TRACKING NEW BORN DISCHARGED FROM SCNU Dr. Gagan Gupta

1. TRACKING NEW BORN DISCHARGED FROM SCNU Dr. Gagan Gupta Health Specialist , UNICEF

2. Background……..

3. 2002- 2006 : IMR reduced by 11 points with out a single point drop in Neonatal Mortality Highest IMR in the Country at 67 per 1000 (SRS 2009)

4. Government Sector: Special Care was Non Existent

5. Key Strategy : Guna ModelContinuum of Care from Community to Facility • Community: • IMNCI • Immunization. • ORS & Zinc in Diarrhea. • ASHA for Social Mobilization • Maternal Death Audit 24 x 7 Referral Transport Facility: -SCNU -NRC -Model Labour Rooms -24 x 7 Safe Delivery Centers at Sub - Block level -Staff trained in Skilled Birth attendance and Essential Newborn Care Piloted in Guna in 2007,Replicated in Shivpuri being Scaled up State Wide

6. Strengthening Facility Based New Born Care • To ensure Continuum of Care with IMNCI in community and SCNU at the Facility. • First 2 Units established by UNICEF at Guna and Shivpuri. • Establishment cost of each unit Rs. 45 Lakhs.( Civil work 25 lakh, Equipments 20 lakh) • Running cost of pilot units and scale up entirely through NRHM. SCNU Shivpuri

7. Scale Up Under NRHM : SCNU Vidisha District Hospital

8. New-Born being treated at SCNU

9. Backed Up By….

10. Model Maternity wing at District Hospital ….. Maternity Ward : Shivpuri District Hospital Model Labor Room : Shivpuri

11. Free 24 x 7 Referral transport with Call Centre Saving Life on Wheels : 24 x 7

12. Status of Special Care New Born Units : M.P 31 Functional 09 to start by 31st January B H D M R N 10 under construction G L R D T A S O P S V P T K M R W A C T P N M C A K N G U N P AN S T N S D H M D S S J P S A V D S R J G D M H N U M R S D L K T R T M B P L U J N J B P R S N S H E A N P N S P D D R I D R J B A M D L D H R D W S H S B S N I H R D C D W K N D B L G K R G B R W B T L B H P

14. What Happens After Discharge ??

15. Objective…. Determine survival at One year in babies discharged from SCNU To follow this cohort for Neurological Development Learn and put in place system for prospective follow up of discharged new born with Community – Facility linkages. Generate evidence for justifying continued investments of large funds on SCNU amongst other competing priorities

16. Methodology…. Study Area: SCNU Guna and Shivpuri - First 2 units in the State were established in these districts. - Presence of Call Centre, Block Coordinators for support Study Sample : All New Born discharged from SCNU since inception till 31st December 2008. Guna : 1617(14th Dec. 2007 – 31st Dec.2008 ) Shivpuri :557 (1st July 2008- 31st December 2008)

17. Methodology…. Type of Study :Retrospective in 3 phases. - Phase 1 : Desk review, Data entry, Telephonic Tracking. - Phase 2 : Visit to community for verification - Phase 3 : Clinical evaluation for developmental assessment.

18. Follow up Stages..….. Phase 1 : Screening of Records Phase 2 : Verification by Home visit Phase 3 : Developmental Assessment

19. ADMISSIONS – FOR WHAT ?? N= 2681

20. FOLLOW UP FINDINGS DISTRICT SHIVPURI ISO : 9001 Certified Unit

21. TRACKING OUTCOME

22. SURVIVAL OUTCOME

23. TIME DISTRIBUTION Total deaths = 70

24. URBAN RURAL DISTRIBUTION Total deaths = 70

25. CASTE WISE DISTRIBUTION Total deaths = 70

26. WEIGHT ON ADMISSION Total deaths = 70

27. FOLLOW UP OUTCOME DISTRICT : GUNA ISO : 9001 Certified Unit

28. SURVIVAL OUTCOME

29. TIME DISTRIBUTION Total deaths = 183

30. WEIGHT ON ADMISSION Total deaths = 183

31. Phase 3 :Developmental Screening District Shivpuri (M.P.)

32. Developmental Screening : Protocols Neurodevelopmental , Visual and Hearing screening done • Neurodevelopmental : Pathaks modification of Baroda Scale. • Hearing : American Academy of Pediatrics criteria • Visual : American Academy of Pediatrics guidelines

33. Developmental Screening… Head Circumference Screening for Visual Deficits

38. SUMMARY : FOLLOW UP OUTCOME • Survival in New Born discharged after successful completion of treatment was 90% at 1 year of age • Deaths were higher in new born who were discharged against medical advise and tertiary referrals. • More than 60 % Deaths occurred in 1st month after discharge. • Deaths were higher in excluded and rural population .

39. SUMMARY : FOLLOW UP OUTCOME • Survival in < 1500 gram birth wt. was 61 % against 93% in > 2500gm. • Deficits were seen in 11 % of Children who survived with Neurological deficit being commonest. • SAM prevalence was unusually low on follow up.

40. LESSONS LEARNED…. • Strong tracking system should be in place. • Vital information on admission should be recorded (Postal Address ,Mobile numbers) • Need to develop follow up protocols with community and facility linkages. (Extending continuum of care) • Local resources are best suited for follow up and tracking. (AWW, ASHA) • First month after discharge is most critical with need to focus on very low birth wt babies < 2000 grams

41. Action Initiated :Tracking System…. SCNU Software developed and all vital information on admission / discharge recorded in it by data operator. On discharge Parents are counseled & provided contact of IMNCI worker along with a community follow up card. Data operator sends SMS to IMNCI trained worker to enroll the discharged child. SMS reminders are sent to Parents as well as worker on day of Follow up.

42. Community Follow up card

43. Actions Initiated : Tracking System IMNCI trained AWW to make Six home visits as per IMNCI schedule in first month. At least one home visit to be done by ANM SCNU follow up at 15 days, 1,3,6 & 12 months or in case of complications Status upgraded at the end of the day of visit.

44. Admission Entry Form

45. Entry after Treatment Outcome

46. Daily Follow - up List

47. SCNU Software Generated Graphs : 2010 DISTRICT SHIVPURI