Table 6 South Africa’s response to improve neonatal survival, economic evidence of these interventions and potential cost-effectiveness of interventions in South Africa

Improve the health system for mothers and babies

Contraception, including for post miscarriage and postpartum

24 h access to functioning emergency obstetric and neonatal care including clear referrals routes with dedicated obstetric and neonatal ambulances

Maternal waiting homes, KMC sites in all hospitals

CEOs to ensure that there is no rotation of nursing staff providing neonatal care

Limited evidence except for contraception which is highly cost-effective in LMICS (Halperin et al.)

Increasing contraception is potentially cost-effective in South Africa, based on a similar South African model

Improve knowledge and skills of health care providers:

 Most hypoxic deaths are as a result of inadequate intrapartum care provided by health care providers.

Train all health care workers providing maternity and neonatal care in the ESMOE-EOST programme and in managing the immature infant using the SA INC toolkit

Train all health care workers who deal with pregnant women in HIV advice, counselling, testing and support, initiation of HAART, monitoring of HAART

Train all health care workers in correct management of intrapartum care (use of the Partogram, 3rd stage of labour)

(Manasyan et al.; Hounton et al.)

(John et al.; Robberstad and Ovjen-Olsen)

Highly cost-effective strategy (Adam et al. 2005; Darmstadt et al. 2007)

Comparable study setting in Zambia with low neonatal mortality rates (NMR). Cost-effectiveness results likely to be similar

HIV prevalence amongst antenatal attendees is high in SA as in settings under study. Cost-effectiveness likely to be high

Differing baseline assumptions assessed by Adam et al. intervention remained highly cost-effective—high cost-effectiveness expected in SA

Reduce deaths due to prematurity:

 The use and application of nasal CPAP at a district hospital can reduce mortality of this group by up to 40 %

Corticosteroids must be given where possible to every women in preterm labour

Antibiotics must be given to every women with preterm premature rupture of membranes

All hospitals (especially district hospitals)must have staff skilled in the use of nasal CPAP

All mothers of immature infants must have easy access to Kangaroo Mother Care

One of the most cost-effective interventions (Adam et al. 2005; Darmstadt et al. 2007)

One of most cost-effective interventions (Adam et al. 2005; Darmstadt et al. 2007)

No data

Cost-saving strategy (Darmstadt et al. 2007)

Differing baseline assumptions assessed by Adam et al. intervention remained highly cost-effective—high cost-effectiveness expected in South Africa

Reduce deaths due to infection:

 Infection is the third largest cause of neonatal deaths in all weight categories, but highest in the 1000–2000 g group

There must be strict adherence to basic hygiene in labour wards and nurseries. D-germ alcohol sprays, soap, clean water and paper towels must be available in all nurseries as essential consumables

There must be presumptive antibiotic therapy for newborns at risk of bacterial infection

There must be case management of neonatal sepsis, meningitis and pneumonia

As breast milk provides the best nutrition and protection for the preterm baby, districts should provide breast milk (not preterm formulas) to all preterm babies by the establishment of human milk banks

Infection dashboard must be introduced in all neonatal nurseries to reduce infections by heightening awareness and surveillance of infection rates

No data for LMICs

One of the most cost-effective interventions (Adam et al. 2005)

One of the most cost-effective interventions in Asia (Adam et al. 2005)

(Darmstadt et al. 2007)

No data in LMICs

Differing baseline assumptions assessed by Adam et al. antibiotic therapy remained highly cost-effective—high cost-effectiveness expected in South Africa