Trends in Newborn Care in India
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Transcript of Trends in Newborn Care in India
TRENDS IN NEWBORN CARE
Presentor: Moderator: Dr. Ramkesh Prasad Dr. (Mrs) Chinmayee Barthakur PG, 2nd year Assistant Professor
Department of Community Medicine
Gauhati Medical College
WHERE DO NEWBORN DIE?
Contribution to global NMR
India 27.8% (34)* Nigeria 7.2% (39)* Pakistan 6.9% (42)* China 6.4% (11)* DRC 4.6% (51)*
* NMR
PROBLEM STATEMENT - INDIA
27 million infants are born each year 0.88 million die in the neonatal period
(which constitutes to about 68% of the total IMR
Neonatal mortality has fallen at a lower rate than post-neonatal or early child mortality
Relatively greater progress has been made in some regions and countries e.g. neonatal mortality is now 58% lower
in high income countries than in 1983, compared to 14% reduction in low/ middle income countries
Large variations in mortality rates exist even within the same country
WHEN DO NEWBORNS DIE?
- About half of child deaths occur in the neonatal period
DISTRIBUTION OF NEONATAL DEATHS - DAY 1 TO 7
Day1 Day2 Day3 Day4 Day5 Day6 Day70
5
10
15
20
25
30
35
40
45
39.3
7.3
10.2
6.2 5.5
2.8 2.8
Based on ICMR study on HBNC
DISTRIBUTION OF NEWBORN DEATHS IN THE FIRST WEEKS
Week 1 Week 2 Week 3 Week 40
10
20
30
40
50
60
70
80
74.1
12.610
3.1
Based on ICMR study on HBNC
WHAT DO NEWBORN DIE OF ?
CAUSE OF NEONATAL & CHILD MORTALITY IN INDIA
Source: Lancet Million Death Study, 2010
FIVE YEAR TRENDS IN OVERALL IMR, NNMR & PNMR
1980 1985 1990 1995 2000 2005 20090
20
40
60
80
100
120
114
97
80
74
68
58
50
69
60
5348
44
3734
45
37
27 26 2421
16
IMRNNMRPNMR
NATIONAL GOALS FOR NEONATAL, INFANT AND U5M
Indicators
Goals Target Status
U5M MDG – 4 for 2015 38 64
IMR NPP, NRHM, RCH for 2010XI Plan goal for 2012
<3028
50
NMR National Plan for Action for Children goal for 2010
Enabling goal for RCH II program for 2010
18
<20
34
EFFECTIVE TECHNICAL INTERVENTIONS TO REDUCE NEONATAL MORTALITY
Continuum of Care : Spans both maternal and neonatal care and encompass interventions for appropriate care during pregnancy, care for the mother and newborn during and immediately after delivery, and care for the newborn during the first weeks of life. e.g. Sri Lanka (IMR – 15, NMR - 9)*
*WHS 2011
MILESTONES IN NEWBORN CARE
1985 - UIP 1992 - CSSM 1995 - NMBS 1997 - RCH I 2004 - IMNCI 2005 - RCH II 2005 – JSY 2005 – NRHM 2009 - NSSK 2011 - JSSK 2011 - HBNC
Other programmes
UNIVERSAL IMMUNISATION PROGRAM
Universal Immunisation of Pregnant mothers with Tetanus Toxoid
To prevent Neonatal Tetanus
CHILD SURVIVAL & SAFE MOTHERHOODThe first public health initiative in India that covered the health of newborns
Strategies for improved neonatal survival
Antenatal care to all pregnant women Promote safe delivery Assist establishment of breathing at birth Maintain newborn’s warmth Promote early exclusive breastfeeding Prevention of infection Early detection and referral of high risk newborns Promote birth spacing
NATIONAL MATERNITY BENEFIT SCHEME National Social Assistance Programme. To ensure all BPL women get cash
assistance 8-12 weeks prior to delivery Rs. 500 per birth irrespective of no. of
children and age of the women* Focus – Provision of nutrition support
during pregnancy
* SC Ruling April 2010
REPRODUCTIVE & CHILD HEALTH I
Integration of
CSSM Family welfare program Adolescent Health Prevention of RTI & STI
IMNCIWHO/UNICEF developed a new approach to tackling the major diseases of early childhood called the Integrated Management of Childhood Illnesses IMNCI is an Indian adaptation of the Integrated Management of Childhood Illness approach, a globally accepted model which has been tested in several countries. The IMNCI strategy, piloted by UNICEF in six districts in 2003–2004, has now been taken up by several state governments,
Major highlights of the Indian Adaptation are:
Inclusion of 0-7 days age Malaria, anemia, Vit. A and Immunizations Training of health personnel begins with sick young infants
upto 2 month
REPRODUCTIVE & CHILD HEALTH II
To reduce maternal and child morbidity and mortality with emphasis on rural health care
Integrated with NRHM Major strategies
Essential Obstetric Care Emergency obstetric care Strengthening referral system
JANANI SURAKSHA YOJNA
Launched on 12th April 2005 Modification of National Maternity
Benefit scheme Objective
Reducing IMR & MMR through increased delivery at health institutions
NAVAJAT SISHU SURAKSHA KARYKRAM
Navjat Shishu Suraksha Karykram (NSSK) Launched on September 15, 2009
Focuses on: Prevention of Hypothermia Prevention of Infection Early initiation of Breast feeding Basic Newborn Resuscitation
Objectives: To train healthcare providers at DH, CHCs and PHCs
JANANI SISHU SURAKSHA KARYKRAM
JSSK supplements the cash assistance given to a pregnant woman under Janani Suraksha Yojana and is aimed at mitigating the burden of out of pocket expenses incurred for pregnant women and sick newborns.
Aims to offer completely free and cashless services, including normal or caesarian delivery in all the government hospitals.
The scheme also envisages free treatment for a sick new born (up to 30 days after birth) in any government health institution in rural or urban areas & transportation facilities
F-IMNCI
From November 2009 IMNCI has been re -baptized as F-IMNCI, (F -Facility) with added component of: Asphyxia Management and Care of Sick new born at facility level, besides all other components included under IMNCI
It focuses on providing appropriate inpatient management of the major causes of neonatal and childhood mortality.
Acts as referral support to IMNCI To help meet the shortage of Pediatrician in the
country.
HOME BASED NEWBORN CARE (HBNC)
RATIONALE OF HBNC
Despite the increasing no. of institutional deliveries a substantial proportion of neonatal deaths occur at home ranging from 25 to 50%.
In case of institutional delivery, where the baby and the mother are discharged after 48 hours.
A significant proportion of mothers prefer to return home within a few hours after delivery.
By 2015 a major proportion of rural population will shift to city slums
Gadchiroli Project, SEARCH
SEARCH, Gadchiroli
ANKUR Project in Mahatashtra
HBNC Replication sites
ICMR Study: Government of India, five states.
Other NGOs
Africa
Other Countries
Total 49 Sites
SEARCH, Gadchiroli
Other States
4 countries
OBJECTIVE OF HBNC
Provision of essential new born care to all newborns and prevention of complications
Early detection and special care of preterm and LBW newborns
Early identification of illness in the newborn and provision of appropriate care and referral
Support the family for adoption of healthy practices and build confidence and skill of the mothers to safeguard her and the newborn health
KEY ACTIVITIES IN HBNC
Care for every newborn through a series of home visits in the first 6 weeks of life.
Information and skill to the mother Examination of every newborn for prematurity Extra home visits for preterm and LBW babies Early identification of illness Follow up of sick newborns after they are
discharged from facilities Counseling the mother on postpartum care Counseling on family planning
HBNC
Home visits Home deliveries: 1st, 3rd,7th, 21st, 28th and 42nd day Institutional deliveries: 3rd, 7th, 14th, 21st, 28th and 42nd
Services offered: Essential care of the newborn Examination of the newborn Early recognition of danger sign Stabilization % Referral Counseling of mother for Breastfeeding Warmth Care of the baby Immunisation Postpartum care & Use of family planning methods
CAPACITY BUILDING OF ASHA
Activities to be provided in HBNC and skills are taught in Module 6 & 7
Through 4 rounds of training of five days each by ASHA trainer, all 4 rounds to be completed within 1 year
After each round, ASHA is evaluated for knowledge and skills
Certification process
SUPPORT TO THE ASHA Incentive of Rs. 250/- for conducting
home visits. Ensuring field level support: by facilitator Paid on the 45th day
Birth weight is recorded in MCP card Newborn is immunized Birth registration Mother and newborn are safe until 42nd
days of delivery
WHO WILL PROVIDE HBNC
ASHA ANM AWW Medical officer
The main vehicle to provide HBNC is the ASHA (as envisaged in XI plan)
Thank You
INDIA- REGIONAL VARIATION
Assam MP Gujarat Rajasthan J&K HP Kerela Tamil Nadu0
10
20
30
40
50
60
70
80
60
67
48
63
45 45
12
28
33
47
34
41
37 36
7
18
IMRNNMR
WHEN DO NEWBORNS DIE? - ABOUT HALF OF CHILD DEATHS OCCUR IN THE NEONATAL PERIOD
Day % U5 deaths
1st day 20
By 3rd day 25
By 7th day 37
By 28th day 503.1
10
12.6
2.8
2.8
5.5
6.2
10.2
7.3
39.3
74.1
0 10 20 30 40 50 60 70 80
Week 4
Week 3
Week 2
D7
D6
D5
D4
D3
D2
D1
Week 1
Percent (%)
When do neonates die?