Naveen Thacker
Past President IAP
SC Member International Paediatrics Association
India is epicenter of Childhood Mortality
Worldwide distribution of child deaths
Each dot represents 5000 deaths
Lancet 2003
 9.7
million < 5 yrs deaths annually world over
India
2.1 million (21%)
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)
51.1
1
Chattishgarh
2
Jharkhand
48.6
3
Uttar Pradesh
47.6
4
Assam
45.5
5
Orissa
45.4
6
Madhya Pradesh
44.9
7
Rajasthan
43.9
8
Andhra Pradesh
40.3
9
Bihar
39.8
10
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
WHY do newborns in India die?
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)
What can be done to
save these newborn
lives now?
Post natal interventions meeting criteria for efficacy for
reducing all cause neonatal mortality/major risk factors
 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%)
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.
these deaths matter too – they
matter to the mother and the family, to the
society and to the health care system.
 However,
 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,
 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 LB
China 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 bagmask. 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
Evaluation Of training- pre-test and post-test
Knowledge by; Written Evaluation
93%
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
83%
10%
Pre
Post
% Change
Evaluation Of training- pre-test and posttest Skills by Performance Evaluation
88%
90%
80%
70%
55%
60%
50%
33%
40%
30%
20%
10%
0%
1
2
3
Navjaat Shishu Suraksha Karyakram (NSSK)
A
new programme on Basic Newborn
Care and Resuscitation, has been
launched nationally by GoI to address
important interventions of care at birth
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
NSSK GOI
Program
ANM
Navjaat Shishu Suraksha Karyakram
Care at birth and newborn care
Nurse
CHC
PHC
Community
SECTOR
District Hospital
Specialist
Medical
officer
Services
PRIVATE
Provider
FGM : NSSK for Pvt. Sector
• Care of
newborn at birth
-Warmth
-Resuscitation
if needed
-Initiation of
breast feeding
-Identifying
LBW and high
risk babies
(prematurity)
How many newborns
could be saved?
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
Percent
Institutional
Delivery
Delivery assisted by
health personnel
41
49
42
34
35
26
NFHS-1
NFHS-2
NFHS-3
NFHS-1
NFHS-2
NFHS-3
 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
First Golden Minute Project
Not only a project..
But ……
a mission
….
THANK YOU