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Improving newborn infant health development in developing countries.
  1. SHOBHA CHERIAN, Specialist Registrar
  1. St Peter's Hospital
  2. Chertsey, UK

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    Improving newborn infant health development in developing countries.Edited by Costello AJ and Manandhar D. Imperial College Press. (Pp 570, hardback; £99.00) UK: Imperial College Press. ISBN 1 86094 097 8

    Improving neonatal care, as with improving any service in any part of the world, would require two main components; (a) good quality information and (b) co-ordination to deliver this service to the client. The information required would have to be specific to that region's demographic, geographic, cultural, economic, characteristics, as well as encompass evidence based appropriate technical and scientific information.

    Costello and Manadhar's book on improving newborn care in developing countries arose from a workshop held in Kathmandu, Nepal in 1997. As with all books produced this way there are specific strengths and weaknesses with a bias towards areas of specific interest. This book's bias appears to be towards the provision of good quality information. The contributors, most of whom have worked in developing countries, come from a variety of professional backgrounds and include epidemiologists, health planners, scientists, paediatricians, obstetricians, and anthropologists.

    They have made a serious effort at putting together all the available information on neonatal care, and the problems encountered with its delivery in the developing world. Three of the five sections deal with the current state of maternal and neonatal care and the relatively low technology-high efficacy interventions that would improve it. Of note are the chapters addressing birth asphyxia, effective neonatal resuscitation, and neonatal hypothermia. As birth asphyxia accounts for over 40% of the 7.6 million annual perinatal deaths, I felt the studies were well reported that introduced face mask to mouth resuscitation delivered by trained traditional birth attendants and room air versus 100% oxygen for neonatal resuscitation were well reported.

    It is depressing that hierarchical monocentric systems—that is, government led health care systems, do not work effectively in most developing countries. In addition, it seems that health education delivered on a one to one basis also does not seem to work. So is there a third way? It is this exploration that I found lacking. The co-ordination of health care systems or the lines of communication necessary to deliver health care, or indeed newborn care, in developing countries are notably weak. Studies akin to home based neonatal care as described by Bang et al are notably underreported.1 In addition, the experience of some regions of developing countries that have managed to establish an effective referral system within their geographic constraints are not called upon.2

    This book does fill the large gap in compiled information on current trends in perinatal care in the developing world. It would probably be invaluable to health professionals working there and should make interesting reading to those paediatric specialist registrars planning to join the VSO scheme of working in the third world.

    Improving newborn infant health development in developing countries.Edited by Costello AJ and Manandhar D. Imperial College Press. (Pp 570, hardback; £99.00) UK: Imperial College Press. ISBN 1 86094 097 8

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