nssk introductory
Post on 13-Feb-2017
218 Views
Preview:
TRANSCRIPT
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?
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
e at
birt
h an
d ne
wbo
rn c
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
S
ECTO
R
NSSK GOINSSK GOI FGMFGM : NSSK for Pvt. SectorNSSK for Pvt. Sector
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
top related