Portal de Periódicos da CAPES

Development and effects of a neonatal care unit in rural India

2005; Elsevier BV; Volume: 366; Issue: 9479 Linguagem: Inglês

10.1016/s0140-6736(05)66823-7

1474-547X

Amitava Sen, Dilip Mahalanabis, Arun Singh, Tapas Som, Sudipta S. Bandyopadhyay,

Infant Development and Preterm Care

The Purulia district of the state of West Bengal, India, has an area of 6259 km2Sen A Mahalanabis D Singh AK Som TK Bandyopadhyay S Mehta P District level sick newborn care unit: a complimentary approach to reduction of neonatal mortality.J Neonatol. 2004; 18: 48-55Google Scholar, a population of 2·54 million, a birth rate of 24·8, and a neonatal mortality rate (NMR) of 55 per 1000 livebirths. The government health infrastructure in this district consists of a district hospital, a subdistrict hospital, five rural hospitals, 15 community health centres, and 53 primary health centres. Caesarean section and blood transfusion services are only available in the district hospital. Although an essential newborn care programme has been operational in the district for several years, no specialised sick newborn care unit (SNCU), government or private, is available in the district. We aimed to set one up in the district hospital and to estimate its effects on NMR. With the limited space, manpower, and funding available, we developed a 12-bed state-of-the-art SNCU (based on level-II criteria from the National Neonatology Forum, India1National Neonatology Forum, India.http://www.nnfi.orgGoogle Scholar). We did extensive hands-on training of in-service doctors and nurses, and mobilised resources from the local self-government (panchayat). The facility included controlled environment, individual warming and close-monitoring devices, intravenous fluid and medications by infusion pump, central oxygen, bedside procedures (eg, resuscitation and exchange transfusion), portable radiograms, and in-house laboratory services. It did not include facilities for mechanical ventilation or neonatal surgery. Ambulatory mothers were freely allowed in the unit. A preliminary report has already been published.2Sen A Mahalanabis D Singh AK Som TK Bandyopadhyay S Mehta P District level sick newborn care unit: a complimentary approach to reduction of neonatal mortality.J Neonatol. 2004; 18: 48-55Google Scholar In the absence of any comparable data before starting the SNCU at the district hospital, we took the data for September and October, 2003, as the baseline reference data for comparison because effective interventions were fully operational only from November, 2003. The two-monthly neonatal mortality rates from November, 2003, to February, 2005, were consistently lower than the reference data for September-October, 2003 (table), even though many sick neonates were managed in the crowded paediatric ward by the SNCU staff.TableNumber of births and deaths of babies after establishing a level II sick newborn care unit in a district hospitalTotal deliveriesStillbirthsTook baby home earlyNeonatal deaths*Pooled deaths at sick newborn care unit, labour room, and paediatric ward during hospital stay. NMR=neonatal mortality rate per 1000 livebirths. Babies taken home early by parents were excluded.NMRSept–Oct, 200311868787165·08Nov–Dec, 200311348694644·27Jan–Feb, 200480857122837·89Mar–Apr, 2004108265114544·73May–Jun, 200411489275451·48Jul–Aug, 200411339394846·56Sept–Oct, 200411929485853·21Nov–Dec, 200412328074337·55Jan–Feb, 20059816613740·48Pooled Nov, 2003–Feb, 200587106336435944·80* Pooled deaths at sick newborn care unit, labour room, and paediatric ward during hospital stay. NMR=neonatal mortality rate per 1000 livebirths. Babies taken home early by parents were excluded. Open table in a new tab We estimate that with the existing 12 SNCU beds, at least 270 neonatal deaths per year could be averted in the district hospital alone, which is 7·8% of the estimated 3464 neonatal deaths per year in the district based on population, birth rate, and NMR. This could reduce the NMR of the district by 4·3 (from 55·0 to 50·7). With more SNCU beds made operational and with adequate staff in the near future, the NMR is expected to fall further. No other single intervention is expected to reduce the NMR to this extent.3Dadhich JP Paul V State of India's newborns. National Neonatology Forum and Save the Children, New Delhi/Washington DC2004: 1-7Google Scholar, 4The Lancet Neonatal Survival Series, 2005. Published online March 3, 2005.http://www.activemag.co.uk/lancet.htmGoogle Scholar, 5World Health Organization. Newborn health policy and planning framework, part I: overview for policy-makers.http://www.who.int/child-adolescent-health/New_Publications/Neonatal/NH-Framework.pdfGoogle Scholar The constraints on the intervention include: difficulty in retaining trained personnel, poor availability of transportation for sick neonates, erratic electricity and running clean water, difficulty in recovering running costs from patients, and continued labour-room deaths (unless the plan also includes upgrading of labour room care). However, the spread of the panchayat system of local government in India should create more opportunities for resource availability at the grass-roots level and increase sustainability. India is committed to achieving an NMR of 20 by 2010. However, the NMR has remained static at 44 over the past decade.3Dadhich JP Paul V State of India's newborns. National Neonatology Forum and Save the Children, New Delhi/Washington DC2004: 1-7Google Scholar With rare exceptions, district hospitals in India do not have an SNCU. We propose that the development of SNCUs in district and subdistrict hospitals be considered for implementation in India and other developing countries to reduce NMR. We thank the chairpersons of Zilla Parishad (local self-government), the district magistrates of Purulia, the Chief Medical Officer of Purulia and his staff, and concerned officials of UNICEF, Kolkata, for their active support. We declare that we have no conflict of interest.