Presented at the Neonatal Society 2016 Autumn Meeting.
University of Cambridge
Background: Worldwide, of annually 8.2 million childhood deaths, 3.3 million occur in the neonatal period. Cuba stands out amongst middle-income countries for its low rates of newborn death. Cuba has neonatal mortality rates (2 per 1000) equal to those in the UK, and far better than the US (4 per 1000). However, Cuba’s per capita expenditure on healthcare is significantly less than that in the UK or the US (as defined in international dollars). This begs the question: what is Cuba doing right to achieve low neonatal mortality with relatively low expenditure? This paper compares antenatal and neonatal care provision in Cuba with that in the UK.
Methods: This paper details antenatal and neonatal care in Cuba and is based on observations during a visit to Cuba in June and July 2016, at Hospital William Soler and Hogar Maternal Habana Vieja. Supplemental research is used regarding international health expenditures, neonatal and maternal mortality, as well as antenatal and neonatal care protocols. Funding sources: Lucy Cavendish College (Cambridge), Addenbrooke’s Hospital (Professor Peacock award), Neonatal Society.
Results: Regarding neonatal care, equipment and access to resources such as imaging (echo, ultrasound, and especially MRI) and certain blood tests (i.e. neonatal screening) are far more limited in the Cuban setting than in the United Kingdom. Machinery is very dated in Cuba (with incubators from the 1980s), but access to commonly used drugs, specialist doctors, and surgical treatment is comparable. Antenatal care differs more substantially in the two countries. Cuba, through its primary care system and provision of Maternal Homes (residential facilities of which there are currently 300 in the country), successfully identifies high-risk pregnancies, particularly those at risk of low birth weight. The system then provides careful monitoring, nutrition, and treatment, as well as psychological and social support. During a pregnancy in Cuba, the average woman has 13 physician visits, compared to 11 in the United Kingdom for a first pregnancy, and only 8 for subsequent pregnancies.
Conclusion: The key lesson to be learned from Cuba, a resource-poor country, regarding its high quality maternal and neonatal care, resulting in low neonatal mortality rates, is the importance of preventative medicine, continuity of care and public health education as opposed to any specific neonatal care practices.
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