Peer-reviewed article
Contribution of improved quality of early essential newborn care to neonatal mortality decline in Cambodia, 2010-2022: a retrospective observational study.
Krang S, Rathavy T, Murray JCS, Kim R, Phal S et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study evaluates how improved early essential newborn care (EENC) contributed to Cambodia's dramatic reduction in newborn deaths between 2010 and 2022. The EENC programme was scaled nationally using clinical coaching and quality improvement methods, reaching 87.6% of birth facilities. Newborn mortality fell from 27 to 8 deaths per 1000 live births, with the rate of decline accelerating after the programme started in 2012. The study estimates that EENC interventions prevented about 21,700 newborn deaths and accounted for 75% of Cambodia's total neonatal mortality reduction during this period.
Key points
- Neonatal mortality declined 70.4% from 27 to 8 per 1000 live births between 2010 and 2022
- Annual rate of newborn mortality decline accelerated 33% after EENC introduction in 2012 compared to the previous decade
- EENC was introduced to 87.6% of birth facilities and integrated into national policies and standards
- Birth practice quality scores improved from 6% in 2011 to 72.9% in 2022, with major gains in clean birth, thermal protection, cord care and immediate newborn stimulation
- EENC interventions averted an estimated 21,704 newborn deaths and accounted for 69.5-80.5% of observed national mortality reduction
Limitations
This is a retrospective observational study using modelling to estimate lives saved, so causation cannot be definitively proven and relies on the accuracy of the Lives Saved Tool model. The study cannot isolate EENC's contribution from other concurrent health system improvements or changes in maternal education and health-seeking behaviour.
Abstract
Introduction Between 2005 and 2010, reductions in newborn mortality fell behind those for maternal and under-five child mortality in Cambodia. To improve newborn outcomes, we developed and scaled-up early essential newborn care (EENC) nationally using a new clinical coaching and data-based quality improvement approach. This study aimed to determine EENC's contribution to Cambodia's observed neonatal mortality decline between 2010 and 2022. Methods Standard indicators in the EENC monitoring and evaluation framework were calculated from programme records, nationally representative population-based surveys and facility-based assessments using standardised methods. The Lives Saved Tool (LiST) was used to model newborn lives saved 2010-2022 using facility estimates of care quality. Results Newborn mortality declined from 27 to 8/1000 live births (70.4%) comparing 2010 and 2022. The average annual rate of newborn mortality decline accelerated by 33% after EENC introduction in 2012 compared with the previous 10 years, with greatest declines among high-risk groups (poorest, rural, uneducated and with low birth interval). Between 2010 and 2022, EENC was integrated into national and subnational policies, standards and implementation plans and introduced to 87.6% of birth facilities. The average birth practice score rose to 72.9% (95% CI 59.0% to 83.4%) in 2022, from 6% (95% CI 1.7% to 20.1%) in 2011. Significant improvements were seen in application of clean birth environments, immediate drying and stimulation, thermal protection (immediate and prolonged skin to skin contact), delayed cord clamping and clean cord care. LiST modelling estimated that EENC interventions averted 21 704 Cambodian newborn deaths (range 17 694-26 450) during 2010-2022 and were responsible for 75.3% (range 69.5%-80.5%) of the observed national mortality reduction. Conclusion A new approach to EENC programme implementation led to sustained country-wide improvements in evidence-based practices around birth. Improved care quality was associated with 69.5-80.5% of the observed neonatal mortality decline in Cambodia between 2010 and 2022.