A key component of the Emergency
A key component of the Emergency Nutrition Response was the implementation of a Child Nutrition Week to deliver a package of essential nutrition services for children younger than 5 years and their mothers before the onset of the monsoon rains. The Child Nutrition Week built on the experience of child health days. In non-emergency settings, such days involve delivery of several child survival interventions periodically and efficiently while improving coverage and equity among populations not reached by routine services. These child health days have been ranked as “very cost-effective” and “pro poor” by the WHO and the World Bank.
WHO estimates that the global prevalence of maternal sepsis is 4·4% among livebirths, representing more than 5·7 million cases per year. Important variations exists between regions, with higher incidence in low-income and middle-income countries (up to 7%) compared with high-income countries (1–2%). Despite the relative low prevalence and the availability of interventions for its prevention and treatment, maternal sepsis remains a life-threatening condition and one of the leading direct causes of maternal mortality worldwide, accounting for up to 10% of maternal deaths. Up-to-date guidance on effective interventions to reduce the global burden of maternal infections at a time when they are most likely to affect maternal and newborn survival is certainly needed. This week, WHO launches new guidance on interventions for women to prevent and treat infections occurring during the peripartum period. In this guideline, the term “maternal peripartum infection” was adopted to consider bacterial infections of the genital tract or its surrounding TAPI-1 occurring at any time between the onset of rupture of membranes or labour and the 42nd day post partum. The overall approach of these recommendations is to highlight and encourage effective practices that are underused and discourage practices that are either ineffective or potentially harmful to women, their babies, and the general public. Caesarean section is the most important risk factor for maternal infection in the immediate postpartum period. The main strategies to prevent post-caesarean infections include the observation of fundamental surgical aseptic techniques and use of prophylactic antibiotics. However, the global use of prophylactic antibiotics for caesarean births varies largely between hospitals, in part because of lack of institutional protocols and uncertainties about the antibiotic regimen of choice and correct timing of administration. The WHO guideline panel made strong recommendations regarding the administration of prophylactic antibiotics before skin incision, rather than after umbilical cord clamping, for women undergoing elective or emergency caesarean section. In view of the overall evidence in favour of prophylactic antibiotics, the panel acknowledged that antibiotics are also effective when given after umbilical cord clamping, particularly in cases of emergency caesarean section where the available time to administer antibiotics before surgery might be limited. Evidence suggests that a single dose of first-generation cephalosporin or penicillin should be used in preference to other classes of antibiotics, particularly because these are broad-spectrum antibiotics and widely available in all settings.
Further progress in decreasing child mortality depends on reducing the 2·9 million neonatal deaths each year, around a quarter of which are directly due to infection. However, systemic underfunding is limiting research and threatens further advances. The need is great: an estimated 6·9 million neonates required treatment for possible serious bacterial infection in 2012 in high-burden settings, and the Global Burden of Disease Study estimates suggest that neonatal infections account for around 3% of disability-adjusted life-years (DALYs), with insufficient data to estimate long-term disability after sepsis or pneumonia.