Naveen ThackerPast President IAP

SC Member International Paediatrics Association

Worldwide distribution of child deathsEach dot represents 5000 deaths

Lancet 2003

India is epicenter of Childhood Mortality

9.7 million < 5 yrs deaths annually world over

India 2.1 million (21%)

1 million newborns die

1 million newborns die

annually in India

annually in India

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

Every year 1 million newborns in India die – where, when and why?

What can be done to save these newborn lives now?

Rank State Neonatal mortality

rate (per 1,000 live births)

1 Chattishgarh 51.12 Jharkhand 48.63 Uttar Pradesh 47.64 Assam 45.55 Orissa 45.46 Madhya Pradesh 44.97 Rajasthan 43.98 Andhra Pradesh 40.39 Bihar 39.810 West Bengal 37.6

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

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)

WHYWHY do newborns in India die?do newborns in India die?

What can be done to save these newborn lives now?

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%)

Post natal interventions meeting criteria for efficacy for reducing all cause neonatal mortality/major risk factors

Birth Asphyxia 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

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.

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,

1 million children who survive birth

asphyxia each year go

1 million children who survive birth

asphyxia each year go

onto suffer cerebral palsy and other disabilities

onto suffer cerebral palsy and other disabilities

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 199K/Yr

Disabled 0-6, 11/1000 LBChina Disabled Person’s Found 2003

Low 5 minute Apgar ( Birth Asphyxia) Decreased 60%

Mortality in delivery room Decreased by 40%

Courtesy: Keenan W J for providing the slide

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 bag-mask. J Perinat 2005; S82-91.

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

83%93%

10%

0%10%20%30%40%50%60%70%80%90%

100%

Pre Post % Change

Evaluation Of training- pre-test and post-test Evaluation Of training- pre-test and post-test Knowledge by; Knowledge by; Written Evaluation Written Evaluation

33%

88%

55%

0%

10%20%

30%

40%50%

60%70%

80%

90%

1 2 3

Evaluation Of training- pre-test and post-Evaluation Of training- pre-test and post-test Skills test Skills by Performance Evaluation by Performance Evaluation

A new programme on Basic Newborn Care and Resuscitation, has been launched nationally by GoI to address important interventions of care at birth

Navjaat Shishu Suraksha Karyakram (NSSK)

GOI and IAP have signed a MoU for training

One trained person at Every Delivery A sustainable system of training , retraining,

certification Follow up/ Monitoring of training Operational Research Study impact on mortality

Car

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wbo

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are • Care of

newborn at birth

-Warmth

-Resuscitation if needed

-Initiation of breast feeding

-Identifying LBW and high risk babies (prematurity)

Community

PHC

CHC

District HospitalSpecialist

Medical officer

Nurse

ANM

Provider Services

Nav

jaat

Shi

shu

Sura

ksha

Kar

yakr

am

Program

PRIV

ATE

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ECTO

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NSSK GOINSSK GOI FGMFGM : NSSK for Pvt. SectorNSSK for Pvt. Sector

How many newborns could be saved?

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

Institutional Delivery

4134

26

NFHS-3NFHS-2NFHS-1

Delivery assisted by health personnel

4942

35

NFHS-3NFHS-2NFHS-1

PercentPercent

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

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

Not only a project.. But ……

….a mission

First Golden Minute Project

THANK YOU