Why Are Newborns Still Dying from Preventable Causes?
- FHS Communications
A closer look at missed opportunities in neonatal care across LMICs
According to the UNICEF’s 2024 report on child mortality estimation, newborns accounted for 2.3 million deaths of children under five years old, nearly half of the annual total. Most of these deaths occurred in LMICs. Perinatal asphyxia and neonatal sepsis are among the leading causes of newborn deaths worldwide; both conditions are largely preventable with timely, proper care for the babies.
This leaves the question: Why are these deaths still happening when the necessary care to manage perinatal asphyxia and neonatal sepsis is prescribed in the World Health Organisation’s (WHO) clinical care guidelines?
Study overview
Wits VIDA researchers collaborated in the research paper titled Adherence to Perinatal Asphyxia or Sepsis Management Guidelines in Low- and Middle-Income Countries. The study was conducted in seven LMICs, namely: Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. The study looked closely at a striking reality: babies who died within the first month of life from perinatal asphyxia—not enough oxygen at birth—or neonatal sepsis, a severe infection, often succumbed to conditions that could have been prevented or treated with timely and appropriate medical care. Using data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network, they reviewed medical records and postmortem findings to see whether healthcare providers followed the World Health Organisation’s (WHO) guidelines for care.
Key findings
The study, which undertook postmortem sampling on 1194 newborns aged 0 to 28 days in December 2015 and October 2023, found that less than 5% the babies sampled with perinatal asphyxia received all the recommended treatments. Those with antemortem diagnosis had a better chance of receiving bag-valve-mask (BVM) ventilation compared to those who were not diagnosed before death.
Only 61% of babies with neonatal sepsis received WHO-recommended antibiotics, although an overall of 86% of babies were administered non-recommended antibiotics.
South Africa had the highest adherence rates for both conditions largely because it has a better-resourced health system compared to other CHAMPS sites. “Even though many of the guidelines require inexpensive resources, some sites still lack consistent access to basics such as routine antibiotics or neonatal resuscitation equipment,” explains Dr Siobhan Johnstone, CHAMPS Program Manager and Epidemiologist at Wits VIDA.
He says in contrast, the CHAMPS South Africa site benefits from better resource availability and more reliable access to healthcare, meaning children, particularly neonates, are more likely to be managed appropriately when needed. The main source of data for the South African site is an academic hospital, where clinical guidelines are more routinely implemented, unlike in some other CHAMPS settings.
This study also found that babies who were older at the time of death were treated with a higher adherence to WHO guidelines. Limited blood culture diagnostics, resource constraints and inadequate documentation of care provided were found to be common challenges, with the least adherent regions having high mortality rates.
The key recommendations are for diagnosis and treatment to commence within the first 24 hours of admission and to strengthen healthcare systems to support guideline-adherent care. Operational processes such as guideline dissemination and feedback mechanisms can enhance care.
Professor Ziyaad Dangor, CHAMPS researcher and Research Director at Wits VIDA, notes that the South African site is expected to have higher levels of adherence to guidelines because it is based in an academic hospital. “Clinicians are more likely to be regularly exposed to updated protocols and supervised practice. Ongoing training also reinforces the importance of evidence-based care and ensures consistency across staff,” he explains, adding that quick reference guides, job aids, or training videos further support adherence in busy clinical settings.