4 million neonatal deaths: When? Where? Why?

This paper, the first in The Lancet neonatal survival series, focuses on the growing proportion of child deaths that occur in the neonatal period (the first four weeks of life), accounting for 38 per cent of all child deaths in 2000, or 4 million a year. Most of these deaths occur in the first week of life. However, preventing deaths of newborns has not been prioritised in either maternal or child health programmes. While 99 per cent of neonatal deaths arise in low and middle income countries, research focuses on the one per cent of deaths in rich countries. Two-thirds of these deaths are in sub-Saharan Africa and South East Asia, where coverage of skilled attendance at birth is lowest. Key causes of death are pre-term birth, severe infections, and asphyxia. Low birthweight, poverty and maternal health are also important factors.

The authors conclude that the Millennium Development Goal for child survival cannot be met without achieving substantial global reductions in neonatal mortality. They argue that inequity should be addressed as a priority in all strategies to improve newborn health, and advocate increased coverage of interventions to reach the poorest and most underserved populations.