Newborn Health Challenge in India

Teaching Aids: NNFTeaching Aids: NNF NBH-NBH- 11

Newborn Health Newborn Health Challenge in IndiaChallenge in India

26 million births / year 26 million births / year – Account for 20% of Global Account for 20% of Global

birthsbirths

1.2 million die in neonatal 1.2 million die in neonatal periodperiod– Account for about 30% of Account for about 30% of

Global deathsGlobal deaths Others70%

India30%

Deaths - Global Vs India

India accounts for highest births & neonatal deathsIndia accounts for highest births & neonatal deaths


Neonatal mortality rate (NMR)Neonatal mortality rate (NMR)

Current - 44/1000 live birthsCurrent - 44/1000 live birthsAccounts for almost 2/3Accounts for almost 2/3rdrd of IMR & ½ of U5-MR of IMR & ½ of U5-MR

Nearly 3/4Nearly 3/4thth of neonatal deaths occur of neonatal deaths occur within 7 days, most during first 48 hourswithin 7 days, most during first 48 hours


NMR - State wiseNMR - State wise

10 in Kerala10 in Kerala

60 in Orissa, M.P.60 in Orissa, M.P.

U.P., M.P, Bihar together contribute to U.P., M.P, Bihar together contribute to nearly 50% of neonatal deaths in India nearly 50% of neonatal deaths in India (about 15% of the global burden)(about 15% of the global burden)


Perinatal indicesPerinatal indices

Still birth rate: 30-35 per 1000 birthsStill birth rate: 30-35 per 1000 births

Perinatal mortality rate: 60-70 per 1000 Perinatal mortality rate: 60-70 per 1000 birthsbirths

Approx. 0.8 million still births & 1.7 million Approx. 0.8 million still births & 1.7 million perinatal deaths annuallyperinatal deaths annually


Place of birthPlace of birth

2/32/3rdrd of deliveries at home of deliveries at home

Only 42% attended by skilled birth attendantsOnly 42% attended by skilled birth attendants**

Higher the institutional births, lower is the NMR

60 11-15M.P/ Bihar

10 95Kerala

NMR Inst. births

(%) State

* doctors, nurses, and midwives* doctors, nurses, and midwives


Causes of Neonatal DeathCauses of Neonatal Death

Neonatal sepsis Neonatal sepsis (includes pneumonia)(includes pneumonia)

Birth asphyxiaBirth asphyxia

PrematurityPrematurity

Tetanus declined Tetanus declined ‘1980-90’‘1980-90’

Prematurity15%

Others13%

Asphyxia20%

Sepsis52%

Source: Bang AT et al, Lancet 1999


Decline of NMRDecline of NMR

Rapid decline in the eighties– 69 in 198069 in 1980– 53 in 199053 in 1990

Stagnation since the nineties– 48 in 199548 in 1995– 44 in 200044 in 2000

NMR Trends

0

10

20

30

40

50

60

70

80

1980 1985 1990 1995 2000

1980 1985 1990 1995 2000


Why static NMR?Why static NMR?Govt. programmes focused to post Govt. programmes focused to post

neonatal periodsneonatal periods -- Diarrhoeal Disease ControlDiarrhoeal Disease Control

- ARI- ARI- Immunization- Immunization

Focus of essential newborn component Focus of essential newborn component was on a limited number of government was on a limited number of government facilitiesfacilities

Lack of skilled persons for managing Lack of skilled persons for managing newborn newborn


Way forwardWay forward

Importance to newborn healthImportance to newborn health

Earlier initiatives CSSM, RCH-IEarlier initiatives CSSM, RCH-I

RCH – II (2005-10)RCH – II (2005-10)

- IMNCI: Community & facility- IMNCI: Community & facility

- Promotion of institutional deliveries- Promotion of institutional deliveries

-Strengthening of health facilities-Strengthening of health facilities


National GoalsNational Goals

CurrentCurrent 1010thth five yr five yr plan 2007plan 2007

NPP 2010NPP 2010 MDG TargetsMDG Targets

20152015

IMRIMR 6464 4545 <37<37 2727

NMRNMR 4444 2626 <20<20 <20<20

MMRMMR 407407 200200 <100<100 100100

Hospital Hospital births births

34%34% 80%80% 80%80%

NPP: National Population Policy; MDG: Millennium Development Goals

Documents

Newborn Health Challenge in India