In this article
A conversation about newborn care
Newborn deaths account for 75 percent of all infant deaths, which have generally declined in recent years but remain a concern. Neonatologist Eduard Tushe explains to Shekulli why infant deaths occur, their main causes and ways to prevent them. According to Ministry of Health data, infant mortality (deaths up to the beginning of the second year of life) has fallen significantly over the past 20 years.
From a reported 30 deaths per 1,000 live births in 1995 to 8.7 deaths per 1,000 live births in 2011. This change has mainly resulted from the decline in mortality after the first month of life (almost 9 times lower), while the rate of decline in newborn deaths (deaths in the first 28 days of life) has been slower (almost 2 times lower). “At present, newborn deaths account for about 75 percent of infant deaths,” says Dr. Tushe.
“This phenomenon highlights the attention that professional associations, governmental and nongovernmental institutions and the public as a whole should devote to developing strategies that can reduce this type of mortality.”
First of all, for example, a child is born… what happens next? What are the procedures? How is the child followed up?
Almost all births in our country take place in the presence of healthcare personnel, and the overwhelming majority in healthcare institutions. After discharge from the maternity hospital, newborn care continues through infant health clinics, which are distributed throughout the country. The newborn goes home with a health booklet, while the clinic receives the newborn’s medical record (which essentially contains more professional information about the newborn).
Why do newborn children die? What are the general causes that can lead to death? How can they be avoided?
Are these cases frequent in Albania? Are there any figures?
The causes that lead to a newborn’s death can be divided into “endogenous” and “exogenous” causes. Endogenous causes involve particular health circumstances of the mother and fetus and/or newborn. Exogenous causes are linked to the country’s socioeconomic and cultural development.
Endogenous causes are themselves divided into avoidable and unavoidable causes (for example, a congenital malformation incompatible with life). This means that about 2/3 of newborn deaths can be avoided if certain measures known to be effective during childbirth and the period immediately after birth are applied. These measures do not necessarily require large financial outlays, but better organization of work, staff training, analysis of outcomes and cases, and so on.
The causes of death differ between institutions, and it is difficult to get a clear picture for the entire country. I can tell you that the main cause of death in Tirana’s maternity hospitals is premature birth and its complications. But this is an international trend, seen all around the world.
Are there external risk factors for newborn children? In other words, beyond health complications that may be congenital, can complications arise from external factors such as temperature fluctuations, inadequate hygiene, unclean water or various sanitation deficiencies? The factors you mention have a great deal to do with hospital management and organization, and therefore fall within what I call avoidable causes.
For example, the temperature in hospitals is low during winter because heating has not yet been provided. Overcoming this problem requires a knowledgeable, responsible group (team) that discusses the problem and knows how to make proper use of the resources available. Complaining alone will not solve it.
A responsible administrator uses their authority; knowledgeable staff use early skin-to-skin contact between mother and newborn, encourage early feeding (feeding-energy-warmth), allow relatives to use heating devices, and so on. When water is lacking, measures are taken to use water storage tanks or distillation vessels, and to make staff and patients aware that the main measures for protecting a child from infections are handwashing, early feeding and keeping mother and child together (rather than separating the child from the mother), and so on. It is therefore an approach involving several measures and, as I said before, a responsible and knowledgeable one.
How many of the new mothers at the maternity hospital come from other districts? Why do you think these mothers choose Tirana?
It is estimated that about 35 percent of births in Tirana are to mothers from other districts. Naturally, Tirana’s institutions are referral centers, and as such, high-risk pregnancies and at-risk children should be brought to Tirana. But a large proportion of women come to give birth in Tirana on their own initiative, bypassing the referral system.
This places an unnecessary burden on Tirana’s hospitals. Individuals may choose where to give birth, and it is their right to do so, but I think the time has come to regulate this. Most of these pregnant women prefer to give birth in Tirana because they think the services offered are of better quality.
During which period is the number of births highest? Is there any link between this period of high birth numbers and infant mortality?
The distribution of births is seasonal. There are fewer births in the late autumn and winter months. There is no link between newborn mortality and the total number of births.
Newborn deaths are linked to babies’ characteristics at birth, for example being premature or having a low birth weight. Naturally, it is not that simple, but to put it in plain language, I used this example as the one most familiar to the public.
Often, when we compare 2 institutions to see which has better outcomes, we judge by the overall numbers. In fact, we need to look at how many at-risk children survive in one maternity hospital and how many in the other, or conversely, how many children without risk factors die in each of the two hospitals.
That would be the fairest assessment.
Have you ever had to break the news of an infant’s death? What was that experience like for you? And for the parents?
This is the most difficult moment in a professional’s life. Communicating bad news requires great sensitivity and clarity. The more unexpected the death, the more difficult the communication.
Parents react differently. Generally, at first they become angry and try to find someone to blame, but everything depends on tact and the careful preparation given to parents in such a case. Excluding parents from their child’s care, a lack of information about the child’s condition and conflicting information communicated by staff are some of the factors that further increase relatives’ pain during this dramatic event in their lives.
“I chose to give birth in Tirana because I did not trust Kukës Hospital”
Mira M. is a 28-year-old mother from Kukës who chose to have her two sons in Tirana rather than in the city where she lives. Her choice was shaped by the sense of insecurity generally associated with the Kukës regional health system. Today, one of her sons is 4 years old and the other 6 months old, and she is happy with the choice she made.
“There has not really been investment in Kukës hospitals. The situation does not make a good impression even today, let alone back then, and, to tell the truth, I was afraid.
We had heard, and continue to hear, of children or mothers dying, and I had no confidence at all in the doctors here (in Kukës). Neither my husband nor I trusted them (the doctors in Kukës) with my life or our children’s lives.
“Conditions here were bad, especially drinking water and heating,” says Mira, the mother of two children who were born in Tirana although they are growing up in Kukës. “During my first pregnancy, we found a way to come to the Koço Gliozheni Maternity Hospital in Tirana. Fully aware that we were bypassing the referral system, because the birth was in fact supposed to take place in Kukës, we were able, through some acquaintances, to arrange follow-up at the New Maternity Hospital in Tirana.
“The care was just what we had hoped for, very, very good. That then gave me the confidence to go there (the Koço Gliozheni Maternity Hospital) for my next pregnancy too. The doctors were not only extremely well prepared; the surroundings and the care also convinced you that you were in the right place,” says Mira.
Increasing investment in children
At a conference focused on increasing public investment in children, Health Minister Ilir Beqaj said that, although infant and child mortality indicators remain relatively high, a downward trend has been seen in recent years. “We aim to ensure that every woman has a healthy pregnancy and that every child is born and develops normally,” Minister Ilir Beqaj said. “The Ministry of Health remains committed to implementing its objectives, which will be part of the National Action Plan for Children, based, of course, on the recommendations of the WHO, UNICEF and Save the Children for improving the health of mothers and newborn babies, to achieve the main goal: continuous improvement in their health and quality of life, while also contributing to a progressive decline in their mortality and morbidity.”
Published in “Shekulli” on 19/12/2014
* This article was reviewed and corrected on 8 October 2026.