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Neonatal Mortality- ACommunity Approach

Dr Neeraj

Dr Shankar

Dr Jalam Singh

Dr Devendra

Dr Sameer

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Neonatal mortality rate

Neonatal mortality rate: The number of children dying under 28 days of agedivided by the number of live births that

year

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Back ground

44 countries mothers from the richest quintile arethree times more likely to have a birth attendantthan those in the poorest quintile

In north India, three fifths of rural women do nothave any antenatal care

four million infants die in the neonatal period, anda similar number are stillborn

Reducing maternal and neonatal mortality in the poorest communities,Anthony Costello,David Osrin, Dharma Manandhar, BMJ2004;329:1166doi:10.1136/bmj.329.7475.1166

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Primary causes of neonatal deaths inPrimary causes of neonatal deaths in

IndiaIndia

(Source: National Neonatology Forum(Source: National Neonatology Forum

and Saving Newborn’s lives, 2004)and Saving Newborn’s lives, 2004)

Diarrhoea

20%

ARI

25%

Sepsis

26%

Asphyxia

10%

Prematurity

8%

Others

11%

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Early Childhood MortalityRates

39

18

57

18

74

0

10

20

30

40

50

60

70

80

Neonatal

mortality

Postneonatal

mortality

Infant

mortality

Child

mortality

Under-five

mortality

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Childhood Mortality Ratesby Sex

37

21

58

23

79

41

15

56

14

70

0

10

20

30

40

50

60

70

80

90

Neonatal

Mortality

Postneonatal

Mortality

Infant Mortality Child Mortality Under-five

Mortality

Female Male

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Infant Mortality Rates byDemographic Characteristics

72

56

50

77

80

62

47

64

37

30

50

86

0 10 20 30 40 50 60 70 80 90 100

40-49

30-39

20-29

< 20

MOTHER'S AGE AT BIRTH

7 or more

4-6

2-3

1

BIRTH ORDER

4 years or more

3 years

2 years

< 2 years

PREVIOUS BIRTH INTERVAL

I f t M t lit R t i I di

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Infant Mortality Rates in India-Rural Urban divide

114

110

105 105 104

97 96 95 94

91

80 80 79

74 74 7472

7172

7068

64

60

119

1 14 1 14 1 14 113

107105 104

102

98

86 8785

82

80 8077 77 77

75 7472

69

82

80

62

65 66 66

59

62 61 62

58

50

53 53

45

52

46 45 44 4442

40

48

40

60

80

100

120

  1   9   8   0    8  1    8   2    8   3    8  4    8   5    8   6    8   7    8   8    8   9    9   0    9  1    9   2    9   3    9  4    9   5    9   6    9   7    9   8    9   9    '   0

   0   '   0

  1   '   0   2

Total

RuralUrban

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CareCare

atatbirthbirth

PrevnPrevn

&&

TxTx

mildmild

illnessillness

TxTx

seriousserious

illnessillness

       I     n     p     a

       t       i     e     n       t

     O    u     t    p

    a     t     i    e    n     tFacility

Home     H   o   m   e

     C   o   m

   m   u   n     i    t   y

I     m   m   

 u   n   i     z   

 a    t    i      o   

n   

Functioning Health System

BCC & Community mobilization

Newborn &Newborn &

Child HealthChild Health

Child Health strategyChild Health strategy

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Some Approaches……

Improving the health and nutrition of mothers-to-beand providing quality reproductive health services

improving access to antenatal care during pregnancy

Improved management of normal delivery by skilled

attendants

Access to emergency obstetric and neonatal care(EmOC) when needed

 Timely post natal care for both mothers and newborns

C it A h

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Community Approach- The Essential

Interventions Drying the newborn and keeping the baby

warm.

Initiating breastfeeding as soon as possible

after delivery and supporting the mother tobreastfeed exclusively.

Giving special care to low-birth weightinfants

diagnosing and treating newborn problemslike asphyxia and sepsis.

C it A h

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Community Approach- The Essential

Interventions...

Visit by Community health worker withfollow up (with in 24 Hr & 2-3 in 1st wk)

Co-ordination of Community and Facility

based care intersect oral coordination with other

departments

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Ray of hope…..

BCC & Community Mobilization

Increasing partnership – Ownership andaccountability