6.6.1 Annex 6A: Newborn Health Indicators for Routine Data Systems
Incorporate key indicators (bold) into national reporting systems. Other indicators are suggested to provide additional information, where feasible.
Note: Numerator and denominator should always be reported along with the percentages and should be for the same reporting period.
| Indicator | Numerator | Denominator | Disaggregation | Utility and limitations of indicators |
|---|---|---|---|---|
| Number of newborns who died during the first 28 days (day 0-27) of life in health facilities in a specified time period | Total number of live births (per 1000) in a specified time period | By timing of death (early neonatal death = 0 to 6 days; late neonatal death = 7 to 27 days) | Reports should indicate whether deaths that occur in the community are recorded at a facility. | |
| Number of babies born live in a facility who die prior to discharge from the facility during the first 28 days (day 0-27) of life in a specified time period | Number of babies born live in a facility in a specified time period | By timing of death (early neonatal death = 0 to 6 days; late neonatal death = 7 to 27 days) | ||
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Number of newborn deaths due to
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Number of newborn deaths recorded at a facility | By timing of death (early neonatal death = 0 to 6 days; late neonatal death = 7 to 27 days) | The indicator is not meant to be interpreted as a case fatality rate but rather provides information on cause of death among known, reported deaths. Reports should indicate whether causes of deaths that occur in the community are recorded at a facility. | |
| Number of fetuses and infants born with no sign of life and born with birthweight of 1000g or more, or after 28 weeks gestation, or 35 or more body length in a specified time period | Total number of births (per 1000) at a facility in a specified time period |
By timing/type of fetal death or stillbirth (antepartum or intrapartum), where possible[1] |
Reports should indicate whether stillbirths that occur in the community are recorded at the facility. | |
| Percent of live births at a facility where the newborn had trouble breathing at birth (or was not breathing at birth) | Number of live births at a facility where the newborn had trouble breathing at birth (or was not breathing at birth) | Number of live births at a facility |
The numerator for this indicator serves as the denominator for “Percent of newborns having trouble breathing at birth (or was not breathing at birth) where resuscitation techniques were used” (see below). Interpret this indicator with extreme caution. If non-breathing babies are often misclassified as stillbirths, introduction of a resuscitation program and training may lead to the apparent increase in the number of babies not breathing at birth. At the same time, high numbers of non-breathing newborns can indicate poor quality of intrapartum care. |
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| Number of live-born neonates with weight less than 2500 g at birth | Total number of live births at a facility |
Important especially where gestational age measurement is unreliable. While specific birthweight should be taken and recorded for each individual baby, if reporting is weak, one category capturing babies weighing <2500g with a yes/no response can be used in registers instead. |
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| Number of newborns born under 37 weeks gestation | Total number of live births at a facility |
Disaggregate by gestational age in weeks and days, where possible:
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If gestational age for births outside a facility is recorded at the facility, the denominator can be changed to total number of live births (see indicator on preterm birth rate (populations based)). Gestational age is often obtained by asking the pregnant woman for the date of last menstrual period rather than by clinical measurement, and is therefore subject to reliability issues. |
| Indicator | Numerator | Denominator | Disaggregation | |
|---|---|---|---|---|
| Antenatal care (at least one visit) | Number of women who were attended by skilled health personnel at least once during the pregnancy that led to their last birth | Total number of women with a live birth |
The numerators for these indicators can be used to calculate “Percent of antenatal clients who had a fourth ANCabbreviation visit” (numerator: number of antenatal clients with 4th ANCabbreviation visit; denominator: total number of antenatal clients with a 1st visit) |
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| Number of women who received antenatal care four or more times from any provider during the pregnancy that led to their last birth | Total number of women with a live birth | |||
| Antenatal client 1st visit before 12 weeks gestation | Number of antenatal clients 1st visit before 12 weeks | Total number of antenatal clients with a 1st visit | Marker for women having contact with a provider early enough in pregnancy to permit delivery of essential pregnancy services and early identification of problems that can be addressed to improve outcomes for women and newborns. | |
| Number of caesarean sections in a specified time period | Total number of women who gave birth at a facility in a specified time period | Marker of comprehensive emergency obstetric care. Large numbers can mean use of non-indicated cesarean sections. Could be disaggregated by urban/rural and/or private versus public sector to capture inequities as well as inappropriate use. | ||
| Number of newborns who were not breathing spontaneously or crying at birth and, subsequently, required resuscitation (stimulation and/or bag and mask) to be performed | Total number of live births at a facility | While important to monitor implementation of resuscitation programs, this indicator needs to be interpreted with extreme caution. See notes above for the indicator percent of live births at a facility where the newborn had trouble breathing at birth (or was not breathing at birth). | ||
| Number of newborns breastfed within one (1) hour of birth in a health facility | Number of total live births in a health facility | It should be noted that the early initiation of breastfeeding indicator is part of essential newborn care, but cannot be used as a proxy on its own for essential newborn care | ||
| Number of newborns who received all four (4) elements of essential newborn care (immediate and thorough drying; immediate skin-to-skin contact; delayed cord clamping; and initiation of breastfeeding in the first hour) | Total number of live births at a health facility | |||
| Number of newborns who received at least one (1) dose of chlorhexidine digluconate (7.1%) to the cord within 24 hours of birth | Total number of live births |
A measure of CHXabbreviation use for clean cord care, as prevention of infection. In some countries, where other antiseptics are used according to standard guidelines or as routine clinical practice, the indicator may be modified to capture the antiseptic being used. |
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| Number of newborns who received PNC with a healthcare provider within 2 days of childbirth | Total number of live births | The timing of expected PNC visits may be modified in accordance with the country specific definition by the MoH | ||
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Number of newborns initiated on KMCabbreviation at a facility (or admitted to KMCabbreviation unit if separate unit exists) |
Total number of live births in the facility |
Does not measure the quality of KMCabbreviation services or whether the newborn received KMCabbreviation for a sufficient length of time. The total number of preterm or eligible babies is difficult to determine, so this indicator uses a ratio of the number of KMCabbreviation admissions to the number of live births. Other information (causes of newborn death, etc) should be used in conjunction with this indicator to estimate whether most preterm/LBWabbreviation births are receiving KMCabbreviation at facilities. |
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| Number of newborns who receive treatment (at least one injection of antibiotic) for suspected serious bacterial infection in the facility. | Total number of live births in facility |
Measure of quality of care because newborns with PSBIabbreviation must complete treatment (based on national guidelines) to maximize chance of survival. Does not include newborn cases initiating treatment in community settings; denominator could be adapted to national treatment policy if sepsis treatment initiation at community level is included. Best used at local level to monitor and improve quality of care. |
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| Indicator | Numerator | Denominator | Disaggregation |
|---|---|---|---|
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Percent of pregnant women attending ANC who received Tetanus toxoid 2+ |
Number of women receiving at least two doses of tetanus toxoid | Total number of women with a live birth |
Tracking the number of ANCabbreviation visits is insufficient – this indicator measures whether important components are delivered, many of which can prevent newborn deaths. Longitudinal registers are preferred for tracking these indicators. |
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Percent of pregnant women attending ANC who received Syphilis screening |
Number of antenatal clients screened for syphilis in a specified time period. | Total number of antenatal clients with a first visit in a specified time period. |
Tracking the number of ANCabbreviation visits is insufficient – this indicator measures whether important components are delivered, many of which can prevent newborn deaths. Longitudinal registers are preferred for tracking these indicators. |
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Number of women counselled and offered voluntary HIVabbreviation testing at ANCabbreviation before their most recent birth and received their test results |
Total number of women with a live birth |
Tracking the number of ANCabbreviation visits is insufficient – this indicator measures whether important components are delivered, many of which can prevent newborn deaths. Longitudinal registers are preferred for tracking these indicators. |
6.6.2 Annex 6B: List of Indicators and Questions to Measure Facility Capacity to Provide Key Newborn Health Services
Adapted from Newborn Indicators Working Group, Newborn Services Rapid Health Facility Assessment, June 2012.
| Indicator | Numerator | Denominator | Disaggregation | Utility and limitations of indicators |
|---|---|---|---|---|
| 24/7 Skilled birth attendance | Number of facilities with inpatient maternity services with a provider skilled in conducting deliveries present at the facility or on call at all times (24 hours a day, 7 days per week) and schedule observed | Total number of facilities with inpatient maternity services that are assessed | Type of facility (e.g, hospital versus health center) | |
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Availability of functional emergency obstetric and newborn care facilities (EmONC) (per population) |
Number of obstetric care facilities that provided EmONC signal functions in the last three months:
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Total population (per 500,000) |
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UNabbreviation guidance on monitoring emergency obstetric care identifies at least five EmOC facilities (including at least one providing CEmONCabbreviation) for every 500,000 population. In sparsely population areas, or locations with major access constraints, more facilities may be needed to ensure services are available to meet population need |
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Number of facilities in which a space is identified for KMCabbreviation and where staff have received KMCabbreviation training (< 2 years) |
Total number of facilities with inpatient maternity services that are assessed | Type of facility |
| Indicator | Numerator | Denominator | Disaggregation | Utility and limitations of indicators |
|---|---|---|---|---|
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Percent of facilities with inpatient maternity services with no stockouts in the past 3 months of:
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Number of facilities with inpatient maternity services with no stock-outs in the past 3 months of:
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Total number of facilities with inpatient maternity services that are assessed |
Provides information on whether commodities are available, but not if they are used as intended or if commodities are functional/unexpired. A stock-out is defined as the complete absence of a commodity or supply at a delivery point for at least one day during the reporting Key commodities may vary by country; adapt indicators based on national essential drug/ commodity lists. |
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Percent of facilities with inpatient maternity services with no stockouts in the past 3 months of:
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Number of facilities with inpatient maternity services with no stock-outs in the past 3 months of:
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Total number of facilities with inpatient maternity services that are assessed | ||
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Percent of facilities with inpatient maternity services with no stockouts in the past 3 months of:
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Number of facilities with inpatient maternity services with no stock-outs in the past 3 months of:
ACSabbreviation is expected to provided only in facilities where the following conditions can be met:
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Total number of facilities with inpatient maternity services that are assessed | ||
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Percent of facilities with ANCabbreviation services with no stock-outs in the past 3 months of:
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Number of facilities with ANCabbreviation services with no stock-outs in the past 3 months of:
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Total number of facilities with ANCabbreviation services that are assessed |
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Percent of facilities with newborn care services with no stock-outs in the past 3 months of:
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Number of facilities with newborn care services with no stock-outs in the past 3 months of:
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Total number of facilities with inpatient maternity services that are assessed | ||
| Injectable uterotonic for PPH prevention/management | Number of facilities with inpatient maternity services and injectable uterotonic available (observed and at least one dose valid) | Total number of facilities with inpatient maternity services that are assessed | Type of facility |
| Indicator | Numerator | Denominator | Disaggregation |
|---|---|---|---|
| Newborn bag & mask | Number of facilities with inpatient maternity services with preemie and newborn bag (size o and 1) & mask available and functioning in delivery area (observed) | Total number of facilities with inpatient maternity services that are assessed | Type of facility |
| Resuscitation table | Number of facilities with inpatient maternity services with resuscitation table with a heat source available and functioning in delivery area (observed) | Total number of facilities with inpatient maternity services that are assessed | |
| Infant scale | Number of facilities with inpatient maternity services with infant scale available and functioning in delivery area (observed) | ||
| Soap or hand disinfectant | Number of facilities with inpatient maternity services with soap or hand disinfectant in delivery area (observed) | ||
| Towel for drying | Number of facilities with inpatient maternity services with towels for drying babies in delivery area (observed) | ||
| Protocols or guidelines |
Number of facilities with each of the following protocols or guidelines available (observed):
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| Indicator | Numerator | Denominator | Disaggregation |
|---|---|---|---|
| Up-to-date delivery register | Number of facilities with inpatient maternity services with up-to-date delivery register (birth outcome for the infant and birthweight recorded for the last 10 births) (observed) | Total number of facilities with inpatient maternity services that are assessed | Type of facility |
| Monitoring postnatal care |
Number of facilities with documentation of monitoring[2] of postnatal care for newborns |
Total number of facilities that are assessed |
| Indicator | Numerator | Denominator | Disaggregation |
|---|---|---|---|
| Trained providers |
Number of interviewed providers of delivery/newborn services trained in the past 12 months in each of the following areas:
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Total number of interviewed providers of delivery/ newborn services | Type of facility |
| Facilities with trained providers |
Number of facilities with at least half of interviewed providers[3] trained in the past 12 months in each of the following areas:
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Total number of facilities with interviewed providers of delivery/newborn services |
| Indicator | Numerator | Denominator | Disaggregation |
|---|---|---|---|
| Facilities with routine supervision | Number of facilities with routine supervision (at least half of interviewed providers reported being personally supervised at least once during the 6 months preceding the survey). | Total number of facilities with interviewed providers of delivery/newborn services | Type of facility |
| Indicator | Numerator | Denominator | Disaggregation |
|---|---|---|---|
| Number of facilities with inpatient maternity services that audit or review of newborn deaths to understand causes/circumstances of death and identify actions to mitigate future occurrences | Total number of facilities visited with inpatient maternity services | ||
| Number of facilities with inpatient maternity services that audit or review intrapartum stillbirths to understand causes/circumstances and identify actions to mitigate future occurrences | Total number of facilities visited with inpatient maternity services | ||
| Number of stillbirths and newborn (perinatal) deaths that were audited | Total number of stillbirths and neonatal deaths at a facility |