MADHYA PRADESH GRAPPLES WITH SPIRALLING NEONATAL DEATHS
Context: According to the National Health Mission (NHM) Madhya Pradesh has recorded the highest percentage of newborn deaths of 11.5% against the total admissions to government-run sick newborn care units (SNCUs) in the past three years across the country
The country’s average is 7%.
- Staff crunch, low community referrals, absence of a special neonatal transport service to health centres
- Reliance on units in cities as last resort and the non-availability of enough units to cater to increasing institutional deliveries have contributed to the spike in the percentage of deaths
- As the units are located at hospitals with the delivery load of more than 3,000 infants per year, mostly in District Headquarters, transporting neonates on time is crucial as they may succumb to fatal diseases within hours.
- Although there is a dedicated service to transport pregnant women to hospitals from remote areas, there is none for neonates, who are mostly dependent on the 108 ambulance service
- With increasing institutional deliveries in the State (80.8% as per the National Family Health Survey-4, 2015-2016), the number of neonatal care units, being optimally utilized, had not been increased proportionally.
- There is no system of continuity of care, the health of children and mothers is not tracked in a systematic way by one platform, and services are often given randomly.
- The major challenge, however, remained community referrals, significantly aided by ASHA workers only one in ten sick neonates born outside a hospital is taken to an SNCU.
- This is due to the absence of transport, inability to identify a disease by parents, and lack of awareness
Urban areas report a higher death percentage as they offer tertiary care, and admit several serious cases from peripheral districts
- According to the Sample Registration System, neonatal deaths in India mainly occur owing to premature births and low birth weight (35.9%), pneumonia (16.9%), birth asphyxia and birth trauma (9.9%), other non-communicable diseases (7.9%), diarrhoea (6.7%), congenital anomalies(4.6%) and infections (4.2%).
- Under the United Nations’ Sustainable Development Goals, each country, including India, has aimed to bring down neonatal mortality to at least 12 per 1,000 live births. In 2018, it stood at 23 for India.
- More than 70% neonatal deaths occur within the first week, most within 48 hours.
- When the first week passes, the probability of survival increases.
- Therefore, when the number of institutional deliveries are increased, the child is the unit’s responsibility.