals would lower both fertility and infant and child maternity 
• enabling women to realize their birth interval preferences would result in substantial decreases in both infant and child mortality and fertility.

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