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What impact NSSK will have on IMR ? Naveen Thacker Past President IAP SC Member International Paediatrics Association
India is epicenter of Childhood Mortality Worldwide distribution of child deaths Each dot represents 5000 deaths Lancet 2003
Childhood Mortality State of World’s Children 2008 9. 7 million < 5 yrs deaths annually world over India 2. 1 million (21%) die rns wbo ia n ne n Ind illio lly i 1 m nua an
Each year in India at least 26 million women become pregnant! Every year…… … about 250, 000 women die of pregnancy-related causes … about 1 million babies are stillborn of which at least 300, 000 due to intra-partum causes … about 1 million neonates die
MDG 4 cannot be met without more purposeful focus on newborn deaths Every year 1 million newborns in India die – where, when and why? What can be done to save these newborn lives now?
WHERE? The 10 States in India where newborns have the highest risk of dying Rank State Neonatal mortality rate (per 1, 000 live births) 51. 1 1 Chattishgarh 2 Jharkhand 48. 6 3 Uttar Pradesh 47. 6 4 Assam 45. 5 5 Orissa 45. 4 6 Madhya Pradesh 44. 9 7 Rajasthan 43. 9 8 Andhra Pradesh 40. 3 9 Bihar 39. 8 10 West Bengal 37. 6
WHEN do newborns die? The first days of life are the riskiest • Up to 50% of all newborn deaths are on the first day of life - 500, 000 babies in India dying on their birth day • 75% of newborn deaths are in the first week
WHY do newborns in India die? The leading causes of neonatal death are: 1. Severe Infections (36%) 2. Pre-Term Births (25%) 3. Birth asphyxia (23%). 4. Other Neonatal Causes (6%) 5. Neonatal Tetanus (4%) Source: WHO World Health Statistics 2007 (India)
What can be done to save these newborn lives now?
Lancet Neonatal Survival Series 2005 Post natal interventions meeting criteria for efficacy for reducing all cause neonatal mortality/major risk factors Neonatal Resuscitation: 6 -42% Breastfeeding : 55 -87% Prevention and management of hypothermia: 18 -42% Kangaroo Mother Care (low birth weight): incidence of infection 51% (7 -75%) Community based pneumonia case management 27% (18 -35%)
Why Newborn resuscitation is important
Why Newborn resuscitation is important Birth Asphyxia – Major cause of “Mortality” and “Stillbirth” Major cause of short and long term morbidity Substantially treatable Estimated Deaths due to Birth Asphyxia in India is 3 lacs/yr
Still Births Till now focus is on live born infants only; stillbirths have largely been overlooked. However, these deaths matter too – they matter to the mother and the family, to the society and to the health care system.
Still Births Estimated no. of still births in India are 1 million More than one third of stillbirths take place intrapartum, i. e. during delivery, and are largely preventable by the same interventions. In Dahanu, India, the stillbirth rate dropped from 18. 6% to 9% with introduction of a TBA training program in neonatal resuscitation; Similar findings from Fatehpur, Belgaum India,
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China Perinatal Statistics 17 M Births Per Year Infant MR – 29. 7/1000 LB Most Deaths Occur in First Day 20 -30% Birth Asphyxia High Rate of Survivors with CP 199 K/Yr Disabled 0 -6, 11/1000 LB China Disabled Person’s Found 2003
Impact of Neonatal resuscitation in China 10 Provinces 2007 Low 5 minute Apgar ( Birth Asphyxia) Decreased 60% Mortality in delivery room Decreased by 40% Courtesy: Keenan W J for providing the slide
Impact of Neonatal Resuscitation Training on asphyxia mortality In rural Gadchiroli India interventions by the trained VHW in basic newborn resuscitation reduced case fatality in severe asphyxia by nearly 50% and asphyxia specific mortality rate by 65% in comparison to management by TBA alone* *Bang AT. Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitation with mouth-to-mouth, tube-mask or bagmask. J Perinat 2005; S 82 -91.
Impact of Neonatal Resuscitation Region Expected Changes References India 31% Ann Trop Peds China 66% Singapore MJ US 39 -72% Pediatrics Africa 38% Expert Estimate Courtesy: Keenan W J for providing the slide
Evaluation Of training- pre-test and post-test Knowledge by; Written Evaluation
Evaluation Of training- pre-test and posttest Skills by Performance Evaluation
New Child Health Initiative by GOI Navjaat Shishu Suraksha Karyakram (NSSK) A new programme on Basic Newborn Care and Resuscitation, has been launched nationally by Go. I to address important interventions of care at birth GOI and IAP have signed a Mo. U for training
What are we going to do? One trained person at Every Delivery A sustainable system of training , retraining, certification Follow up/ Monitoring of training Operational Research Study impact on mortality
NSSK GOI Program ANM Navjaat Shishu Suraksha Karyakram Care at birth and newborn care Nurse CHC PHC Community SECTOR District Hospital Specialist Medical officer Services PRIVATE Provider FGM : NSSK for Pvt. Sector • Care of newborn at birth -Warmth -Resuscitation if needed -Initiation of breast feeding -Identifying LBW and high risk babies (prematurity)
How many newborns could be saved?
Lives can be saved now If the all essential interventions in “The Lancet Newborn Survival series” reached 90% of Indian women and babies then 36 -67% of newborn deaths could be prevented Additional cost of $1. 39 per capita per year
NFHS 3: Trends in Delivery Care Percent
Expected outcomes If we train more than 90% health personnel attending institutional deliveries (41%) in essential interventions , an estimated 15 – 30 % reduction in NMR can be expected There will be greater impact in states with higher neonatal mortality
Everyone has a role to play…. . Ghulam Nabi Azad Union health minister INDIA As government officials to lead As policymakers to guarantee essential interventions and equity As partners and donors to support programmes As health workers to provide high quality care and as humans to advocate for India’s newborns, mothers an children
First Golden Minute Project Not only a project. . But …… …. a mission
It’s a long road ahead. . . But Challenge is to ensure that every newborn counts THANK YOU