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Simple Measures Help Curb Infant Mortality

The World Health Organization and its partners say each year up to half a million African infants die the day they are born. But health experts say many of these babies could be saved with a few low-cost interventions. From Washington, VOA reporter William Eagle looks at a few solutions to the problem.

Among the devices that can save newborns are resuscitators to start or continue breathing when a baby doesn't breathe immediately at birth; kits that help provide a clean environment for childbirth, and a dose of the antiretroviral drug nevirapine to give to an infant within three days of birth.

One group that's helping support these interventions, and connecting their manufacturers with governments and the NGOs seeking them, is PATH, the Program for Appropriate Technology in Health.

Patricia Coffey is a program officer for PATH, which is based in Seattle, Washington.

She said infants' inability to begin breathing accounts for 24 percent of the more than one million deaths during the first month of life in sub-Saharan Africa each year.

She described how a simple resuscitator can solve the problem:

"The most typical design is," she said, "is a bag made of plastic or silicon substance with a mask over a child's nose and mouth. Then you manually compress the bag, and it provides a breath of air into the child. You do that at a steady rate, and that allows the child to begin breathing. It helps their lungs expand, and they can begin breathing on their own."

One problem is the cost. Coffey said many of the resuscitators sell for up to 100 dollars. However, PATH has produced a buyer's guide of what it says are 10 of the least expensive and easy-to-use devices -- some costing less than 30 dollars. The guide, whose full name is "A Practical Guide to the Selection of Neonatal Resuscitators," can be found on the group's web page: ( )

The booklet helps individuals or NGOs to make direct contact with manufacturers. PATH is also negotiating to have the devices included in UNICEF's supply catalog, which is used by governments and NGOs in Africa.

PATH is also working in three districts of South Africa's Kwazulu-Natal Province to help train health-care providers in resuscitation and in the active management of women during their third stage of labor.

PATH also promotes the use of another potential lifesaver: clean delivery kits, which help prevent infection during childbirth.

Each delivery kit includes a clean piece of plastic for the mother to lie on, a clean string and single-edged razor blade for tying and cutting the umbilical cord, and a bar of soap for anyone helping with the delivery.

Coffey said a PATH study in Tanzania confirmed that women who used the kits were less likely to develop puerperal sepsis, often called "child bed fever." Also, newborns whose mother used the kits were substantially less likely to develop infections of the umbilical cord after delivery.

Where kits are not available, women may purchase some of the items separately:

She said, "You certainly can go and purchase each piece individually, and often in places before birth a provider or clinic will tell a woman or her family she needs to purchase different elements in preparation for her delivery. The benefit of the kit is its ease. You just purchase it all in one piece. When you have a child there or other kids you have to take care of as well and other household duties, the convenience factor is appreciated. [Moreover] all of the elements are appropriate ones -- like a single-edged razor blade…which is the safest way to cut the cord, rather than a double-edged one."

A third live-saving intervention supported by PATH is the improved packaging of an infant-sized dose of the AIDS medication nevirapine. It helps inhibit the spread of HIV / AIDS from an infected mother to her newborn. The mother takes a tablet when she goes into labor, but the drug must be given to the infant in the form of syrup and must be given within 72 hours of delivery.

Coffey said many mothers go to a clinic only one or two times before delivery. For that reason, she says it is essential for the drug to be packaged in a way that is easy for the mother to take home and store until the child's birth.

An international pharmaceutical company, Boehringer Ingelheim, supplied the medication, and PATH has developed a better way to help deliver it safely to the women who need it. The syrup is prefilled into an oral dosing syringe and sealed in a foil pouch. The package includes pictorial instructions that can be given to the mother two months before delivery.

She said, "So what (PATH) created was improved packaging for an infant-dose of nevirapine, which is used in combination with an oral dosing syringe. It is filled with [the syrup] and given to a woman during an antenatal care visit [because she may not make it back to a health facility to give birth]. [The syringe] is capped securely and sealed in a foil pouch (with a self-sealing strip) and the (illustrated) instructions for use are written right on the pouch. You send it home with the mom prior to birthing."

PATH hopes that by adopting some of these low-cost interventions, health specialists can help bring about a decline in the staggering mortalities associated with childbirth in Africa.