Center for Global Child Health, Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
Lancet. 2014 Jul 26;384(9940):347-70. doi: 10.1016/S0140-6736(14)60792-3. Epub 2014 May 19.
Progress in newborn survival has been slow, and even more so for reductions in stillbirths. To meet Every Newborn targets of ten or fewer neonatal deaths and ten or fewer stillbirths per 1000 births in every country by 2035 will necessitate accelerated scale-up of the most effective care targeting major causes of newborn deaths. We have systematically reviewed interventions across the continuum of care and various delivery platforms, and then modelled the effect and cost of scale-up in the 75 high-burden Countdown countries. Closure of the quality gap through the provision of effective care for all women and newborn babies delivering in facilities could prevent an estimated 113,000 maternal deaths, 531,000 stillbirths, and 1·325 million neonatal deaths annually by 2020 at an estimated running cost of US$4·5 billion per year (US$0·9 per person). Increased coverage and quality of preconception, antenatal, intrapartum, and postnatal interventions by 2025 could avert 71% of neonatal deaths (1·9 million [range 1·6-2·1 million]), 33% of stillbirths (0·82 million [0·60-0·93 million]), and 54% of maternal deaths (0·16 million [0·14-0·17 million]) per year. These reductions can be achieved at an annual incremental running cost of US$5·65 billion (US$1·15 per person), which amounts to US$1928 for each life saved, including stillbirths, neonatal, and maternal deaths. Most (82%) of this effect is attributable to facility-based care which, although more expensive than community-based strategies, improves the likelihood of survival. Most of the running costs are also for facility-based care (US$3·66 billion or 64%), even without the cost of new hospitals and country-specific capital inputs being factored in. The maximum effect on neonatal deaths is through interventions delivered during labour and birth, including for obstetric complications (41%), followed by care of small and ill newborn babies (30%). To meet the unmet need for family planning with modern contraceptives would be synergistic, and would contribute to around a halving of births and therefore deaths. Our analysis also indicates that available interventions can reduce the three most common cause of neonatal mortality--preterm, intrapartum, and infection-related deaths--by 58%, 79%, and 84%, respectively.
新生儿存活率的提高一直较为缓慢，降低死产率的进展则更为缓慢。若要在 2035 年之前实现每个国家每 1000 例活产中新生儿死亡人数少于 10 例和死产人数少于 10 例的目标，就需要加速推广针对新生儿死亡主要原因的最有效护理。我们系统性地回顾了整个护理过程和各种提供途径的干预措施，并对 75 个倒计时高负担国家的推广效果和成本进行了建模。通过为所有在医疗机构分娩的妇女和新生儿提供有效护理来消除质量差距，预计每年可预防 11.3 万例孕产妇死亡、53.1 万例死产和 132.5 万例新生儿死亡，估计每年运行成本为 45 亿美元（每人 0.90 美元）。到 2025 年，增加孕前、产前、产时和产后干预措施的覆盖率和质量，每年可避免 71%的新生儿死亡（190 万例[160-210 万例]）、33%的死产（82 万例[60-93 万例]）和 54%的孕产妇死亡（16 万例[14-17 万例]）。每年增加的运行成本为 56.5 亿美元（每人 1.15 美元），这相当于每挽救一条生命（包括死产、新生儿和孕产妇死亡）的成本为 1928 美元。这一效果的大部分（82%）归因于医疗机构护理，虽然其成本高于社区护理策略，但提高了生存的可能性。大部分运行成本也用于医疗机构护理（36.6 亿美元或 64%），即使没有计入新医院和特定国家的资本投入成本。对新生儿死亡影响最大的是分娩期间的干预措施，包括产科并发症（41%），其次是对小而患病新生儿的护理（30%）。满足对现代避孕方法的计划生育需求将具有协同作用，并有助于将分娩和因此导致的死亡人数减少一半左右。我们的分析还表明，现有的干预措施可以分别将早产儿、产时和感染相关死亡这三个导致新生儿死亡的最常见原因减少 58%、79%和 84%。
