Its that time of year again. Our financial year ends at the end of February so annual fees are now due for 2020. Our membership fee remains the same at R300. On the 31st of March we will be debiting those of you with debit orders. For those of you who prefer doing it yourselves you can pay by EFT or via the website (with a credit card).

Your R300 gets you our quarterly newsletters, membership of the Council of International Neonatal Nurses (COINN), a once off membership pin and discounted registration at the national conferences (and some local workshops).

It also joins your voice with ours-there is power in numbers! The more members we represent the more influential we can be in advocating for our precious babies and for neonatal nurses (particularly for the need for training). It links you to a network of nurses where you can share best practices and obtain support when you need it.

Although your national board members are all volunteers, unfortunately there are ongoing costs to run an Association-bank and auditing charges, paying a part time secretary, annual COINN membership fees, website and email hosting, merchandise and branding, up from costs for conference (particularly very high venue costs) travel to national meetings to represent NNASA and more. Without your membership fees NNASA cannot function. Please support us as we support you and Renew Today.

Thank you

As nurses it is crucial that we embrace data so that we can knowledgeably and confidently advocate for our babies. Below you will find a link to download a Fact sheet on South Africa’s progress toward the 2030 SDG targets.

The Healthy Newborn Network has compiled all the latest data from multiple sources into one user friendly tool called Newborn Numbers. An extract from their Newsletter gives details and links below. We encourage you to become familiar with South Africa’s numbers and then find out how your facility is doing using your own facility data base eg DHIS or the Vermont Oxford network amongst others.

From The Healthy Newborn Network-“The latest version of the Newborn Numbers is now available, along with updates to relevant numbers in our Issue and Country pages. The updates include a comprehensive database of the most recently published data relating to newborn survival and health – including under-5, neonatal and maternal mortality, stillbirths, causes of death, preterm birth rates, coverage of interventions, health financing and contextual data.

The updates also include an interactive data visualization tool allowing users to easily and quickly generate graphs for over 50 newborn related indicators. All data are already in the public domain but available across multiple websites and peer-reviewed publications. Newborn Numbers consolidates this information in order to support easy data access and use for advocacy and decision making. The database can be downloaded for offline use. Learn more. “

Caring hands

A small but growing amount of evidence suggests that newborns also do not always receive respectful, evidence-based care, which could have lasting implications on their health, and discourage their families from seeking subsequent care. This is especially important for small and sick newborns, who are at the highest risk of morbidity and mortality. Newborns’ experiences with caregivers can have significant and lasting impact— newborn babies feel pain and discomfort, and can experience emotional distress, particularly when separated from their families in the first hours of life. Good early care, including attachment and breastfeeding, has a lasting positive impact on the health and well-being of newborns throughout their lives. More research is needed to determine how widespread these issues are, how to better define mistreatment of newborns, and how to provide better care for all families as well as support to health care providers.

Find links to resources below:

The transition to becoming a parent for the first time is a time of rapid changes (sexual debut, first pregnancy, marriage, first birth, learning to care for a newborn), often within the space of a year. Globally, about 13 million adolescent girls (ages 15-19) and many more young women (ages 20-24) become parents every year.

South Africa has a high teenage pregnancy rate. Click below to read the whole article and access resources.

Envisage this – you are a neonatal nurse and you go to work in a busy neonatal unit.  Here you find yourself the only nurse in that room for that shift – caring for all 45 babies sharing 30 cots as there are not enough cots for all the babies. Four of the babies are sharing phototherapy lights. You are advised that mothers will generally come every three hours to feed the babies, except for the few babies that have no family. Although highly skilled, from a simple mathematics calculation, you realise you have a maximum of 10 minutes to spend with each baby in an 8 hour shift – not including any breaks, writing notes, or new admissions. Reflect a little on how this would affect the quality of your care.

Karen Walker and Carole Kenner from the Council of International Neonatal Nurses (COINN) -of which NNASA is a member and is represented on the board-reflect on the importance of neonatal nurses in reducing costs and improving outcomes for neonates globally. Read the rest of their article below.

The reference to Economic assessment of neonatal intensive care by Irene Guat Sim Cheah also makes for interesting reading and good advocacy points.

We need your care!

High rates of avoidable maternal and newborn mortality and morbidity in low-income and middle-income countries could be mitigated by improving quality of care. A Lancet Global Health Commission highlighted the need for high-quality health systems that improve health, and are valued, trusted, and responsive to dynamic population needs. Kruk and colleagues have called for health systems to “measure and report what matters most to people”, including user experiences, health outcomes, competent care, and confidence in the system. Maternal health indicators have historically focused on process and coverage outcomes related to life-saving interventions (eg, proportion of births with skilled attendance) and health outcomes (eg, maternal mortality).

These indicators do not fully reflect or correlate well with quality, nor account for women’s perceptions or experiences of care, particularly respect, communication, and emotional support. Poor experiences of maternity care can negatively affect both the woman herself and future health seeking behaviors but are typically not routinely assessed. For example, in a Cochrane review of continuous support for women during childbirth, only 11 (41%) of 27 trials reported women’s experiences, a primary review outcome.

Evidence suggests that women across the world experience mistreatment during childbirth, including physical abuse, verbal abuse, discrimination, non-consented procedures, and non-supportive care. Bowser and Hill’s landscape analysis brought this issue to global attention and our mixed-methods systematic review developed a typology of what constitutes mistreatment. The WHO intrapartum care guideline recommends respectful maternity care for all women, which is care that maintains “dignity, privacy, and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth.”

Manifestations and structural drivers of mistreatment are now well documented, but debate remains about measurement approaches, including the type (observation, woman-reported) and timing (exit interviews, community-based interviews) of measurement. For example, across 15 studies in seven low income and middle-income countries,18–32 location, timing, and populations varied substantially: facility-based exit interviews, facility-based interviews during postnatal immunization, and community-based interviews  with women from 3 to 5 years post partum. The use of different populations, sampling, tools, and data collection methods might influence the risk of bias (selection, social desirability, information, recall) and render cross-study and cross-context comparisons challenging. Accurate measurement is essential to improve accountability, design interventions, and measure impact over time.

In 2013, a technical consultation recommended that WHO initiate research to develop and validate tools to measure the mistreatment of women during childbirth. The aim of the present study was to use a systematic, evidence-informed approach to develop tools to provide comparable data on the burden of mistreatment across contexts. The formative phase consisted of systematic reviews and primary qualitative research in Nigeria, Ghana, Guinea, and Myanmar. Formative research and a review of existing tools informed the measurement phase, which used continuous observations of women during labour and childbirth, and community-based surveys with post-partum women to measure the prevalence of mistreatment in Nigeria, Ghana, Guinea, and Myanmar. We report the prevalence of mistreatment during childbirth based on continuous labour observations and a community-based survey with women.

Access the article below.

Breast is always best!


In 2011, South Africa committed to promoting exclusive breastfeeding (EBF) for six months for all mothers, regardless of HIV status, in line with World Health Organization recommendations. This was a marked shift from earlier policies, and with it, average EBF rates increased from less than 10% in 2011 to 32% by 2016.


The aim of this mixed-methods systematic review was to describe EBF practices in South Africa and their multi-level influences over four policy periods.


We applied PRISMA guidelines according to a published protocol (Prospero: CRD42014010512). We searched seven databases [Africa-Wide, PubMed, Popline, PsychINFO, CINAHL, Global Health, and The Cochrane Library] and conducted hand searches for eligible articles (all study designs, conducted in South Africa and published between 1980–2018). The quality of articles was assessed using published tools, as appropriate. Separate policy analysis was conducted to delineate four distinct policy periods. We compared EBF rates by these periods. Then, applying a three-level ecological framework, we analyzed EBF influences concurrently by method. Finally, the findings were synthesized to compare breastfeeding influences by policy period, maintaining an ecological framework.


From an initial sample of 20,226 articles, 72 unique articles were reviewed, three of which contributed to both quantitative and qualitative analysis. Despite the large sample, several provinces were poorly represented (if at all) and many studies were assessed as low to moderate quality. Despite these limitations, our historical lens enabled us to explore why South African progress on increasing EBF practices has been slow. The review reflects a context that increasingly supports EBF, but falls short in accounting for family, community, and workplace influences. The findings also highlight the unintended damage caused by rapidly adopting and introducing global guidelines to an unsupported health workforce.


From a South African perspective, we identified geographic and methodological biases, as well as gaps in our understanding and potential explanations of inequities in EBF. Our recommendations relate to policy, programming, and research to inform changes that would be required to further improve EBF practice rates in South Africa. While our review is South Africa-specific, our findings have broader implications for investing in multi-level interventions and limiting how often infant feeding guidelines are changed.

To view the article click on the link below.


Zir Chinar Kham, Afghanistan—In Ghutai’s third home delivery, her newborn struggled to breathe and died before help could be found. When the Afghan mother of two went into labor with her next child, she was determined that the outcome would be different. With the help of a neighbor, she made it 10 kilometers to her local health facility.

Just like before, Ghutai’s newborn had breathing problems. But thankfully, Dehdadi District Hospital’s midwife Enjila Yaqoobi knew what to do. A recent training on newborn resuscitation had given Yaqoobi the confidence and skills to resuscitate Ghutai’s baby. Today, baby Muzda is healthy and growing strong.

Midwife Yaqoobi attributes her lifesaving actions to the Helping Mothers and Children Thrive project—known as HEMAYAT— a training and mentorship program funded by the United States Agency for International Development (USAID) and led by Jhpiego, in collaboration with Afghanistan’s Ministry of Public Health.

Read more by clicking the link below.

Routine health information systems (RHIS), based on data reported by health facilities, are an important source of health statistics that feature prominently in national and subnational health plans and program. Multiple indicators generated by the RHIS data can be used to track national and subnational progress towards universal health coverage, often in combination with household survey and other data. Scorecards and dashboards are increasingly popular tools to visualize the statistics based on health facility data, aiming to facilitate the interpretation, communication and use of data.

Countries and development partners have been investing in the improvement of the data generation and use through the RHIS. A notable development is the introduction of the District Health Information System (DHIS), which is an open-source software platform for reporting, quality checks, visualization, analysis and dissemination of data for all health program. From 2010 onwards, an increasing number of countries began to introduce the web-based DHIS2 platform, and today many countries are using this electronic platform.

Common RHIS data-based indicators include causes of death and morbidity patterns among persons using health services, health service utilization and efficiency indicators, as well as a range of program-specific indicators on the coverage of interventions. Several programs such as immunization and HIV have been relying extensively on facility data-based coverage statistics for country and global monitoring.

Studies have shown multiple issues regarding the quality of data generated by health facilities that affect the credibility and utility of RHIS-based statistics at local and national levels. The main challenges are associated with incomplete and inaccurate reporting of events, as well as problems with defining accurate denominators (ie, target populations) for the computation of coverage statistics.

This paper describes the situation in 14 countries in Eastern and Southern Africa in 2017, based on an analysis project involving teams of Ministry of Health and country public health institutions analysts, organized by the African Population Health Research Centre, Countdown to 2030 for Women’s, Children’s and Adolescents’ Health, WHO and UNICEF. The focus was on ‘endline’ analysis where all relevant health facility data are compiled and systematically assessed, including assessment and adjustment for incomplete reporting, detection and correction of extreme outliers, assessment and revision of denominators, comparison with survey-based results and computation of statistics based on the adjusted data set. These analyses were done in MS Excel 2013, using data exported from the DHIS2 country databases.

Click on the link below to access the article.

Manzou Diarra, born premature, is in good health thanks to kangaroo mother care. He is 4 months old. Photo credit: Amadou Keita, SSGI/Save the Children.

Prematurity is one of the leading causes of newborn deaths. In Mali, 29% of neonatal deaths are due to babies born before 37 weeks of gestation (CHERG 2010). Kangaroo Mother Care (KMC) is an intervention where the mother carries her baby skin-to-skin at the chest, with breastfeeding support and close monitoring by a health provider. KMC gives a chance to premature babies or those born low birth weight to survive and thrive, especially in countries where access to specialized neonatal care services are still lacking.

Read this success story about the USAID-funded Services de Santé à Grand Impact (SSGI), which supports the Ministry of Health to improve the quality of maternal and newborn health services in Mali through training, supervision and coaching on obstetric and neonatal care, including KMC

Read more by clicking the link below.