SeriesEvidence-based, cost-effective interventions: how many newborn babies can we save?
Section snippets
Identification of effective interventions
The Bellagio child survival series7, 8, 9, 10, 11 has been important in drawing attention to the unfinished child survival agenda. Writing for the series, Jones and colleagues8 estimated that implementing existing evidence-based interventions at high coverage (99%) could avert 63% of all child deaths and 35–55% of neonatal deaths. These estimates have limitations, however, especially in terms of putting the interventions into a health systems context.1, 12 Several potential interventions,
Cost-effective delivery of interventions
In a health-systems context, to package interventions according to their target populations and service delivery modes is logical (panel 3).27, 28, 29 We therefore considered how to deliver these interventions for home births and neonatal care in settings where access to health services is poor, as well as how to integrate them into facility-based maternal and child health care. We packaged interventions according to common service delivery mode and time of implementation (table 2). Moreover,
How many lives can be saved?
Although cost-effective interventions to prevent neonatal mortality are available, coverage of many of these interventions is low (figure 2), especially in resource-poor settings. The number of neonatal deaths that could be prevented through wider implementation of evidence-based interventions in the 75 countries included in the WHO 2005 world health report25 was estimated as described in panel 1. These 75 countries include the 42 analysed by the Bellagio child survival study group, plus
Cost of saving newborn babies
We estimated annual running costs for current degrees of coverage (US$1·97 billion) with evidence-based interventions, and the additional costs for expansion of coverage (excluding initial investments for scaling up coverage, such as building new facilities) from current levels to 90% ($4·11 billion) for the 75 countries included in our analyses (panel 1, webtable 4 [http://image.thelancet.com/extras/05art1217webtable4.pdf]). Of the additional expenditures needed to maintain expanded coverage
Discussion
Analyses of the evidence base for efficacy and effectiveness of interventions, cost-effectiveness, and the potential to avert neonatal deaths if implemented at increased coverage indicate that feasible, highly cost-effective interventions are available that could avert up to 72% of neonatal deaths. These interventions can be packaged according to service delivery modes and provided to populations in need in a complementary way within health systems.
Our data further suggest that emphasis on
References (42)
- et al.
Why are 4 million newborn babies dying each year?
Lancet
(2004) - et al.
Where and why are 10 million children dying every year?
Lancet
(2003) - et al.
How many child deaths can we prevent this year?
Lancet
(2003) - et al.
Applying an equity lens to child health and mortality: more of the same is not enough
Lancet
(2003) - et al.
Reducing child mortality: can public health deliver?
Lancet
(2003) - et al.
Overcoming health-systems constraints to achieve the Millennium Development Goals
Lancet
(2004) - et al.
Making health systems more equitable
Lancet
(2004) - et al.
Effect of a participatory intervention with women's groups on birth outcomes in Nepal: cluster-randomized controlled trial
Lancet
(2004) - et al.
Effect of home based neonatal care and management of sepsis on neonatal mortality: field trial in rural India
Lancet
(1999) - et al.
Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials. Review
Lancet Infect Dis
(2003)
4 million neonatal deaths: When? Where? Why? Published online
Reducing maternal and neonatal mortality in the poorest communities
BMJ
Perinatal and newborn care in Pakistan: seeing the unseen
An interpretation of the decline in mortality in England and Wales during the twentieth century
Pop Stud
Epidemiology
Knowledge into action for child survival
Lancet
Beyond Bellagio: addressing the challenge of sustainable child health in developing countries
Arch Dis Child
Community-based interventions for improving perinatal and neonatal outcomes in developing countries: a review of the evidence
Pediatrics
Methods for generalized cost-effectiveness analysis
Cost-effectiveness analysis: can we reduce variability in costing methods?
Int J Technol Assess Health Care
Cited by (1197)
An artificial intelligence approach to predict infants’ health status at birth
2024, International Journal of Medical InformaticsMaternal mortality, stillbirths, and neonatal mortality: a transition model based on analyses of 151 countries
2023, The Lancet Global Health
Lancet Neonatal Survival Steering Team listed at end of article