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Initiatives for Strengthening Newborn Care

Initiatives for Strengthening Newborn Care. EPIDEMIOLOGY. In India 26 million babies born every year & 9,40,000 babies dies before 1 month. Neonatal period is of 28 days with current (2010) Neonatal mortality rate is 33/1000 live birth.

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Initiatives for Strengthening Newborn Care

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  1. Initiatives for Strengthening Newborn Care

  2. EPIDEMIOLOGY • In India 26 million babies born every year & 9,40,000 babies dies before 1 month. • Neonatal period is of 28 days with current (2010) Neonatal mortality rate is 33/1000 live birth. • Neonatal mortality contributes to two third of all infant death (47/1000 live birth) & half of all under 5 death. • IMR in India steadily declined 58/1000 in 2004 to 47/1000 in 2010 but NMR declined from 37 in 2004 to 33 in 2010. • About 40% of neonatal deaths occur on the first day of life, almost half within three days and nearly three-fourth in the first week.

  3. Five year trends in in overall infant mortality rate & neonatal mortality

  4. Causes of neonatal & child mortality in India (nationally representative mortality survey lancet Million death study NOV2010)

  5. Distribution of newborn death in the first 4 weeks (ICMR STUDY)

  6. Wealth index & Neonatal mortality ( NFHS 3 ,2005-06)

  7. Comparison of wealth index with Neonatal & Post neonatal mortality

  8. Neo-natal mortality rates and percentage share of Neo-natal deaths to Infant deaths by residence, India and bigger States (SRS 2010 )

  9. Neonatal, Post neonatal & infant mortality rates , NFHS - 3 ,NFHS-2 and NFHS-1 India

  10. National goals for neonatal , infant & under 5 mortality

  11. Programme Milestone: • NPP programme launched in 1951 & the earliest child health initiative consisted of immunisation with Small Pox & BCG. • The EPI is started in 1978 to protect against six vaccine preventable diseases. • In 1980 primary health operationalize in Alma Ata declaration. the goal for Health for All by 2000 articulated , MCH goal to bring down IMR <60/1000 live birth, PMR 35 /1000 live birth. • The first NHP formulated in 1983. Universal immunisation programme (UIP ) launched in 1985-86 • CSSM launched in 1992. • RCH -1 in 1997. • RCH -2 in 2005.

  12. CSSM Program • Newborn health is recognised as priority in 1990. • Essential newborn care(ENC) introduced as a part of CSSM in 1992 at conclusion of UIP. • ENC Package: Resuscitation of asphyxiated newborn. Prevention of hypothermia & infection. Exclusive Breastfeeding. Referral of sick newborn.

  13. RCH PHASE 1 • On the recommendation of ICPD , RCH -1 launched in 1997. • RCH -1 programme integrate the SM & CS component of CSSM, but separate FP program & added RTI /STD intervention. The services are client centred, demand driven ,high quality & based on need of the community. • ENC is continued to be part of programme. • During implementation Govt of India approached NNF to operationalize district for newborn care.

  14. RCH PHASE 2 (2005-10) • RCH -2 launched in 2005. • Goal : to reduce NMR < 20 BY 2010. • CHILD HEALTH COMPONENT: Home Based Newborn Care: for the use of ASHA. In UP it is integrate with IMNCI for the training of ASHAs & ANM & named it comprehensive child survival programme. Pre service IMNCI: it is included in curriculums of medical college of country. IMNCI: it is the intervention under RCH-2 , to prevent & manage commonest childhood illness.

  15. RCH PHASE 2 (2005-10) CONTD.... • F-IMNCI: it is facility base care with IMNCI package, to empower the skill of health personnel. It focus on providing appropriate inpatient M/M of major causes of Neonatal & childhood mortality. • Sick new born care unit: to provide specialised services to sick new born. • As of JAN 2010 : 267 SNCU, 1,772 NBSU, 5892 NBCC are operational in the country.

  16. Major stakeholder & partners • National Neonatology Forum • Indian academy of Paediatrics • FOGSI • BPNI • ICMR • UNICEF • WHO • UNFPA • DFID • USAID • INDIAclen • PATH

  17. Continuum of care for Maternal & Newborn survival

  18. Objective of HBNC • Essential newborn care & prevention of complication.. • Early detection & special care of preterm & low birth weight newborn. • Early detection of illnesses in newborn babies & provision of appropriate care & referral. • Support of family to adopt healthy practices & build confidence & of the mother to safeguard her newborn.

  19. Key activities in HBNC • Care of every newborn through series of home visit up to 6 weeks of life. • Skill to the mother & family for better outcome. • Examination of every newborn for preterm & LBW. • Extra home visit to preterm & LBW by ASHA & ANM. • Early identification of illness & follow up illness of sick New born. • Follow up mother for postpartum care & family planning methods.

  20. Capacity building & support • ASHA is expected to acquire the skill listed in module 6& 7. • There will 4 rounds of training of 5 days each, all round expected to complete within 1 year ,there is gap of 10-12 week b/w each round. • Support : Rs 250 Paid for 6 home visit (3,7,14,21,28 &42), payment given on 45 days for following if : • Birth wt is recorded. • Ensuring birth registration • Both mother & child are safe till 42 days • Newborn is immunised for BCG, FIRST DOSE OF OPV & DPT COMPLETED & entered in the card .

  21. Skill needed by ASHA in provision of HBNC Detect sign symptoms of sepsis & prompt referral. Recognise postpartum complication. Use the check list for first visit to newborn. Immediate newborn care in case of home delivary • Mobilize the women for full ANC package. • Birth planning & preparedness. • Newborn care through series of home visit include skill for measuring weight, temperature, exclusive breastfeeding, warmth, hand washing promotion providing skin , eye & cord care.

  22. FACILITY BASED NEWBORN CARE

  23. Newborn care facility at different level

  24. Terminology • Newborn care corner (NBCC): is mandatory for all the health facility where delivery is conducted. • Newborn stabilization unit (NBSU): close to maternity ward where sick & LBW newborn kept for short period. All FRUs/CHC need to have a NBSU in addition to NBCC. • Special newborn care unit (SCNU): is a neonatal unit which provide special care to sick newborn. (all care except assisted ventilation & major surgery) • Any facility with more than 3000 delivery / year should have SNCU.

  25. Expected services provided at newborn facility:

  26. Expected services provided at newborn facility contd..:

  27. Cost of setting newborn care facility :

  28. Indication for admission to NBSU • Apnoea or gasping • Respiratory distress ( rate >70/min with severe retraction/ grant) • Hypothermia <35.4 c • Hyperthermia >37.5c • Central cyanosis • Shock (CFT >3 second) • Significant bleeding

  29. Criteria for admission to SNCU HYPOTERMIA Central cynosis Shock (CFT>3 Sec) Coma, convulsion, encephalopathy Abdominal distension Diarrhoea / dysentery Bleeding Major malformation • Birth weight <1800gm or gestation <34 weeks • Large baby(4.0kg) • Perinatal asphyxia • Apnoea or gasping • Refusal to feed • Respiratory distress (rate >60/min) • Severe jaundice

  30. Setting, Human resources & training for newborn care services

  31. Nawjaatshishusurakshakaryakaram is equips the staff with appropriate knowledge & skill to provide essential newborn care. NSSK addresses newborn resuscitation , prevention of hypothermia, infection & early initiation of breast feeding

  32. Facility based IMNCI(F-IMNCI) • it is recommended that All NBSU staff at FRUs is trained in F-IMNCI which includes “Facility base care of new born. • Is skill based training based on participatory approach combining classroom session with hand on clinical session.

  33. Facility Based Newborn Care : • All doctors & nurses posted in SNCU need to undergo a more intensive training programme , including observership at a recognised centre.

  34. Facility for newborn care in a district having one district hospital with more than 3000 delivery per year, 5 FRUs & twenty 24x 7 PHCs.

  35. Operational status of Special newborn care unit in INDIA( Fourth Quarterly Technical Report Oct –Dec 2011)

  36. Operational status of Special newborn care unit in INDIA( Fourth Quarterly Technical Report Oct –Dec 2011)

  37. References • Home Based Newborn Care, operational guidelines,2011 MOHFW, GOI . • Facility based newborn care operational guidelines,2011 MOHFW , GOI . • Status of India’s Newborn ,2004, National Neonatology Forum, MOHFW, WHO . • Fourth Quarterly Technical Report , operational status of special Newborn Care unit in India Oct-Dec 2011, MOHFW, NCHRC-NIHFW . • The million death study collaborators, LANCET;2010: 1853-60

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