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      The multi-agency partnership roadmap for newborns in humanitarian settings: Timely and crucial during the COVID-19 pandemic

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          Abstract

          Despite the fact that mortality rates for COVID-19 seem to be low in children and in women of reproductive age, these groups might be disproportionately affected by the disruption of routine health services in low- and middle-income countries, especially in fragile and humanitarian settings. A very recent study traced all babies less than 29 days old with COVID-19 across the UK and confirmed that severe infection in newborn babies is still very rare. While the main symptoms of the infection included high temperature, poor feeding, vomiting, cough and lethargy, the study found that 1 in 1785 newborns (0.06% of births) required hospital treatment and a small proportion of babies caught COVID-19 from their mother (only 17 out of 66 newborns were suspected to have caught the virus from their mother in the first seven days of life). This reinforces the concept whereby a baby does not need to be separated from his mother if she tests positive for COVID-19 [1]. Countries facing conflict and political instability have the highest rates of neonatal mortality and stillbirths: if India and China are excluded, countries experiencing chronic conflict or political instability account for approximately 42% of all neonatal deaths worldwide [2]. While it is important to point out that even in the most precarious situations, many of the deaths that occur around the time of birth are preventable [3], a recent report showed how reduced coverage of antibiotics for pneumonia, neonatal sepsis and diminished access to rehydration solution for diarrhea would together account for around 41% of additional child deaths during the COVID-19 pandemic [4]. As correctly underscored by Brenda Sequeira Dmello and colleagues [5], the consequences on maternal and newborn health of disruption of health services in the context of fragile health care systems could be devastating and one of the critical aspect is the complex procedure of contextualizing recommendations in such settings due to scarcity of data [6]. Humanitarian crises threaten the health and safety of communities directly and through the destruction of existing health systems and infrastructure, with pregnant women and newborn especially vulnerable. Based on these needs, a Declaration to Accelerate Newborn Health in Humanitarian Settings was released in February 2019 by key stakeholders from multiple sectors within the humanitarian and development fields, co-convened by Children, UNICEF, UNHCR and WHO, to catalyze a global agenda for improving newborn health in humanitarian settings. This resulting declaration was a call for the dignity, health, and well-being of every woman, every child, and every newborn – in humanitarian and fragile settings – to be urgently upheld and prioritized [7]. Photo: This picture shows a mother breastfeeding her baby in a rural community in Mozambique (source: private photo repository, Saverio Bellizzi, used with permission). The close collaborative effort triggered the production of a dedicated strategy for newborn health in humanitarian and fragile settings with the contribution and benefit of inputs of a wide range of stakeholders, including clinicians, implementers, academics, policymakers, government representatives, donors, private sector representatives, and professional associations across the reproductive, maternal, neonatal, child and adolescent health and nutrition continuum. The Roadmap to accelerate progress for every newborn in fragile and humanitarian settings 2020-2025 calls for collective and accountable action. It emphasizes the need to engage stakeholders from across humanitarian and development sectors to ensure that mothers and newborns – the essential dyad – survive and thrive even in the most difficult circumstances and across all phases of emergency response using a health systems approach. The roadmap clearly emphasizes the fact that the mother-newborn relationship is often underestimated or overlooked, and interventions such as promoting early and exclusive breastfeeding and skin-to-skin care are at risk of being de-prioritised during humanitarian response, despite their cost-effectiveness. In this regards, promotion and support for early initiation and exclusive breastfeeding are lifesaving interventions that should be provided during humanitarian response for both healthy and high-risk newborns [8]. It is particularly important that staff receive training on neonatal resuscitation to address asphyxia, and that they implement kangaroo mother care (KMC), feeding support, and monitored oxygen for premature babies [9]. Leadership by national and local governments is fundamental to contribute to rapid improvements in maternal and newborn survival during crises. This leadership is vital towards maintaining sustainable progress. Governments can develop policies and allocate resources to ensure mothers, pregnant women and newborns receive the care they need during an emergency. Health system resilience at national and sub-national levels should be strengthened by integrating priority maternal and newborn health interventions into preparedness and response plans, using global guidance and evidence to inform policies. The Roadmap to accelerate progress for every newborn in fragile and humanitarian settings 2020-2025 represents an important momentum for the existing workstream on newborn health in humanitarian settings and is even more relevant during the current pandemic to raise the voices of children and mothers in the highest mortality and morbidity burden zones of the world.

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          Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

          Summary Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9% and the prevalence of wasting is increased by 10–50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding Bill & Melinda Gates Foundation, Global Affairs Canada.
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            Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance

            Background Babies differ from older children with regard to their exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, data describing the effect of SARS-CoV-2 in this group are scarce, and guidance is variable. We aimed to describe the incidence, characteristics, transmission, and outcomes of SARS-CoV-2 infection in neonates who received inpatient hospital care in the UK. Methods We carried out a prospective UK population-based cohort study of babies with confirmed SARS-CoV-2 infection in the first 28 days of life who received inpatient care between March 1 and April 30, 2020. Infected babies were identified through active national surveillance via the British Paediatric Surveillance Unit, with linkage to national testing, paediatric intensive care audit, and obstetric surveillance data. Outcomes included incidence (per 10 000 livebirths) of confirmed SARS-CoV-2 infection and severe disease, proportions of babies with suspected vertically and nosocomially acquired infection, and clinical outcomes. Findings We identified 66 babies with confirmed SARS-CoV-2 infection (incidence 5·6 [95% CI 4·3–7·1] per 10 000 livebirths), of whom 28 (42%) had severe neonatal SARS-CoV-2 infection (incidence 2·4 [1·6–3·4] per 10 000 livebirths). 16 (24%) of these babies were born preterm. 36 (55%) babies were from white ethnic groups (SARS-CoV-2 infection incidence 4·6 [3·2–6·4] per 10 000 livebirths), 14 (21%) were from Asian ethnic groups (15·2 [8·3–25·5] per 10 000 livebirths), eight (12%) were from Black ethnic groups (18·0 [7·8–35·5] per 10 000 livebirths), and seven (11%) were from mixed or other ethnic groups (5·6 [2·2–11·5] per 10 000 livebirths). 17 (26%) babies with confirmed infection were born to mothers with known perinatal SARS-CoV-2 infection, two (3%) were considered to have possible vertically acquired infection (SARS-CoV-2-positive sample within 12 h of birth where the mother was also positive). Eight (12%) babies had suspected nosocomially acquired infection. As of July 28, 2020, 58 (88%) babies had been discharged home, seven (11%) were still admitted, and one (2%) had died of a cause unrelated to SARS-CoV-2 infection. Interpretation Neonatal SARS-CoV-2 infection is uncommon in babies admitted to hospital. Infection with neonatal admission following birth to a mother with perinatal SARS-CoV-2 infection was unlikely, and possible vertical transmission rare, supporting international guidance to avoid separation of mother and baby. The high proportion of babies from Black, Asian, or minority ethnic groups requires investigation. Funding UK National Institute for Health Research Policy Research Programme.
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              Confronting stillbirths and newborn deaths in areas of conflict and political instability: a neglected global imperative

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                Author and article information

                Journal
                J Glob Health
                J Glob Health
                JGH
                Journal of Global Health
                International Society of Global Health
                2047-2978
                2047-2986
                16 January 2021
                2021
                : 11
                : 03015
                Affiliations
                [1 ]Medical Epidemiologist, Independent Consultant, Geneva, Switzerland
                [2 ]University of Sassari, Sassari, Italy
                [3 ]Ospedale San Francesco, Nuoro, Italy
                [4 ]Kingston Hospital NHS Foundation Trust, Microbiology Unit, Kingston Upon Thames, UK
                [5 ]Mater Olbia Hospital, Olbia, Italy
                Author notes
                Correspondence to:
Dr Saverio Bellizzi
Via Verona 22
Sassari Italy Saverio.bellizzi@ 123456gmail.com
                Article
                jogh-11-03015
                10.7189/jogh.11.03015
                7898555
                07ea311e-616d-444e-ab75-5fc751fc1653
                Copyright © 2021 by the Journal of Global Health. All rights reserved.

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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