Caregivers learn from every new born death

In Malawi, every child who dies in the first 28 days is a bittersweet learning point. When a newborn cannot survive the critical month, an inquiry must begin with role players detailing what they did or failed to do to prevent the tragedy. The mandatory briefings are part of neonatal death audits that help close the gaps On how hospital staff care for fragile babies.

“When we get the reports, we meet to analyse the cause of death and isolate modifiable factors that call for urgent or long-term interventions. We draw action plans to ensure no life is lost needlessly,” says nursing officer Hellen Mwafulirwa. The nurse coordinates neonatal care at Chikwawa District Hospital and 25 rural health facilities that help women deliver safely.

“Every death calls for an audit. Within 72 hours or three days, the clinician is supposed to certify the death, fill neonatal registration forms and notify the team of the probable cause,” she says. The committee is supposed to meet every Tuesday and Thursday for the stock-take.

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However, neonatal death audits in Chikwawa suddenly stuttered in January 2025 when the US Agency for International Development (USAid) stopped funding some of its programmes. The committee resumed three months later with support from Unicef through the Umoyo Wathu Health Systems Strengthening project funded by the UK’s Foreign, Commonwealth and Development Office. Mwafulirwa recounts: “Unicef intervened at the right time.

The district recorded 75 deaths in three months—31 in January, 24 in February and 20 in March. With little motivation, members of the neonatal death audit committee kept skipping meetings and giving excuses. “The support helped us scrutinise 60 percent of these deaths between April and June, which helped us to learn and almost halve neonatal deaths from 24 percent to 13 percent.

This is a big improvement.” Chikwawa District Health Office targets reducing newborn deaths to eight percent by March 2026, beating the national goal of 12 percent by 2030. The audits exposed gaps in the treatment of premature and critically ill babies requiring artificial oxygen, persuading Unicef to support Chikwawa with six oxygen concentrators. As part of the recommendations from the audits, health authorities placed oxygen cylinders in some ambulances for safe referrals of critical patients.

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