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Insights on India's Strategies to Reduce Newborn Mortality

An Expert Opinion by Dr.M.M.A. Faridi





A baby is considered as a newborn for up to 28 days

The newborn babies have a lot of milestones to reach in this period, from day 1. The newborns are more susceptible to infections and developmental problems if any problem occurs during this period. Commonly, newborns are at a high risk for morbidity and mortality. During the first year of life, the mortality rate for infants is 42 per 1000 live births. Out of these, 29 babies die in the first month of life. Therefore, corrective measures must be taken to reduce these deaths.


One of the significant challenges in providing adequate newborn care is the need for more trained healthcare personnel. It is critical to have trained paediatricians and neonatologists present in the delivery room to ensure that newborns receive immediate and appropriate medical attention. This is crucial because any delay or inadequacy in care can have serious consequences on their health and survival. The shortage is profoundly found in rural and tribal areas.


“Newborn Corner” has been established in several places across India to take care of the newborn babies. This resulted in improvement in the last 4 to 5 years but trained manpower is not available in the labour room, which is very essential.


On Sep.14, 2018, the Government of India devised the “India newborn action plan” based on WHO’s (World Health Organization) global concern for improving newborn survival.


The goal is to bring down newborn deaths from 29 to less than 10.

Major causes of Child Mortality in India





Birth Asphyxia:


The largest cause of mortality is that babies are not able to take a breath after they are born. This problem is called “Birth Asphyxia”. They should have enough oxygen in the blood to ensure normal development. To control this condition, there is Neonatal Resuscitation Programme (NRP), under which nurses and doctors are trained to resuscitate a baby at birth. Oxygen support is also provided to the babies. It is done by the National Neonatology Forum (NNF) and the Indian Academy of Paediatrics (IAP) with great support from the Indian government. Currently, training for this programme is being provided to ASHA (Accredited Social Health Activists) workers, basic health workers and Doctors.


Infection:


The next major cause is an infection due to insufficient hygiene of the surroundings. All the things should be clean such as hands, coats and equipment. To ensure this, Special Care Newborn Units (SCNUs) are established, in all the districts of the country.


Preterm Birth:


The third is preterm birth. Preterm babies are more prone to infections than term babies. More early the baby is born, more the problems it's vulnerable to. A major hurdle is the LBW babies (<2.5 Kg). They could be preterm or full-term while most of them are pre-term. They are prone to asphyxia, feeding problems and infections.


Providing care for preterm babies both in hospitals and their communities is one form of intervention and another is Kangaroo Mother Care (KMC), for which Nurses and Doctors are being trained to teach mothers to breastfeed the baby by placing it between the breast of the mother, to enhance eye contact and skin-to-skin contact.


Theoretical knowledge in India is fairly robust, but currently, there is a lack of adequate practical training. Therefore, the Medical Council of India (MCI) is making more efforts to train nurses and doctors.


All the State governments and the Central government are working coherently with other NGOs like UNICEF and the nurses are trained in NRP, KMC and home-based care for babies. India provides training to individuals from other countries as well.


Hypothermia:


Selective hypothermia” has also become a major problem among newborns, lately. The first intervention for this condition is to cool down the brain to avoid mortality. Several centres in India are implementing this method. Another intervention is the use of several new drugs which facilitates options like closing Patent Ductus Arteriosus (PDA), without surgery.


A key breakthrough that has come up is non-invasive ventilation like CPAP, very special high-flow oxygen with very long catheters, while conventional Mechanical ventilation is very expensive and causes long-time mortality.


Key Government Initiatives


In 2011, the Government of India started the scheme such as Janani Suraksha Yojana (JSY) and Jananis Shishu Suraksha Karyakaram (JSSK) to provide free delivery, free treatment for sick babies until they reach 1 year, cash assistance to mandate that all deliveries must be done in hospital. Due to this intervention, currently, 80% of deliveries are done in hospitals, where all facilities are available for the safety of newborns.


While progress has been made, it has been slow. However, it is hopeful that by the year 2030, we will make significant improvements and achieve single-digit mortality rates.

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