New born survival strategy and challanges

Dr. Harivansh Chopra

Dr. Harivansh Chopra, DCH, MD

Professor,&Head Department of Community Medicine, LLRM Medical College, Meerut.

NEONATAL SURVIVALSTRATEGY &CHALLANGES

1


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


Whether this NEWBORN will survive

? ?3


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…


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


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


RURAL URBAN TRENDS…

• 33/1000 LIVE BIRTHS

RURAL NMR


URBAN NMR

7


NMR OF URBAN POOR


NMR OF URBAN

AVERAGE

INAP DOCUMENT BY MOHFW


GEOGRAPHICAL

DIFFERENCES…

NMR > 30/1000

NMR 7/1000

8INAP GUIDELINES BY MOHFW


9


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


STRATEGY

11


12

Everyone wants to be HAPPY


Secret to be HAPPY Lies in the word itself

13


Strategy is H.A.P.P.Y

14


H

HYPOTHERMIA PREVENTION

15


Asphyxia prevention

16


Provisions of antenatal, natal, post natal and neonatal care

17


Prevention of infection

18


Promotion of referral

19


Prevention of prematurity & Low Birth Weight

20


Prevention of congenital malformation

21


Yes to exclusive Breast feeding

22


• 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

23


24

NEWBORN SURVIVAL STRATEGIES


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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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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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

27


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

28


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

29


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.

30


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.

31


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


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.

33


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

34


35

CHALLENGES


3Qs

Quantity

QualityQuestionable Policy

Challenge is how to implement H.A.P.P.Y ?

CHALLENGES

36


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


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


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


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

40


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

41


• 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

42

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


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


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


46

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


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


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

Health & Medicine

New born survival strategy and challanges