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Volume 23 Supplement 2

Small and sick newborn care: learning for implementation across Africa and beyond


Publication of this supplement has been supported by the NEST360 Alliance. The articles have undergone the journal's standard peer review process for supplements. The Supplement Editors declare that they have no competing interests.

Guest editors: Bogale Worku, Muhammed Zuman, Tanya Doherty, Joy E. Lawn, Sarah Murless-Collins. 

Managing editor: Caroline Noxon

Annually, an estimated 2.3 million newborns die within their first 28 days, comprising nearly half of under-five deaths. Sustainable Development Goal target 3.2 calls for countries to reduce neonatal deaths to <12 per 1000 live births by 2030. Meeting this SDG target necessitates countries reaching high coverage and quality for WHO level-2 neonatal services, including respiratory support with continuous positive airway pressure for preterm babies. Countries needing the most acceleration are in sub-Saharan Africa where 1 million babies die needlessly from preventable causes each year. Faster progress requires 80% of districts to have functioning small and sick newborn care units with level-2 newborn care, including the right infrastructure, devices, data, and skilled staff, necessitating systems change.

NEST360 (Newborn Essential Solutions and Technologies) alliance have compiled a series of papers sharing evidence-based tools and learnings for the scale-up of effective SSNC from four countries in sub-Saharan Africa, and relevant beyond. NEST360 is an alliance of 20 organisations, 17 in Africa, with four African country governments: Kenya, Malawi, Nigeria, and Tanzania. NEST360 is supporting these governments to implement a health systems package for high-quality level-2 small and sick newborn care. Frontline clinicians, biomedical technicians, and quality improvement leaders form a learning network in more than 67 facilities across the four countries. Ethiopia is joining the Alliance.

The team of >100 authors is interdisciplinary, international, and diverse, with the majority from Africa, where neonatal mortality is highest. Papers in this supplement inform implementation for high-quality newborn care in low- and middle-income contexts, including co-development of standardised data tools, systematic approaches to device selection, costing and set-up, education modules, and approaches to help catalyse investment. Many of the tools are open access on

  1. Thirty million small and sick newborns worldwide require inpatient care each year. Many receive antibiotics for clinically diagnosed infections without blood cultures, the current ‘gold standard’ for neonatal ...

    Authors: Sarah Murless-Collins, Kondwani Kawaza, Nahya Salim, Elizabeth M. Molyneux, Msandeni Chiume, Jalemba Aluvaala, William M. Macharia, Veronica Chinyere Ezeaka, Opeyemi Odedere, Donat Shamba, Robert Tillya, Rebecca E. Penzias, Beatrice Nkolika Ezenwa, Eric O. Ohuma, James H. Cross and Joy E. Lawn
    Citation: BMC Pediatrics 2023 23(Suppl 2):568
  2. Medical devices are critical to providing high-quality, hospital-based newborn care, yet many of these devices are unavailable in low- and middle-income countries (LMIC) and are not designed to be suitable for...

    Authors: Rebecca P. Kirby, Elizabeth M. Molyneux, Queen Dube, Cindy McWhorter, Beverly D. Bradley, Martha Gartley, Z. Maria Oden, Rebecca Richards-Kortum, Jennifer Werdenberg-Hall, Danica Kumara, Sara Liaghati-Mobarhan, Megan Heenan, Meaghan Bond, Chinyere Ezeaka, Nahya Salim, Grace Irimu…
    Citation: BMC Pediatrics 2023 23(Suppl 2):564
  3. Every Newborn Action Plan (ENAP) coverage target 4 necessitates national scale-up of Level-2 Small and Sick Newborn Care (SSNC) (with Continuous Positive Airway Pressure (CPAP)) in 80% of districts by 2025. Ro...

    Authors: James H. Cross, Christine Bohne, Samuel K. Ngwala, Josephine Shabani, John Wainaina, Olabisi Dosunmu, Irabi Kassim, Rebecca E. Penzias, Robert Tillya, David Gathara, Evelyn Zimba, Veronica Chinyere Ezeaka, Opeyemi Odedere, Msandeni Chiume, Nahya Salim, Kondwani Kawaza…
    Citation: BMC Pediatrics 2023 23(Suppl 2):567
  4. As countries strive to achieve sustainable development goal 3.2, high-quality medical education is crucial for high-quality neonatal care. Women are encouraged to deliver in health units attended by a skilled ...

    Authors: Josephine Langton, Sara Liaghati-Mobarhan, Edith Gicheha, Jennifer Werdenberg-Hall, June Madete, George Banda and Elizabeth M. Molyneux
    Citation: BMC Pediatrics 2023 23(Suppl 2):565
  5. High-quality neonatal care requires sufficient functional medical devices, furniture, fixtures, and use by trained healthcare workers, however there is lack of publicly available tools for quantification and c...

    Authors: Alice Tarus, Georgina Msemo, Rosemary Kamuyu, Donat Shamba, Rebecca P. Kirby, Kara M. Palamountain, Edith Gicheha, Meghan Bruce Kumar, Timothy Powell-Jackson, Christine Bohne, Sarah Murless-Collins, Sara Liaghati-Mobarhan, Alison Morgan, Z. Maria Oden, Rebecca Richards-Kortum and Joy E. Lawn
    Citation: BMC Pediatrics 2023 23(Suppl 2):566
  6. Millions of newborns die annually from preventable causes, with the highest rates occurring in Africa. Reducing neonatal mortality requires investment to scale hospital care, which includes providing hospitals...

    Authors: Elizabeth Asma, Megan Heenan, George Banda, Rebecca P. Kirby, Lucky Mangwiro, Claudia Ziegler Acemyan, Kara M. Palamountain, Philip Kortum, Kondwani Kawaza, Z. Maria Oden and Rebecca Richards-Kortum
    Citation: BMC Pediatrics 2023 23(Suppl 2):569
  7. Health system shocks are increasing. The COVID-19 pandemic resulted in global disruptions to health systems, including maternal and newborn healthcare seeking and provision. Yet evidence on mitigation strategi...

    Authors: Rosie Steege, Hannah Mwaniki, Ifeanyichukwu Anthony Ogueji, Jitihada Baraka, Sangwani Salimu, Meghan Bruce Kumar, Kondwani Kawaza, Opeyemi Odedere, Donat Shamba, Helen Bokea, Msandeni Chiume, Steve Adudans, Chinyere Ezeaka, Catherine Paul, Laurent Banyira, Gaily Lungu…
    Citation: BMC Pediatrics 2023 23(Suppl 2):572
  8. Small and sick newborn care (SSNC) is critical for national neonatal mortality reduction targets by 2030. Investment cases could inform implementation planning and enable coordinated resource mobilisation. We ...

    Authors: Rosemary Kamuyu, Alice Tarus, Felix Bundala, Georgina Msemo, Donat Shamba, Catherine Paul, Robert Tillya, Sarah Murless-Collins, Maria Oden, Rebecca Richards-Kortum, Timothy Powell-Jackson, Meghan Bruce Kumar, Nahya Salim and Joy E Lawn
    Citation: BMC Pediatrics 2023 23(Suppl 2):632
  9. Each year an estimated 2.3 million newborns die in the first 28 days of life. Most of these deaths are preventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness i...

    Authors: Rebecca E. Penzias, Christine Bohne, Samuel K. Ngwala, Evelyn Zimba, Norman Lufesi, Ekran Rashid, Edith Gicheha, Opeyemi Odedere, Olabisi Dosunmu, Robert Tillya, Josephine Shabani, James H. Cross, Sara Liaghati-Mobarhan, Msandeni Chiume, George Banda, Alfred Chalira…
    Citation: BMC Pediatrics 2024 23(Suppl 2):655
  10. Service readiness tools are important for assessing hospital capacity to provide quality small and sick newborn care (SSNC). Lack of summary scoring approaches for SSNC service readiness means we are unable to...

    Authors: Rebecca E. Penzias, Christine Bohne, Edith Gicheha, Elizabeth M. Molyneux, David Gathara, Samuel K. Ngwala, Evelyn Zimba, Ekran Rashid, Opeyemi Odedere, Olabisi Dosunmu, Robert Tillya, Josephine Shabani, James H. Cross, Christian Ochieng, Harriet H. Webster, Msandeni Chiume…
    Citation: BMC Pediatrics 2024 23(Suppl 2):656

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