Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Glob Health. 2023 Mar 3;13:04024. doi: 10.7189/jogh.13.04024.
We aimed to describe the availability of newborn health policies across the continuum of care in low- and middle-income countries (LMICs) and to assess the relationship between the availability of newborn health policies and their achievement of global Sustainable Development Goal and Every Newborn Action Plan (ENAP) neonatal mortality and stillbirth rate targets in 2019.
We used data from World Health Organization's 2018-2019 sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) Policy Survey and extracted key newborn health service delivery and cross-cutting health systems policies that align with the WHO health system building blocks. We constructed composite measures to represent packages of newborn health policies for five components along the continuum of care: antenatal care (ANC), childbirth, postnatal care (PNC), essential newborn care (ENC), and management of small and sick newborns (SSNB). We used descriptive analyses to present the differences in the availability of newborn health service delivery policies by World Bank income group in 113 LMICs. We employed logistic regression analysis to assess the relationship between the availability of each composite newborn health policy package and achievement of global neonatal mortality and stillbirth rate targets by 2019.
In 2018, most LMICs had existing policies regarding newborn health across the continuum of care. However, policy specifications varied widely. While the availability of the ANC, childbirth, PNC, and ENC policy packages was not associated with having achieved global NMR targets by 2019, LMICs with existing policy packages on the management of SSNB were 4.4 times more likely to have reached the global NMR target (adjusted odds ratio (aOR) = 4.40; 95% confidence interval (CI) = 1.09-17.79) after controlling for income group and supporting health systems policies.
Given the current trajectory of neonatal mortality in LMICs, there is a dire need for supportive health systems and policy environments for newborn health across the continuum of care. Adoption and implementation of evidence-informed newborn health policies will be a crucial step in putting LMICs on track to meet global newborn and stillbirth targets by 2030.
本研究旨在描述中低收入国家（LMICs）在整个新生儿保健服务连续体中各项政策的可及性，并评估这些政策的可及性与 2019 年全球可持续发展目标和每个新生儿行动计划（ENAP）新生儿死亡率和死产率目标的实现之间的关系。
我们使用了世界卫生组织（WHO）2018-2019 年性、生殖、母婴、新生儿、儿童和青少年健康（SRMNCAH）政策调查的数据，并提取了与 WHO 卫生系统组成部分相一致的关键新生儿卫生服务提供和跨部门卫生系统政策。我们构建了综合措施，以代表连续体中五个部分的新生儿保健政策包：产前护理（ANC）、分娩、产后护理（PNC）、基本新生儿护理（ENC）和小而病新生儿管理（SSNB）。我们使用描述性分析来展示在 113 个 LMICs 中，按世界银行收入分组的新生儿卫生服务提供政策的可及性差异。我们采用逻辑回归分析评估了每个综合新生儿保健政策包的可及性与 2019 年全球新生儿死亡率和死产率目标实现之间的关系。
2018 年，大多数 LMICs 在整个连续体中都有关于新生儿保健的现有政策。然而，政策规范差异很大。虽然 ANC、分娩、PNC 和 ENC 政策包的可及性与 2019 年实现全球 NMR 目标无关，但在 SSNB 管理方面有现有政策包的 LMICs 达到全球 NMR 目标的可能性是其四倍（调整后的优势比（aOR）=4.40；95%置信区间（CI）=1.09-17.79），在控制了收入分组和支持性卫生系统政策后。
鉴于目前 LMICs 中新生儿死亡率的发展轨迹，迫切需要在整个连续体中为新生儿保健提供支持性的卫生系统和政策环境。采用和实施循证新生儿保健政策将是使 LMICs走上实现 2030 年全球新生儿和死产目标的关键一步。
