1) India accounts for 27.8% of global newborn mortality, with 0.88 million neonatal deaths annually. Half of deaths occur in the first week, and 39.3% occur on the first day of life. 2) Major programs and policies introduced in India to reduce newborn mortality include the Child Survival and Safe Motherhood program in 1992, National Maternity Benefit Scheme in 1995, Integrated Management of Neonatal and Childhood Illnesses in 2004, and Home-Based Newborn Care implemented nationwide in 2011. 3) Home-Based Newborn Care involves community health workers making home visits on the 1st, 3rd, 7th, 21st, 28th and 42nd day

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 ?

11. CAUSE OF NEONATAL & CHILD MORTALITY IN INDIA
Source: Lancet Million Death

12. 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

13. 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

14. 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

16. 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

17. UNIVERSAL IMMUNISATION PROGRAM
 Universal Immunisation of Pregnant mothers
with Tetanus Toxoid
To prevent Neonatal Tetanus

18. 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

19. 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

20. REPRODUCTIVE & CHILD HEALTH I
 Integration of
 CSSM
 Family welfare program
 Adolescent Health
 Prevention of RTI & STI

21. 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

22. 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

23. JANANI SURAKSHA YOJNA
 Launched on 12th April 2005
 Modification of National Maternity Benefit
scheme
 Objective
 Reducing IMR & MMR through increased
delivery at health institutions

24. 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

25. 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

26. 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.

27. HOME BASED NEWBORN CARE (HBNC)

28. 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

29. Gadchiroli Project, SEARCH

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. WHO WILL PROVIDE HBNC
 ASHA
 ANM
 AWW
 Medical officer
 The main vehicle to provide HBNC is the
ASHA (as envisaged in XI plan)

38. 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

39. 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?