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Meeting the Neonatal Challenges in Orissa

This report discusses the current status of neonatal mortality in Orissa, major causes, state child health policy, interventions, and challenges in achieving Millennium Development Goal Target 4a.

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Meeting the Neonatal Challenges in Orissa

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  1. Meeting the Neonatal Challenges in Orissa

  2. Contents • NMR in Orissa-Status • Major Causes • State Child Health Policy • Interventions • Challenges…

  3. Millennium Development Goal Target 4a: Reduce by two thirds the mortality rate among children under five Enhancing Neonatal survival is essential if MDG- 4 is to be reached.

  4. IMR from 71 to 50 / 1000 live births by 2012 (Source:-SRS 2008) NMR from 46 to 35/ 1000 live births by 2012 Where to go….

  5. INFANT MORTALITY TRENDS IN ORISSA AND INDIA Orissa - 20 points decline India - 13 points decline Almost plateaued-2004-07 66% of IMR is contributed by Neo-natal Mortality Source: SRS, RGI

  6. Causes of Neonatal deaths

  7. Prematurity Causes • Malaria Burden in the state is high (Emergence of Chloroquine resistant malaria) • Anaemia: Prevalence ranges from 53.4%(Others) to 73.8% (ST) amongst different social groups 100 IFA consumption- ranges from 27% in SC to 37% in other social groups • Malnutrition & inadequate rest

  8. Sepsis & Pneumonia Causes • Poor availability of Skilled attendant at birth – in case of home delivery • Lack of Post Natal Care • Non initiation of early & exclusive breast feeding • Infections of Umbilical Cord & Skin • Cultural practices like bathing, pre lacteal feeds, throwing away colostrum etc • Lack of identification of critical signs & referral

  9. Birth Asphyxia • Untrained birth attendance • 3 Delays- Delay in decision taking at household level, delay in reaching the facilities, delay in getting services • Lack of facilities at except 24X7 & FRUs

  10. Tetanus • Poor antenatal registration & check up • Mothers with at least 3 ANC(Over all -62%) SC-59 % ST-46% • Two TT (Overall- 83%) ST- 73% SC- 88% Source –NFHS -3 (2005-06)

  11. Challenges - general • Geographical inaccessibility of tribal populations affects coverage • Illiteracy, poverty, migration, inherent traditional customs influence health seeking behaviour in spite of service provisions • Vacancies of the service providers especially in hard to reach areas and backward districts • Gaps in socio cultural perspectives between service provider and beneficiaries

  12. Strategies 1.Improved preventive management of malaria amongst pregnant women- LLIN 2.Implementation of IMNCI for improved case management of newborn at household level 3.SBA at delivery with enhanced institutional delivery to improve early neonatal survival through better neonatal resuscitation. 4. Establishment of facility based special newborn care unit networks: in block, sub division & district levels with referral chain –SNCU- I , II ,NBC 5. Enhanced dedicated transportation availability

  13. Prematurity-Implementational Challenges Intervention for Malaria Control Provision of LLIN to Pregnant Women (proposed) Early diagnosis & treatment; ASHA trained for BS collection, RDK testing ,referral & treatment Challenges Procurement of bed net –delay Usage of bed net – Cultural & social issues Hand holding support to ASHA for use of RDK Rational distribution of RDK & monitoring Inaccessibility & late arrival at health facilities contd..

  14. Attempts to address Challenges LLIN provided during 1st ANC after counselling Supply of LLIN through GKS Continued Counselling for use at VHND RDK supplied & replenished at VHND Awareness created for use of SC untied fund for referral of complicated malaria cases

  15. Prematurity-Implementational Challenges Intervention for Anaemia & Malnutrition Adolescent Anaemia programme for in school(through Teacher) & out of School girls(through AWW) -Weekly Observed Iron supplementation Mamta Divas -Hb testing & monitoring by ANM, referral of severely anaemic Pregnant women using untied fund, Counseling for IFA & appropriate food intake Challenges Ensuring Compliances of IFA consumption – PW & Out of school girls Attempts to address Challenges Linking with self help groups for Compliances of IFA consumption & nutritional counseling

  16. Sepsis & Pneumonia(26%)-Implementational Challenges Interventions IMNCI SNCU PNC –Home visit & YASHODA at facilities Challenges Ensuring Quality of training- Availability of Alopathic doctors for imparting training Regular supply of drugs & logistics Handholding of trained IMNCI Worker Constraint in attending hospital if referred Scaling of facility based New born care- procurement & maintenance, Clinical man power, execution of civil work contd...

  17. Sepsis & Pneumonia(26%)-Implementational Challenges Recent attempts to address Challenges Involving AYUSH Doctors to impart training Equipment Maintenance Unit established Funds allocated for sector level support supervision Baby-kits for Institutional deliveries

  18. Birth Asphyxia- Implementational Challenges Interventions Promotion of Institutional Deliveries SBA Training Provision of DDK Challenges Infrastructure support to cater to increased load of Institutional deliveries Unavailability of adequate skilled manpower-Anaesthesia & EmOC Scaling up of SBA training sites –Eligibility of institution for conducting training, residential accommodation within hospital premises, ensuring quality of training Recent attempts to address Challenges Annual grant for development of civil infra to FRU & 24 X7 hospitals on priority basis Short term Anaesthesia & EmOC training – on going Service package for institutional delivery – Birth registration, Counselling for Early initiation of breast feeding, BCG, Zero dose polio, JSY cheque, Mother & baby kit, 48 hour Institutional stay- Diet to attendant Provision of DDK during 3rd ANC at VHND

  19. Equity Lens • Poverty among STs ranges from 67 to 82% across all regions of state. • Mothers with at least 3 ANC (over all 62%) • Two or more TT over all 83% , ST-73% • Stunting among STs is 57% , SCs is 50% & wasting is 28% (ST) • Full Immunization coverage is 30% among ST • IMR among STs is 79 & U5 MR is 136

  20. Challenges in general Challenges Referral Transportation Infrastructure support to cater the increased load of Institutional deliveries 48 hrs institutional stay Unavailability of adequate skilled manpower-Anaesthesia & EmOC

  21. Response Strengthening referral linkages : • Janani Express : One in each block • 169 Ambulances provided : Rationalized provision (areas with high mortality and inaccessible institutions given priority) • 191Mobile Health Units deployed in difficult pockets- ANMs in MHU are giving thrust on ANC and PNC • Sensitization of ANM, PRI members & representatives of GKS – Increased utilisation of untied fund

  22. Response • Focus on civil infra of FRU & 24 X7 hospitals on priority basis • Outsourced engagement of Yosadha services at DHH – SHG Federation • Short term Anaesthesia & EmOC training – on going

  23. Response FBNC initiatives : • 7 SNCU-II are functional • Another 13 SNCU-II-to be functional by Sept’09 • 28 SNCU-I are functional • 80 SNCU-I - to be functional by Mach’10 • 185 New born corners functional in 24X7 institutions • 150 New born corners - to be functional by March’10

  24. Thank You

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