Saving India’s Newborns by Community Participation
A spate of infants deaths have been reported from public hospitals in Andhra Pradesh, Tamil Nadu and West Bengal. They are a reflection of the prevailing social, economic, cultural and political conditions. Experts believe that infant mortality can be reduced with the available resources and technology infant deaths. Statistics show that two-thirds of infant deaths happen during the neo natal period, that is below 28 days. Saving neonates amounts to saving infants.
A recent study conducted in 193 countries WHO, Save the Children and London School of Hygiene and Tropical medicine revealed that 9,00,000 newborns are dying in India every year, that is 28 per cent of deaths globally. In 1990, India was ranked was ranked fifth in infant mortality but it has not attained the dubious distinction of being ranked second. Preterm delivery/ low birth weight, birth asphyxia and severe infection are the three major causes for these deaths.
In the early eighties, I worked as Medical Officer in a 30-bed Government hospital at Proddatur in Andhra Pradesh. It did not have incubators or radiant warmers or intensive care facility. A woman approached me for treatment of her day-old daughter whose birth weight was 0.9 kgs which makes survival difficult even in a well-equipped hospital. All I could do was to advise her home-based newborn care for low birth weight. The mother followed it scrupulously and saved the child !
A decade later, I was posted in the District headquarters hospital in Chittoor. A woman gave birth to twins who weighed 1.4 kgs and 1.2 kgs respectively. I advised them home care and breastfeeding for both. The obstetrician who delivered the babies insisted on top feeding for at least one child. I convinced the obstetrician that breastfeeding was best for both children. The children survived with home care and breastfeeding. The hospital got accreditation as the first baby friendly hospital in A.P, the first such in the Government sector, according to Dr. S. Jayam, former chairperson of National Neonatology Forum.
Dr. Abhay Bang and Dr. Rani Bhang run an NGO called SEARCH at Gadchiroli in Maharastra. By involving community volunteers, they reduced newborn deaths by 62% during 1995-98, a record unmatched even by reputed institutes. Experts say that millions of babies should not be dying when there are proven, cost effective interventions to prevent newborn deaths.
Community participation is an important component for success of any health programme. Following are some areas where community can involve and prevent newborn deaths:
Age at Marriage: The best period for pregnancy is between 20 to 30 years. Child mothers usually give birth to low weight babies and are usually not equipped to take care of them. The community must promote the concept that women should marry only after they are 18.
Cleanliness during delivery: Clean delivery room, clean hands of health functionaries, clean blade, clean thread and clean umbilical stump go a long way in preventing sepsis and newborn deaths.
Care during pregnancy: Pregnant women should undergo all antenatal checkups. They should eat adequately, they should use iodised salt, iron and Folic acid tablets, undergo H.I.V screening and receive Tetanus Toxoid shots.
Breastfeeding: Mothers should initiate breastfeeding within first hour after delivery and continue exclusive breastfeeding up to 6 months. Breast milk meets all the nutritional needs of babies for first six months. If the baby is passing urine more than 6 times a day and making satisfactory weight gain, the milk is deemed to be adequate. Complimentary feeding with homemade foods should be started at six months of age and continued well into second year of life. Breastfeeding saves mothers too from postpartum haemorrhage – a life threatening problem and cancer of breasts and ovaries.
Care of low birth weight babies: The normal birth weight is 2.5 kgs but if a child is less than 1.5 kgs, he /she requires hospitalization. Others can be cared with home based care which health workers must promote.
Essential newborn care: Providing warmth to newborns is very important to prevent babies dying from hypothermia. The liquids on the baby should be mopped with soft cloth. Vernixcaseosa, the white membrane on the body should not be removed as it will fall on its own. The baby should be kept warm in the layered, dry and clean clothes. Eyes should be wiped with clean cotton or cloth. Nothing should be applied to umbilical stump.
Danger signs : Not passing motion in first 24 hours, not passing urine in first 48 hours, birth injuries, birth handicap, jaundice, cyanosis (Blue color), fits, distress in breathing , cold to touch, persistent cry, unable to suck, altered sensorium, redness of umbilical stump, pus from umbilical stump, presence of more than 10 pustules and diarrhea in newborn are danger signs. These signs warrant immediate hospitalization of baby in a well-equipped hospital.
Medical Consultant, Indian Institute of Health and Family Welfare, Hyderabad, Founder – Organization for Promotion of Social Dimensions of Health (OPSDH), Former Additional Director of Health of A.P., Former State Coordinator , Breastfeeding Promotion Network of India (BPNI)