Malawi is one of the countries that made significant progress in reducing child mortality, achieving MDG 4 targets ahead of the 2015 deadline recognised in the Promise Renewed report of 2014. The current under-five mortality rate has fallen to 71 per 1,000 live births from 244 in 1999. Neonatal mortality is still very high at 27 per 1,000 live births and accounts for over 40 percent of under-five mortality. Newborn survival is receiving international attention, with an established global target of 12 deaths per 1000 live births by 2030. Newborns in Malawi continue to die from preventable conditions, namely infection, prematurity and asphyxia. Malawi’s Every Newborn Action Plan (ENAP) targets reducing preventable neonatal deaths from 27 per 1,000 live births to 23 by 2020 and to 15 per 1,000 live births by 2035. The Action Plan contains interventions that have proven to have an impact in the reduction of neonatal deaths in Malawi. Improving quality of care is one of the pillars for ensuring attainment of the objectives.
The Ministry of Health (MoH) fully recognizes the immediate and long-term health, social and economic repercussions of acute and prolonged morbidity and mortality among neonates and infants. In the last few years there have been major advances for the care of newborns in Malawi. To achieve these ambitious targets purpose-built special newborn care units (SNCU) have been opened in most hospitals. Nurses and midwives are now assigned to the neonatal wards and a package of equipment for comprehensive care has been provided to every hospital in Malawi. Trained and skilled health workers are one of the cornerstones of quality care and in order to address the knowledge and skills gap that were there, the MoH in collaboration with the Paediatric and Child Health Association (PACHA) and UNICEF developed the Care of the young Infant and Newborn (COIN) training course in 2015. The COIN manual and course have been updated on a regular basis to reflect new developments in neonatal care and respond to changes in practice.
The use of modern technologies played a vital role in improving outcomes of neonates in the West and is critical if Malawi is to achieve the ambitious neonatal mortality targets. To address this need the MOH partnered with NEST 360° (Rice University and Malawi College of Medicine) to create a package of durable, high impact, low cost technologies for comprehensive newborn care. For these reasons a supplement has been added to the COIN course to explain the use and maintenance of the technologies. The manual is intended to be used by clinicians, nurses/midwives and biomedical technicians/engineers involved in taking care of neonates and young infants with the equipment placed in the SNCUs. The manual contains guidelines on basic clinical management of major causes of morbidity and mortality of neonates and young infants presenting to health facilities in Malawi. It is complementary to the existing MoH policies and guidelines on Maternal, Newborn and Child Health.
It is the hope of the Ministry that this document will be widely disseminated and utilised across the country to achieve the desired goal. The MoH would like to acknowledge and appreciate contributions made by individuals and institutions in various forms.
Dr Charles Mwansambo
Secretary for Health