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Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
Trends in Newborn Care in India
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Trends in Newborn Care in India

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Trends in Newborn Care in India

Trends in Newborn Care in India

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  • 1. 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
  • 2. 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
  • 3. 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
  • 4.  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
  • 5. WHEN DO NEWBORNS DIE? - About half of child deaths occur in the neonatal period
  • 6. DISTRIBUTION OF NEONATAL DEATHS - DAY 1 TO 7 39.3 7.3 10.2 6.2 5.5 2.8 2.8 0 5 10 15 20 25 30 35 40 45 Day1 Day2 Day3 Day4 Day5 Day6 Day7 Based on ICMR study on
  • 7. DISTRIBUTION OF NEWBORN DEATHS IN THE FIRST WEEKS 74.1 12.6 10 3.1 0 10 20 30 40 50 60 70 80 Week 1 Week 2 Week 3 Week 4 Based on ICMR study on
  • 8.  WHAT DO NEWBORN DIE OF ?
  • 9. CAUSE OF NEONATAL & CHILD MORTALITY IN INDIA Source: Lancet Million Death
  • 10. FIVE YEAR TRENDS IN OVERALL IMR, NNMR & PNMR 114 97 80 74 68 58 50 69 60 53 48 44 37 34 45 37 27 26 24 21 16 0 20 40 60 80 100 120 1980 1985 1990 1995 2000 2005 2009 IMR NNMR PNMR
  • 11. NATIONAL GOALS FOR NEONATAL, INFANT AND U5M Indicators Goals Target Status U5M MDG – 4 for 2015 38 64 IMR NPP, NRHM, RCH for 2010 XI Plan goal for 2012 <30 28 50 NMR National Plan for Action for Children goal for 2010 Enabling goal for RCH II program for 2010 18 <20 34
  • 12. 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
  • 13. 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
  • 14. UNIVERSAL IMMUNISATION PROGRAM  Universal Immunisation of Pregnant mothers with Tetanus Toxoid To prevent Neonatal Tetanus
  • 15. CHILD SURVIVAL & SAFE MOTHERHOOD The 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
  • 16. 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
  • 17. REPRODUCTIVE & CHILD HEALTH I  Integration of  CSSM  Family welfare program  Adolescent Health  Prevention of RTI & STI
  • 18. IMNCI WHO/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
  • 19. 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
  • 20. JANANI SURAKSHA YOJNA  Launched on 12th April 2005  Modification of National Maternity Benefit scheme  Objective  Reducing IMR & MMR through increased delivery at health institutions
  • 21. 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
  • 22. 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
  • 23. 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.
  • 24. HOME BASED NEWBORN CARE (HBNC)
  • 25. 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
  • 26. Gadchiroli Project, SEARCH
  • 27. 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
  • 28. 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
  • 29. 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
  • 30. 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
  • 31. 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
  • 32. 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
  • 33. WHO WILL PROVIDE HBNC  ASHA  ANM  AWW  Medical officer  The main vehicle to provide HBNC is the ASHA (as envisaged in XI plan)
  • 34. INDIA- REGIONAL VARIATION 60 67 48 63 45 45 12 28 33 47 34 41 37 36 7 18 0 10 20 30 40 50 60 70 80 Assam MP Gujarat Rajasthan J&K HP Kerela Tamil Nadu IMR NNMR
  • 35. 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 50 3.1 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?

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