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Dr. Harivansh Chopra
Dr. Harivansh Chopra, DCH, MD
Professor,&Head Department of Community Medicine, LLRM Medical College, Meerut.
NEONATAL SURVIVALSTRATEGY &CHALLANGES
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Dr. Harivansh Chopra
Conclusions
80% of the newborns can be managed at home either by mother or with the assistance of skilled and trained workers.
Reduction in infant mortality can only be achieved by reducing Neonatal mortality
Neonatal mortality can only be decreased by reducing the Incidence of low birth weight children.
Empowerment of the mothers as well as provision of essential Antenatal care are the key to success.
7 feb. 2003
Dr. Harivansh Chopra
Whether this NEWBORN will survive
? ?3
Dr. Harivansh Chopra
1980 1990 2000 2010 2012 2013
0
20
40
60
80
100
120 114
80
68
4742 40
69
53
44
3329 28
COMPARISON OF INFANT AND NEONATAL MORTALITY
Infant MortalityNeonatal Mortality
YEAR
PER
100
0 L
IVE
BIR
THS
66%65%
4
60%
70% 69% 70%
HBNC GUIDELINES BY MOHFW…
Dr. Harivansh Chopra
week 1 week 2 week 3 week 4
0
10
20
30
40
50
60
70
80
74.1
12.6 103.1
Distribution of neonatal death weeks 1 to 4
PER
CE
NT
AG
E %
5
DISTRIBUTION OF NEONATAL DEATH WEEKS 1 TO 4
HBNC GUIDELINES BY MOHFW
Dr. Harivansh Chopra
DISTRIBUTION OF NEONATAL DEATHS DAY 1 TO 7
D 1 D 2 D 3 D 4 D 5 D 6 D 7
05
10152025303540
39.3
7.3 10.26.2 5.5 2.8 2.8
Distribution of Neonatal Deaths Day 1-7
DAYS
PER
CE
NT
AG
E %
HBNC GUIDELINES BY MOHFW6
Dr. Harivansh Chopra
RURAL URBAN TRENDS…
• 33/1000 LIVE BIRTHS
RURAL NMR
• 16/1000 LIVE BIRTHS
URBAN NMR
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• 37/1000 LIVE BIRTHS
NMR OF URBAN POOR
• 29/1000 LIVE BIRTHS
NMR OF URBAN
AVERAGE
INAP DOCUMENT BY MOHFW
Dr. Harivansh Chopra
GEOGRAPHICAL
DIFFERENCES…
NMR > 30/1000
NMR 7/1000
8INAP GUIDELINES BY MOHFW
Dr. Harivansh Chopra
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Dr. Harivansh Chopra
CAUSES FOR NEONATAL DEATHS IN INDIA
BIRTH ASPHYXIA
20%
PRE TERM35%
SEPSIS15%
PNEU-MONIA
16%
DIAR-RHOEA
2%
MAL-FOR-MA-
TIONS9%
OTHER3%
BIRTH ASPHYXIAPRE TERMSEPSISPNEUMONIADIARRHOEAMALFORMATIONSOTHER
Lancet 201210
Dr. Harivansh Chopra
STRATEGY
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Everyone wants to be HAPPY
Dr. Harivansh Chopra
Secret to be HAPPY Lies in the word itself
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Dr. Harivansh Chopra
Strategy is H.A.P.P.Y
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Dr. Harivansh Chopra
H
HYPOTHERMIA PREVENTION
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Dr. Harivansh Chopra
Asphyxia prevention
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Dr. Harivansh Chopra
Provisions of antenatal, natal, post natal and neonatal care
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Dr. Harivansh Chopra
Prevention of infection
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Dr. Harivansh Chopra
Promotion of referral
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Dr. Harivansh Chopra
Prevention of prematurity & Low Birth Weight
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Dr. Harivansh Chopra
Prevention of congenital malformation
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Yes to exclusive Breast feeding
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Dr. Harivansh Chopra
• HYPOTHERMIA PREVENTIONH
• PROVISIONS OF ANTENATAL, NATAL, POSTNATAL & NEONATAL CARE
• PROMOTION OF REFERRALP• PREVENTION OF PREMATURITY &
LOW BIRTH WEIGHT• PROMOTION OF SMALL FAMILY• PREVENTION OF CONGENITAL
MALFORMATIONSP
• YES TO EXCLUSIVE BREAST FEEDINGY
• ASPHYXIA PREVENTIONA
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NEWBORN SURVIVAL STRATEGIES
Dr. Harivansh Chopra
MILESTONES IN CHILD SURVIVAL AND SAFE MOTHERHOOD PROGRAMME
2014 – INDIA NEWBORN ACTION PLAN
2013 – NATIONAL HEALTH MISSION
2013 – RMNCH + A STRATEGY
2005 – NATIONAL RURAL HEALTH MISSION
2005 – RCH II
1997 – RCH I
1992 – CHILD SURVIVAL AND SAFE MOTHERHOOD PROGRAMME
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Dr. Harivansh Chopra
JANANI SURAKSHA YOJNA
INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS
NAVJAT SHISHU SURAKSHA KARYAKARAM
JANANI SHISHU SURAKSHA KARYAKARAM
FACILITY BASED NEWBORN CARE
HOME BASED NEWBORN CARE
RASHTRIYA BAL SWASTHA KARYAKARAMINDIA NEWBORN ACTION PLAN
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Dr. Harivansh Chopra
1. Janani Suraksha Yojna
• Launched in 2005 • Objective : Safe motherhood intervention to increase
institutional delivery through demand-side financing and conditional cash transfer
• Status: implemented in all States/UT’s Special Focus on Low performing States
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Dr. Harivansh Chopra
2. Integrated Management Of Neonatal and Childhood illness (IMNCI)
• Launched in 2007 • Objective: Standard case management of major causes of neonatal and
childhood morbidity and mortality • Status: operationalized in more than 500 districts
5.9 lakh health and other functionaries, including physicians, nurses, AWWs, ASHAs trained under IMNCI. 26,800 medical officers and specialists placed at CHCs / FRUs trained under F-IMNCI
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Dr. Harivansh Chopra
3. Navjat Shishu Suraksha Karyakaram (NSSK)
• Launched in 2009 • Objective: Basic newborn care and
resuscitation training programme• Status: 1.3 lakh health providers trained to
date
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Dr. Harivansh Chopra
4.Janani Shishu Suraksha Karyakaram (JSSK)
• Launched in 2011• Objective: Zero out of pocket expenditure for
maternal and infant health services through free health care and referral transport entitlements.
• Status: implemented in all States / UT’sAssured service package benefits extended to sick children upto age one.
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Dr. Harivansh Chopra
5. Facility Based Newborn (FBNC)
• Launched in 2011• Objective: Newborn Care facilities at various levels of Public Health
Services that includes NBCCs, NBSUs, and SNCUs. • Status: NBCCs
NBSUsSNCUsmore than 6300 persons provided FBNC training.online reporting system reported and scaled up in 7 states.
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Dr. Harivansh Chopra
6. Home Based Newborn Care (HBNC)
• Launched in 2011 • Objective: provision of essential newborn care to all newborns,
special care of preterm and LBW newborns by ASHA workers.
• Status: implemented in all States and UT’s • Most of ASHA’s trained in newborn care• ASHA’s visited more than 12 lakh newborn in 2013.
32
Dr. Harivansh Chopra
7. Rashtriya Bal Swasthya Karyakaram (RBSK)
• Launched in 2013• Objective: Screening of children with birth defects, diseases,
deficiencies, and developmental delays. • Status: All children 0 to 18 targeted
More than 8 crore children screened and more than 10 lakh children identified for tertiary care in 2013.
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Dr. Harivansh Chopra
8. INDIA NEWBORN ACTION PLAN
• Launched in September 2014• Objective: To reduce NMR to below 10 by 2030To reduce Still Birth Rate below 10 by 2030
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Dr. Harivansh Chopra
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CHALLENGES
Dr. Harivansh Chopra
3Qs
Quantity
QualityQuestionable Policy
Challenge is how to implement H.A.P.P.Y ?
CHALLENGES
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Dr. Harivansh Chopra
Status of Health Services in U.PRequired In Position
Sub-centres 31037 20521
Primary Health Centers 5172 3692
Community Health Centers 1293 515
(Source: RHS Bulletin, March 2012, M/O Health & F.W., GOI)37
Dr. Harivansh Chopra
Seats for Pediatrics in UP…DEGREE/DIPLOMA GOVERNMENT
INSTITUTION PRIVATE
INSTITUTIONTOTAL
MD PEDIATRICS 53 21 74
DCH 41 04 45
TOTAL 94 25 119 38
Dr. Harivansh Chopra
STATISTIC INDIA UP UP %
POPULATION (in crores) 121.06 19.96 16.4%
No. of SNCUs Established 418 15 3.6%
No. of NBSUs Established 1554 92 5.9%
No. of NBCCs Established 13167 1430 10.9%
State Of India’s Newborn, 2014 by PHFI
STATUS OF INFRASTUCTURE IN INDIA AND UP
SOURCE: STATE OF INDIA’S NEWBORN, 2014 BY PHFI 39
Dr. Harivansh Chopra
Some useful data…
Presently working SNCUs in UP: 15
LBW babies requiring Facility Based Care is 15% of all LBW : 228480
No. of LBW babies in UP/year: 1523200
Prevalence of low birth weight : 28%
Total newborn born every year: 5440000
Crude birth rate : 27.2/1000 mid year population
Total population of UP : 19.6 crores
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Dr. Harivansh Chopra
Requirement is for 22.8 lakh children and we are able to provide to only 7800 i.e. 3.4% only.
So total babies who can be given bed : 150 x 52 = 7800
Total no. of beds : 15 x 10 = 150
Then 52 babies per year can be given per bed
No. of Days Stay per bed assume to be 7
Beds per SNCUs approx 10
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Dr. Harivansh Chopra
• So we are able to provide Facility Based Care to only 3.4% children.
• So if we wish to reduce our IMR by reducing NMR we have to provide services to those 96.6% children who are devoid of necessary Facility Based Care.
• In order to combat such difficulty there is an Essential Need for • HOME BASED NEWBORN CARE
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Dr. Harivansh Chopra2012 2015 2020 2025 2030 20350
5
10
15
20
25
30
35
2926.2
22.1
18.6
15.7
2925.9
20.5
15.2
9.9
PROJECTED LEVELS OF NEONATAL MORTALITY RATES IN INDIA: 2012-2030
NMR (BASED ON CURRENT AAR)NMR (ACCELERATED LEVELS TO ACHIEVE GLOBAL TARGETS) 43
Dr. Harivansh Chopra
44
Impact targetsTargets Current 2017 2020 2025 2030
NMR (per 1000 live births)
29 24 21 15 <10
SBR (per 1000 live births)
22 19 17 13 <10
Dr. Harivansh Chopra
45
Coverage targetsTargets Current 2017 2020 2025 2030
Safe delivery (institutional +
home delivery by SBA (%)
76 90 95 95 95
Initiation of breastfeeding within
one hour of birth (%)
- 75 90 90 90
Women with preterm labour
receiving at least one dose of
antenatal corticosteroids (%)
- 75 90 95 95
Dr. Harivansh Chopra
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Coverage targetsTargets Current 2017 2020 2025 2030
Babies born in health facilities with birth
asphyxiareceived resuscitation (%)
- 75 90 95 95
Babies received complete schedule of home visits
underHBNC by ASHA (%)
- 50 75 95 95
Newborn with sepsis in the community received
Gentamicin by ANM (%)
- 50 75 75 75
Dr. Harivansh Chopra
47
Coverage TargetsTarget Current 2017 2020 2025 2030
Newborn discharged from SNCU followed
untilage one (%)
- 35 50 75 75
Newborn with low birth weight / Prematurity
managedwith KMC at facility (%)
- 35 50 75 90
Dr. Harivansh Chopra
Neonatal Mortality is the major obstacle in reducing Infant Mortality Rate
as well as Under 5 Mortality Rate
To reduce Neonatal mortality we have to reduce incidence of Low Birth
Weight
To reduce Low Birth Weight we have to have Robust Mechanism of
provision of quality Antenatal care as well as Intranatal care
CONCLUSION
48
Dr. Harivansh Chopra 49
THANK YOU
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