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5 Ways to Save Newborns' Lives

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In the past two decades, the world has seen a dramatic reduction in childhood deaths. Compared to 1990, in 2012 (the latest year for which we have complete data), 47% fewer kids died before the age of 5. Globally, more women survive pregnancy and childbirth, and more children survive their early years than at any point in history.

This is a great accomplishment, but there's an equally big problem—newborn babies account for 43% of all deaths of children under age 5. Most of the progress we've made in improving health for children and mothers simply has not made it to newborns. Here are five research-backed ways to help newborns survive.

1. Encourage Breastfeeding

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Breastfeeding is a powerful, simple, and proven way to help newborns survive. UNICEF provides some statistics (emphasis added):

Children who are exclusively breastfed for the first six months of life are 14 times more likely to survive than non-breastfed children.

Studies show that initiating breastfeeding immediately after birth can reduce the risk of newborn death by up to 20 per cent, by boosting the child’s immune system.

But what's so special about breastfeeding? In the first few hours and days after a baby is born, the mother produces colostrum, a special form of milk that is a powerful immune system booster for the baby. When mothers begin breastfeeding immediately after birth, this boost is passed along to the newborn. The best health outcomes come when breastfeeding is both immediate and exclusive for the first six months of the newborn's life.

So what can we do to encourage breastfeeding? According to a study published last year in The Lancet, "Counselling, education and support can increase exclusive breastfeeding rates among children less than six months old by up to 90 per cent." Put simply, explaining the benefits of breastfeeding and supporting mothers through the process can make the difference.

2. Make Direct Skin-to-Skin Contact

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Direct skin-to-skin contact between baby and mother (or father) after birth can have a dramatic positive effect on the newborn's longterm health. Part of the benefit is that the newborn is exposed to the same bacteria as the parent, helping to establish a healthy immune system. But there are other benefits too—skin-to-skin contact can help improve a newborn's temperature, respiration, and heart rate. (Skin-to-skin contact with the baby also has benefits for the mother and father as well, including reductions in parental stress and depression.)

All babies can benefit from direct contact with their mothers' skin, but it's especially important with low-birthweight or preterm babies. A method dubbed "Kangaroo Mother Care" encourages mothers of these high-risk babies to frequently and exclusively breastfeed, while maintaining plenty of skin-to-skin contact. According to the International Breastfeeding Center, a baby given skin-to-skin contact:

• Is more likely to latch on

• Is more likely to latch on well

• Maintains his body temperature normal better even than in an incubator

• Maintains his heart rate, respiratory rate and blood pressure normal

• Has higher blood sugar

• Is less likely to cry

• Is more likely to breastfeed exclusively and breastfeed longer

• Will indicate to his mother when he is ready to feed

Costs nothing, can be done with no equipment at all, and helps everybody involved? Sounds like a winner to me.

3. Clean the Umbilical Cord

When the umbilical cord is cut after a baby is born, that cut can be an entry point for infections. The common "dry" method of cutting the cord can leave the baby's belly button exposed to infection. Using a dash of the antiseptic chlorhexidine on the cut provides extra protection for the baby, and in many parts of the world, means the difference between life and death. Here are some statistics from medical studies bearing this out (emphasis added):

Nepal: 24% reduction in newborn mortality when community health workers applied chlorhexidine to the cord during home visits. This intervention can be successfully incorporated into maternal and newborn care programs using [the] existing cadre of female community health volunteers. (The Lancet, March 2006)

Pakistan: When chlorhexidine was recommended and provided by traditional birth attendants to families, risk of newborn infection dropped by 42%, and neonatal mortality reduced by nearly 40%. (The Lancet, March 2012)

Meta-Analysis: Application of any CHX [chlorhexidine] to the umbilical cord of the newborn led to a 23% reduction in all-cause neonatal mortality in the intervention group compared to control.... (BMC Public Health, September 2013)

The simple conclusion here? An inexpensive disinfectant, applied once, saves newborns' lives.

4. Use Antenatal Corticosteroids (ACS) for Preterm Babies

Babies born prematurely face greater risks than full-term babies—and more than 1 in 10 babies worldwide are born preterm. According to Healthy Newborn Network, "over 1 million children die each year due to complications of preterm birth." But we have medicine that can dramatically improve the odds.

The Healthy Newborn Network breaks it down (emphasis added):

Antenatal corticosteroids (ACS) are a class of drugs which can reduce the risk of preterm death by more than 50% in facilities where ventilation support technologies are not available, and by roughly 30% even where advanced Neonatal Intensive Care Units (NICUs) are available.

These drugs are among the best documented, most effective, safest, and least expensive interventions we have to reduce preterm deaths. Antenatal steroids are now identified by the UN-led Commission on Life-Saving Commodities for Women and Children as an essential medicine that should be available everywhere.

The use of ACS is also supported by The National Institutes of Health as well as The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice.

5. Choose When to Become Pregnant

When births are spaced out by three or more years, the later siblings have a much better shot at life (though their odds of being on the same high school sports teams as their older brothers and sisters are pretty much nil). According to the Healthy Newborn Network, "Children born less than two years after a sibling are two times more likely to die within the first year of life than those born 3 or more years later." The reason for this is simple: birth spacing allows the mother to devote her energy to breastfeeding and caring directly for one baby at a time in the crucial first and second years of life. Birth spacing benefits the mother, the existing child (or children) and the new baby.

Another factor here is mothers bearing children while the mothers are too young. Again quoting the HNN (emphasis added): "More than 1 million babies born to adolescent girls [each year] die before their first birthday. In developing countries, if a mother is under 18, her baby's chance of dying in the first year of life is 60% higher than that of a baby born to a mother older than 19." What's more, reducing adolescent pregnancies keeps more girls in school; this raises their earnings over a lifetime, benefiting not just them, but their families and communities down the line.

According to The London Summit on Family Planning:

By 2020, if 120 million more women who want contraceptives could get them, there would be:

• More than 100 million fewer unintended pregnancies

• 200,000 fewer women and girls dying in pregnancy and childbirth

• Over 50 million fewer abortions

• Nearly 3 million fewer babies dying in their first year of life

Giving women the means to space their pregnancies would decrease deaths of children under age 5 by 25%. That's a goal worth fighting for.

The Every Newborn Action Plan

On May 19, the Every Newborn Action Plan will be presented to the World Health Organization. This is the start of the first-ever global initiative to improve newborn health and save lives. If this issue speaks to you, the Every Newborn toolkit is well worth a read.

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5 Fun Facts About Health, Toilets, Muppets, and Presidents
YouTube / thelostdisney
YouTube / thelostdisney

We've been running a series about global health since August 2013. Here are five of the most interesting facts we've uncovered since then.

1. There is a "World Toilet Organization" Run By "Mr. Toilet"

Jack Sim goes by "Mr. Toilet." He left the business world to found the WTO—no, not that one, the World Toilet Organization—in 2001. Starting that year, Mr. Toilet declared November 19 "World Toilet Day," and since then has been on a mission to bring sanitation to people in developing countries.

I urge you to drop what you're doing and watch this short video about Mr. Toilet. Yes, he says "shit" a lot. And it's awesome.

In addition to founding the World Toilet Organization and establishing World Toilet Day, Mr. Toilet is working to convince the world to abandon flush toilets, because they waste water. Sim reminds us that flush toilets waste up to 22 liters of water every day. Something to think about next time you debate whether to "let it mellow."

Learn more in 5 Reasons World Toilet Day is Awesome.

2. The Seven Dwarfs Helped Fight Malaria

Disney made an animated film in 1943 called The Winged Scourge featuring the Seven Dwarfs. It was the first in a series of animated propaganda shorts dealing with public health issues, and the only to feature established Disney characters. I'll summarize this ten-minute video for you: mosquitoes transmit malaria, malaria is bad, so let's kill mosquitoes. With help from dwarves. (Snow White doesn't make an appearance.)

Note that around 0:45 in the video, we see that malaria is still established in the United States in the world map. Malaria wasn't eliminated in the U.S. until 1951.

Read more in 8 Surprising Facts About Malaria.

3. George Washington Had Tremendous Health Problems

"Life of George Washington—The Christian Death" by Junius Brutus Stearns, courtesy of the Library of Congress

George Washington is likely the founding father to have suffered from the widest variety of awful diseases, so let's review some of the worst things that happened to him. As a young man, Washington traveled to Barbados with his brother Lawrence in 1751, in an attempt to cure Lawrence of his TB with fresh air. The attempted cure failed, and George became infected with TB in the process. He also managed to pick up smallpox while in Barbados.

George Washington returned from Barbados only to come down with pleurisy, while his brother Lawrence died from TB. George also contracted malaria (see above), and later suffered from dysentery. He died at age 67 while being treated for a throat infection. The treatment involved bleeding him (32 ounces of blood removed—probably what actually killed him), making him gargle vinegar, inducing vomiting, and nearly suffocating him with a molasses/butter/vinegar potion.

Washington's struggle with disease was so epic that PBS produced an entire article describing and discussing his medical problems and how they might have been solved today. (They noted that he also suffered from diphtheria, quinsy, a carbuncle, pneumonia, and epiglottitis. Ouch. Oh yeah, and he lost his teeth to infection and decay, leaving him with just one remaining tooth upon inauguration as president. He lost that one too.)

Check our the history of presidential pain in 6 Awful Illnesses Suffered By US Presidents.

4. Cookie Monster Promotes Handwashing and Healthy Eating

In April 2013, Cookie Monster emphasized the importance of handwashing as part of an effort to promote sanitation work around the world. (2.5 billion people don't have access to toilets!) He granted an interview on the subject, conducted by the Impatient Optimists blog. Here's a snippet:

Impatient Optimists: We know you’re a cookie enthusiast. Can you tell us your cookie eating ritual?

Cookie Monster: Me cookie eating reputation precedes me. Of course me have ritual! First me wash hands. This part very important because it help keep me healthy. Me not sure exactly how long me wash, but me sing the ABCs slowly and when me get to Z, it time to rinse and then look out, om nom nom nom nom. Me also like to share me cookies with Elmo and Big Bird. Little known secret, a birdseed cookie is delicious.

Cookie Monster also famously sang in 2005 that "A Cookie is a Sometimes Food" in an effort to combat obesity. (In the song, various fruits are declared "anytime foods.") In this video, he struggles with the choice between fresh fruit and a delicious cookie:

Cookie Monster also tackled food issues with a 90s-style rap about healthy eating, complete with gold chains. "Nutrition, it really hip!" Me love it.

Read more in 13 Sesame Street Muppets That Make a Difference.

5. One Man Created Eight of the Most Common Vaccines

Image courtesy of Images from the History of Medicine

Although most people have never heard of him, Maurice Hilleman developed dozens of vaccines, including eight vaccines that you may have received. Hilleman developed vaccines for chickenpox, Haemophilus influenzae bacteria, hepatitis A, hepatitis B, measles, meningitis, mumps, and pneumonia (among many others). His vaccines saved millions of lives, and I've received a bunch of them myself! His obituary read, in part (emphasis added):

"Hilleman is one of the true giants of science, medicine and public health in the 20th century," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

"One can say without hyperbole that Maurice has changed the world," he added.

... "If I had to name a person who has done more for the benefit of human health, with less recognition than anyone else, it would be Maurice Hilleman," Gallo said six years ago. "Maurice should be recognized as the most successful vaccinologist in history."

His obituary is well worth a read, including colorful lines like: "'Montana blood runs very thick,' [Hilleman] said later, 'and chicken blood runs even thicker with me.'" (He grew up on a farm and worked with chickens quite a bit in developing vaccines.) His story is also told in the book Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases.

Read more in 5 Things You Might Not Know About Vaccines.

YouTube / ONE
How Missed Calls Amplify Farmers' Voices
YouTube / ONE
YouTube / ONE

This week, Farm Radio International (FRI) announced the results of an innovative poll covering thousands of farmers. The biggest surprise was the way farmers voted: by calling a phone number and hanging up.

The survey was conducted in Tanzania, where smallholder farms (small family farms) make up around 75% of all farm production. FRI, an international radio service that partners with local stations, wanted to poll those farmers in order to help make their voices heard by the Tanzanian government. But how do you reach thousands of tiny farms spanning a whole country? In the case of Tanzania, the answer was radio talk shows and basic cell phones.

Photo courtesy of ONE / Do Agric

The Power of Radio Talk Shows and Cell Phones

Across Tanzania, there are radio stations broadcasting talk shows aimed at farmers. Those programs are already popular for the people the survey aimed to reach, so FRI partnered with five radio stations in different regions across the country. The local presenters added discussion segments to their programs dealing with the poll issues.

Radio broadcasters concluded the poll segments by asking yes/no questions, then giving out phone numbers that voters could dial into. But people generally don't want to waste their cell phone minutes on a poll, so a clever solution came into play: just call the number, then hang up. The missed call is logged, and that log constitutes a vote. This system is called "Beep to Vote," and it's free for voters because the missed call doesn't incur charges for using cell phone minutes. For yes/no questions, there was one phone number for "yes" and another for "no." A total of 8,891 smallholder farmers participated.

In addition to the "Beep to Vote" yes/no questions, the poll included a multiple-choice question that most voters responded to using SMS. Voters texted a single character ("1" for the first option, "2" for the second, and so on) to a specified phone number, and those results were tallied by computer. In addition to the SMS voting method, farmers could opt to make a voice call to an automated system, listen to the five options, and press a number to indicate their choice. 4,372 people responded to the multiple-choice question. The system was also able to send SMS reminders to voters in case they voted for one of the poll questions, but not the others.

The data was crunched in realtime using a system made by Telerivet, so poll workers could watch as votes came in. The system also checked incoming phone numbers so each phone (which roughly equates to each voter, or household) could only vote once per question.

Photo courtesy of ONE / Do Agric

Why This Matters

From a technological perspective, this poll is a brilliant example of choosing the right technology for the job. If a similar poll were conducted targeting middle-schoolers in the United States, it's likely that technologies like YouTube videos and click-to-vote within the video would be used. But for these Tanzanian farmers, the prevalent technologies are radio and cell phones. By putting them together, in a near zero-cost way, FRI was able to collect data that could influence government policies, which in turn could change livesusing just cellphones and radio.

This poll was part of a campaign called Do Agric, focused on encouraging African leaders to invest more in agriculture, in order to improve farming (and in turn, daily life) in Africa. Here's a video about the program:

When the results were announced earlier this week, Tanzania's President Kikwete said, "Action on agriculture has to be today, not tomorrow!" The voices of 8,891 farmers reached the president's ears.

For more on the survey, check out FRI's page on methodology and results.


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