 My name is Jelemba Louvala. I'm a pediatrician and epidemiology working in newborn researcher, particularly focusing on hospital care of newborns in Kenya and potentially in other low middle income countries. So my interest is looking at how best to improve care and survival of, by extension survival of newborns in our part of the world. My core business is being a clinician, taking care of children and my interests are deriving from my experience as a clinician is how best to improve care for newborns. So the first 28 days of life because in our part of the world there's lots of preventable deaths which occur in the first day of life. And so this led me into research and trying to answer questions which we met on a day to day basis in our clinical practice. Within the HSDN, so with that as my background within the HSDN work, largely the most common illnesses for the newborns reflects what occurs in the population. So we have infections, we have the preterm birth, the babies were born too soon and the complications of being born too soon. We have babies who are born with low birth weight and the complications of low birth weight. We also have babies who don't breathe well or don't breathe at all at the time of a birth and particularly we are interested in the effect of that on their brains. And also quite commonly for the newborns who we see in the hospitals, lots of them have jaundice, the yellowing of their skin. The small and sick babies who are admitted to the facilities, the package of care most of them need is what you call the essential newborn care. This refers to infection prevention and control, feeding the babies, keeping the baby warm, kangaroo mother care for the low birth weight babies. So whereas these interventions are directed at particular vulnerabilities that these babies have in the larger scheme of things, this need to be provided continuously and they need to be provided within a system. And what we realize is that the families are a very important part of the system that provides care within hospitals particularly the mothers and the support system that the mothers need to have from the extended family to be able to provide care. But we also know that when we start reducing the deaths we will have lots of babies who are surviving and the care that we provide them is to ensure that just beyond surviving they should survive and thrive. Because we know if we don't provide quality of care they may survive but survive with lots of disabilities for instance they may have convulsive disorders, they may have cerebral palsy, they may have problems with their eyes. So whereas we are looking at improving survival we are also looking beyond, it is quite possible with the existing interventions to reduce the mortality that we are observing in hospitals by up to, well in the population level by up to 80% and up to 70% of this mortality can actually be reduced by providing good quality interventions at hospital level. When we receive the small and sick babies in hospitals so we need to have better ways of identifying who is at highest risk of death or who is at highest risk of potential adverse outcomes. So one of the ways currently what we have been doing is using the gestation at the time of delivery but we have problems in availability of that data. We have also tried using their weights and categorizing their weights but that still leaves differences within the existing weight category. So we are looking at using approaches where you combine several characteristics of these babies to come up with an estimate of what the risk of a particular outcome for instance death is and we can use that information for instance for individual patient level. We are trying to combine these, they are called prognostic scores to decide that if this baby has a certain, past a certain threshold of risk of death, should we care for them in certain facilities or should we transfer them to a higher level facilities. That's at individual patient level but looking at the organization of care so we are also coming to a point at which we are trying to categorize the levels of care of neonatal care across our health system and one of the things we are looking at is how do you link the risk of certain outcomes. To the appropriate level of care. So looking at newborn health specifically in Nairobi so we know from existing data that the highest risk of death for the newborns in Kenya is actually in Nairobi where we have 39 deaths per thousand like bats so it's a critical area for the country. And when we looked at recently looked at the services that are available at inpatient level for the small and sick newborns we actually found that most of the care that is available care is actually provided in four public facilities. And whereas lots of this case in this facilities there's also lots of opportunity to actually improve the kind of care that we are providing in this facility. We understand that based on what information that you have that the standard level of care is what is going to make the biggest difference in Nairobi because that is the level that is most lacking currently. There's a lot of research that can be done but right now once we start improving survival we want to look at other important outcomes for instance describing for instance growth the primary business of babies is to grow and develop so how well a baby is growing and can you measure their weights for instance can you measure their head circumferences and if you are able to measure their weights how rapidly are they growing are they growing appropriately are they attaining their weights as expected and which is this is particularly linked to how well they are feeding and just looking beyond the hospital measuring their growth and weight gain in hospitals we are also particularly interested once they live for home there are special group of babies are they able to sustain the growth at home is the weight gain at home appropriate and beyond just the weight gain are they the brains of these babies are particularly vulnerable to the insults during the time when they are small and sick in the newborn unit are able to look at their neurodevelopmental outcomes and are they for instance attaining their learning appropriately are they having any other behavioral issues and any other neurodevelopmental problems like cerebral palsy and convalcy disorders and so on which you can pick up and follow up and manage the outpatients and look at the long term survival of these babies