In news:

• According to the National Health Mission (NHM), Madhya Pradesh has recorded the highest percentage of newborn deaths of 11.5% against the total admissions to government-run sick newborn care units (SNCUs) in the past three years across the country. The country’s average is 7%.

 

 

About:

• Although admissions of neonates (under 28 days) in the Madhya Pradesh have dropped from April 2017 to December 2019 — remaining lower than West Bengal, Rajasthan and Uttar Pradesh — the percentage of deaths at 12.2% surpassed Bihar’s last year.
• In Bhopal, the capital city of Madhya Pradesh, one in every five children admitted to a unit died in the three years — the highest death percentage of 19.9% in the State, ten times above the NHM’s mandated key performance indicator of below 2%.
• Staff crunch, low community referrals, absence of a special neonatal transport service to health centres, and the non-availability of enough units to cater to increasing institutional deliveries had contributed to the spike in the percentage of deaths.
• Meanwhile, West Bengal, where 34,344 neonatal deaths occurred in the period, the most in the country, the declining percentage of deaths from 9.2% in 2017 to 8.9% in 2019 coincided with a slump in admissions. 

Definition: Neonatal Mortality Rate(NMR) Number of deaths during the first 28 completed days of life per 1 000 live births in a given year or period. Neonatal deaths may be subdivided into early neonatal deaths, occurring during the first seven days of life, and late neonatal deaths, occurring after the seventh day but before the 28 completed days of life.   # of neonatal deaths x 1000 __________________  Total # of live births

 

 

What is Infant Mortality Rate (IMR)?

• Death of children under the age of 1 is measured by Infant Mortality Rate, which is the number of deaths per 1000 live births while child mortality refers to the death of children under the age of five.

 

Significance:

• It provides key information about maternal and infant health, the infant mortality rate is an important marker of the overall health of a society.
• It acts as a measure of population health development. IMR also reflects the intuition that structural factors affecting the health of entire populations have an impact on the mortality rate of infants.
• It can also be used to analyse the strength of the health architecture of a country.

 

Causes of Infant mortality rate:

• Birth defects such as cerebral palsy.
• Low birth weight
• Lack of education in the mother
• Age of the mother at the time of birth, spacing, and whether the child is born at home or in a facility (infection risks in a non-institutional birth)
• Pneumonia, Prematurity, low birth weight, Diarrhoeal diseases, Neonatal infections, Birth asphyxia
• Low vaccine compliance level.
• According to a UNICEF factsheet on child mortality in India, “… Children born to mothers with at least 8 years of schooling have 32% lesser chances of dying in neonatal period and 52% lesser chances in the post-neonatal period, as compared to the illiterate mothers.”
•  It also notes that infant and under-five mortality rates are highest among mothers under age 20. The rates are lowest among children born to mothers between the ages of 20-24, remain low up to 25-34, and increase again after that age.
  • Sudden Infant Death Syndrome(SIDS)
  • Congenital malformations such as down’s syndrome, and heart defects.
  • Premature birth
  • Birth asphyxia
  • Prolonged labour and
  • Neonatal infections which make the infants susceptible to diseases such as malaria or measles. 

 

The factors which contribute to infant mortality are:

• • Mother’s health condition
  • Malnutrition
  • Environmental factors such as air pollution, are consistently associated with post-neonatal mortality due to respiratory effects and sudden infant death syndrome. The additional presence of carbon monoxide in the air causes greater harm to the infants as their respiratory system is not developed yet.
  • Political and medical infrastructure.
  • Unavailability of the required equipment in hospitals and other medical centres.

 

Efforts being made by India:

• The National Rural Health Mission (NRHM) was launched by the Government of India to provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. The scheme covers a wide range of aspects under its umbrella.
• The various programmes and schemes under National Health Mission implemented by the States/ Union Territories are:
• Navjat Shishu Suraksha Karyakram (NSSK) aims to train healthcare personnel in newborn care and resuscitation. 
• Nutritional Rehabilitation Centres (NRC): These centres are set up with the aim of reducing the fatality rate of Severe Acute Malnutrition (SAM) children through standard case management protocol like specialized treatment and prevention interventions at NRCs (Nutritional Rehabilitation Centres). 

• Under the National Health Programme (NHP), SAM patients can be of two types- those who have medical conditions and require facility-based treatment and those who do not have medical conditions.

• India Newborn Action Plan (INAP): It was launched in 2014. It aims to make concerted efforts towards the attainment of the goals of “Single Digit Neonatal Mortality Rate” and “Single Digit Stillbirth Rate,” by 2030.
• Strengthening of delivery points for providing comprehensive and quality Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Services.
• Universal Immunization Programme (UIP) has been set up to provide vaccination to all children against life-threatening diseases such as Tuberculosis, Diphtheria, Polio etc.
• Guidelines on standardization of Labour Rooms and creation of Obstetric High Dependency Unit (HDU) and Obstetric Intensive Care Unit (ICU) at District Hospitals and Medical Colleges has also been prepared and disseminated to the States for improving quality of care during delivery and childbirth as health is a state subject
• Rashtriya Bal Swasthya Karyakram (RBSK): is set up to provide quality health screening, early detection of birth defects, diseases, deficiencies, development delays and early intervention services. 

 

 

World Health Organization’s (WHO’s) Essential Newborn Care

• Simple interventions around the time of birth(such as hand washing, cleaning the umbilical cord with a regular antiseptic, ensuring the newborn is warm, dry, and fed) are affordable and more effective than previously thought
• These interventions can reduce newborn death rates in low-resource settings
• Most of these strategies do not require a specialist
• These practices form the basis for the World Health Organization’s (WHO’s) Essential Newborn Care
• Essential Newborn Care is a set of activities that each newborn child needs, irrespective of place or condition at birth
• WHO offers brief training courses and provides simple checklists that ensure all the essential steps are carried out at the time of birth
• It strengthens the capacity of the health system by distributing essential responsibilities among a larger group of health workers and emphasizing shared responsibility for high-quality outcomes

 

Way forward

• It is not reasonable, moral or practical, to wait until the capacity of the national health system develops sufficiently to handle this public health crisis.
• Instead, we must empower and train healthcare providers who work in remote communities and serve populations that are unable to access safe and affordable obstetric care in the current health system.
• Losing almost a million lives every year to preventable causes is a travesty of sound health policy.