What impact NSSK will have on IMR ?

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What impact NSSK will have on IMR ?

• Naveen Thacker
• Past President IAP
• SC Member International Paediatrics Association

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India is epicenter of Childhood Mortality
Worldwide distribution of child deaths Each dot
represents 5000 deaths Lancet 2003
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Childhood MortalityState of Worlds Children 2008

• 9.7 million lt 5 yrs deaths annually world over
• India 2.1 million (21)

1 million newborns die annually in India
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Each year in India at least 26 million
women become pregnant!
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
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MDG 4 cannot be met without more purposeful focus
on newborn deaths
Every year 1 million newborns in India die
where, when and why? What can be done to save
these newborn lives now?
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WHERE? The 10 States in India where newborns
have the highest risk of dying
Rank State Neonatal mortality rate (per 1,000 live births)
1 Chattishgarh 51.1
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
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WHEN do newborns die?

• 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

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WHY do newborns in India die?

• The leading causes of neonatal death are
• Severe Infections (36)
• Pre-Term Births (25)
• Birth asphyxia (23).
• Other Neonatal Causes (6)
• Neonatal Tetanus (4)
• Source WHO World Health Statistics 2007 (India)

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What can be done to save these newborn lives
now?
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Lancet Neonatal Survival Series 2005
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)

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WhyNewborn resuscitation is important

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WhyNewborn resuscitation is important

• 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
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Still Births

• Till now focus is on live born infants only
  stillbirths have largely been overlooked.
• However, these deaths matter too they matter to
  the mother and the family, to the society and to
  the health care system.

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Still Births

• 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,

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1 million children who survive birth asphyxia
each year go onto suffer cerebral palsy and other
disabilities
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China Perinatal Statistics

• 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 Persons Found 2003
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Impact of Neonatal resuscitation in China 10
Provinces 2007

• Low 5 minute Apgar ( Birth Asphyxia)
• Decreased 60
• Mortality in delivery room
• Decreased by 40

Courtesy Keenan W J for providing the slide
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Impact of Neonatal Resuscitation Trainingon
asphyxia mortality

• 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 bag-mask. J
  Perinat 2005 S82-91.

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Impact of Neonatal Resuscitation
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
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Evaluation Of training- pre-test and post-test
Knowledge by Written Evaluation
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Evaluation Of training- pre-test and post-test
Skills by Performance Evaluation
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New Child Health Initiative by GOI

• 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
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What are we going to do?

• One trained person at Every Delivery
• A sustainable system of training , retraining,
  certification
• Follow up/ Monitoring of training
• Operational Research
• Study impact on mortality

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NSSK GOI
FGM NSSK for Pvt. Sector
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How many newborns could be saved?
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Lives can be saved now

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
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NFHS 3 Trends in Delivery Care
Percent
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Expected outcomes

• 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

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Everyone has a role to play.. Ghulam
Nabi Azad Union health minister INDIA
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
Indias newborns, mothers an children
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First Golden Minute Project

• Not only a project..
• But
• .a mission

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Its a long road ahead... But Challenge is to
ensure that every newborn counts
THANK YOU