Dr. Farah Fatupaito
PRSH Conference
Samoa 2013
2
main- Upolu
 1 main Savaii
 8 district hospitals
 Experienced Midwives in each
hospital
 All sick newborns referred to
Tupua Tamasese Meaole Hospital
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neonatal health issues
Mortality rates
Progress to achieving MDGs of reducing child
mortality
Strategies to achieving MDG 4
Challenges and opportunities to improve
services
 Respiratory
tract infections
 Acute gastroenteritis
 Low birth weight babies and
congenital abnormalities
 Malnutrition
 Rheumatic fever
 Iron deficiency anemia
 Breast feeding
 Immunization coverage
1
Pneumonia
2
3
Acute bronchiolitis
Acute gastroenteritis
4
5
Typhoid fevers
Infections of the skin/ subcutaneous
tissues
Injuries , wounds , fractures , poisoning
Aspiration syndromes ( meconium )
Bacterial sepsis of the newborn
prematurity / Low birth rates
Asphyxia / fetal distress
6
7
8
9
10
Total number of
admissions to NNU
 2009 -823
 2010 - 911
 2011
806
 2013 -1020
Number of deliveries
at TTM
 2009
3490
 2010
3057
 2011
3972
 2012
4012
total number of admissions to
NNU
1200
1000
800
600
number
400
200
0
2009
2010
2011
2013
Admission by disease to NNU (%) 2011
low bwt
22%
csect
42%
home del
3%
MSAF
11%
MAS
twins
3%
cong abn
2%
big babies
8%
asphyxia
4%
5%
admission to NNU by disease (%)2012
Abnormal Babies Home
delivery Twins
2%
2%
3%
Big babies
8%
LBW
17%
C-Section
45%
MSAF
Asphyxia
6%
13%
Meconium
aspiration
4%
total number of low birth weight babies per
year
180
171
160
150
140
137
128
120
100
80
60
40
20
0
2009
2010
2011
2012
low birth weight over 4 years
140
t
120
o
t 100
a
l
80
LBW
VLBW
n
u
ELBW
60
m
b
40
e
r
20
0
2009
2010
2011
2012
Conditions
RESUSCITATION
 FLUID AND ELECTROLYTE mx
 Prevention and treatment
of INFECTION
 Long stays in NNU

250
200
150
MAS
100
MSAF
50
0
20092010
20112012
Rates
 2009- 5%
 2010- 6.8%
 2011- 3%
 2013-4%
Years
Neonatal Post
Infant
Child
Under
precedin mortality neonatal mortality mortality five
g SDHS
mortality
mortality
0-4
5
5
9
6
15
5-9
6
3
9
4
13
1014
5
3
8
4
12
Source :Samoa Demographic
Survey
Years
Neonatal
preceding mortality
SDHS
Post
neonatal
mortality
Infant
mortality
Child
mortality
Under
five
mortality
0-4
5
5
9
6
15
5-9
6
3
9
4
13
1014
5
3
8
4
12
Source :Samoa Demographic
Survey
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
Samoa
Tonga
Fiji
Tuvalu
Kiribati
PNG
Solomon Is
micronesia

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
8
8
8
14
19
23
11
17
TARGET
Reduce child
mortality by 2/3
between 1990 and
2015
 INDICATORS
Under five mortality
rates
Infant mortality rates
Proportion of 1 year
old children
immunised against
measles

Seven essential service
Package for child survival
• Skilled attendance during pregnancy,
delivery and immediate postpartum
• Care of the newborn
• Breastfeeding and complementary
feeding
• Micronutrient supplementation
• Immunization of children
and mothers
• Integrated management of
sick children
4
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Bubble CPAP 2009- improve survival rates in
LBW
POINTS training for nurses 2012-2013
Protocols
Visiting Neonatologist Specialists
Medicines eg. surfactant, probiotics,
Newborn screening tests
Annual neonatal resuscitation courses
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Prematurity and
complications
Meconium
Big babies
Congenital
abnormalities
Home deliveries
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Staff turnovers
Need for
specialisation in
neonatal nursing
Early referrals from
TBA
Continuous trainingNewborn resus/care
Better antenatal care
Equipments for new
hosp?
research