Home based care successful in reducing neo- natal deaths & infant mortality
Infant mortality in the country stands very high at 57 per thousand live births and neo natal mortality at 43 per thousand live births.
Tweet-- India is faced with an unparalleled child survival and health challenge. The country contributes 2.38 million of the global burden of 10.8 million under-five child deaths, which is the highest for any nation in the world! Nearly 26 million infants are born each year, of which 1.2 million die before completion the first 4 weeks of life and 1.7 million die before reaching the first birthday... – World Health Organisation (WHO)
New DelhiMay 29, 2009: Good quality health care is a every child’s right and along with parents all the society and State also needs to be concerned about it. As recommended in the ‘Strategies for Children Under Six’ framework for 11th Five Year Plan, the care of young children cannot be left to the family alone – it is also a social responsibility. Proper home based care and a sound neo natal environment determines the future of millions of babies that are born every year in India
There is mounting evidence, that some of the most common causes of infant mortality i.e. diarrhoea, malaria, neonatal infection, pneumonia, nutritional deficiencies etc could be prevented and managed at home, through timely detection and intervention.
According to a report by UNICEF (April 2008), infant mortality in the country stands very high at 57 per thousand live births and neo natal mortality at 43 per thousand live births. One of the main reasons for high infant mortality is malnutrition (46 % of children under the age of 5 are malnourished). The report also stated that 53 % of women give birth in the absence of skilled health personnel.
0-5 years are very critical for a child’s mental and physical well being. Denial of basic determinants of health, food, safe drinking water resulting in malnutrition, acute repeated and prolonged untreated infection, poor access to health care services added to poor health literacy and awareness about health hygiene sanitation, and low purchasing power of services even if available (due to poverty), generally results in high infant mortality rate.
Under 5 Mortality Rate in Major States of India
India / States
NFHS 2
1998-99
NFHS 3
2005-06
India
94.9
74.3
Assam
89.5
85.0
Bihar
105.1
84.8
Chhattisgarh
Part of MP earlier
90.3
Jammu & Kashmir
80.1
51.2
Jharkhand
Part of Bihar earlier
93.0
Kerala
18.8
16.3
Madhya Pradesh
137.6
94.2
Maharashtra
58.1
46.7
Orissa
104.4
90.6
Punjab
72.1
52.0
Rajasthan
114.9
85.4
Uttar Pradesh
122.5
96.4
Source: NFHS 2 (1998-99|, NFHS 3 (2005-06)
In the light of such high infant mortality, it would be logical to note that about 80 % of health care in developing countries occurs in the home – and therefore a majority of children too die at home, without being seen by a health worker. According to experts, as many as 40 % of child deaths could be prevented with improved community and home based care and not high-tech health equipment and supplies. Social intervention is required, both in the form of enabling parents to take better care of their children at home, and in the form of direct provision of health, nutrition, pre-school education and related services. At the community level, these services are provided by aanganwadi worker, ASHA and ANM. But a further expansion of this team is required for effective service delivery. The child rights experts have been demanding an additional aanganwadi worker to work specifically on children under 3 years of age and converting aanganwadis into daycare centres wherever required.
Some of these essential interventions include: drying the newborn and keeping the baby warm, initiating breastfeeding as soon as possible after delivery and supporting the mother to breastfeed exclusively, giving special care to low-birth weight infants, and diagnosing and treating newborn problems like asphyxia and sepsis, and control of diarrhoeal diseases, respiratory infections and provision of micro nutrient supplementation (Vitamin A, Iron etc) could save lives of infants and children under five years of age .
According to Mr. Jitendra Panda, Technical Adviser on Health, Plan India, “Timely identification of risk factors at home, is crucial for prevention of infant mortality. In some villages the community health workers are playing an important role by visiting pregnant women and providing them information on taking care for themselves during pregnancy and their new born babies, and recognition of danger signs, which may indicate that there are complications. Simple treatments can be carried out on sick newborns at home by following some standard medical practices. These home based care and treatments are also significant in reducing the burden on Primary Health Centres (PHCs).”
UNICEF, a key player in the national effort to operationalise an innovative, newborn-centric child survival strategy started the Integrated Management of Neonatal and Childhood Illness (IMNCI) – used to strengthen the skills sets of community workers. IMNCI, the Indian adaptation of IMCI (Integrated Management of Childhood Illness) -- a global model currently being tested in 100 countries worldwide -- is pivotal to the Government of India’s vision of child health and comes under the overarching policy framework of the National Rural Health Mission and Reproductive and Child Health Programme (RCH –II, a 5 year programme, 2005-2010).
First piloted in selected blocks in 6 districts in as many states (Maharashtra, Gujarat, Rajasthan, Madhya Pradesh, Orissa and Tamil Nadu) in the country between 2002 to 2004, IMNCI is being currently implemented in nearly 25 districts across the country, including in Andaman and Nicobar islands after the devastation wrought by the tsunami. The plan also included up-scaling it to 125 more districts in some of the poorest regions.
The key componentsof the IMNCI package for newborn care included: a) A home visitation programme to promote best practices for the young infant. Three home visits are provided to every newborn starting with first visit on the day of birth (day 1) followed by visits on day 3 and day 7. For low birth weight babies, 3 more visits (total of six visits) are to be undertaken before the baby is one month of age. b) A special provision for follow-up of the low-birth weight baby, delivered at the village level. c) Reinforcement through meetings of womens’groupsand other community-level activities and a linkage between the village and home. d) Facility-based assessment at PHC, sub-centres, and hospitals through referrals, etc.