About 0.75 million neonates die every year in India, the highest for any country in the world. The neonatal mortality rate (NMR) declined from 52 per 1000 live births in 1990 to 28 per 1000 live births in 2013, but the rate of decline has been slow and lags behind that of infant and under-five child mortality rates. The slower decline has led to increasing contribution of neonatal mortality to infant and under-five mortality. Among neonatal deaths, the rate of decline in early neonatal mortality rate (ENMR) is much lower than that of late NMR. The high level and slow decline in early NMR are also reflected in a high and stagnant perinatal mortality rate. The rate of decline in NMR, and to an extent ENMR, has accelerated with the introduction of National Rural Health Mission in mid-2005. Almost all states have witnessed this phenomenon, but there is still a huge disparity in NMR between and even within the states. The disparity is further compounded by rural–urban, poor–rich and gender differentials. There is an interplay of different demographic, educational, socioeconomic, biological and care-seeking factors, which are responsible for the differentials and the high burden of neonatal mortality. Addressing inequity in India is an important cross-cutting action that will reduce newborn mortality.

Neonatal units in teaching and non-teaching hospitals both in public and private hospitals have been increasing in number in the country since the sixties. In 1994, a District Newborn Care Programme was introduced as a part of the Child Survival and Safe Motherhood Programme (CSSM) in 26 districts. Inpatient care of small and sick newborns in the public health system got a boost under National Rural Health Mission with the launch of the national programme on facility-based newborn care (FBNC). This has led to a nationwide creation of Newborn Care Corners (NBCC) at every point of child birth, newborn stabilization units (NBSUs) at First Referral Units (FRUs) and special newborn care units (SNCUs) at district hospitals. Guidelines and toolkits for standardized infrastructure, human resources and services at each level have been developed and a system of reporting data on FBNC created. Till March 2015, there were 565 SNCUs, 1904 NBSUs and 14 163 NBCCs operating in the country. There has been considerable progress in operationalizing SNCUs at the district hospitals; however establishing a network of SNCUs, NBSUs and NBCCs as a composite functional unit of newborn care continuum at the district level has lagged behind. NBSUs, the first point of referral for the sick newborn, have not received the desired attention and have remained a weak link in most districts. Other challenges include shortage of physicians, and hospital beds and absence of mechanisms for timely repair of equipment. With admission protocols not being adequately followed and a weak NBSU system, SNCUs are faced with the problem of admission overload and poor quality of care. Applying best practices of care at SNCUs, creating more NBSU linkages and strengthening NBCCs are important steps toward improving quality of FBNC. This can be further improved with regular monitoring and mentoring from experienced pediatricians, and nurses drawn from medical colleges and the private sector. In addition there is a need to further increase such units to address the unmet need of facility-based care.

Purpose – The purpose of this paper is to study differing demographic factors affecting fast-food customers loyalty towards national or international fast food chains. It also compares the variation between global and local fast food chains as the products offered are culturally different. Design/methodology/approach – A variety of variables used to gain a holistic view, which includes factors such as quality, price, food and demographic profile of consumers affecting loyalty of fast food chains. The study adopts the theory and method of the trust-commitment-loyalty explanation chain and examines the consumer survey adapted from Fast food by Sahagun et al. (2014). The present analyses 542 filled questionnaires in which systematic sampling is used. Systematic sampling procedure is adopted. Findings – Indians prefer global fast food chains compared to Indian fast food chains. Loyalty towards global brands is higher than that for Indian brands because they are found to be of better quality which leads to higher frequency of visit and recommendation of the brands to their friends and colleagues. There are ethnic variations towards global and Indian fast food chains. Global brand of food chains generated more good word of mouth publicity compared to Indian food chains. Demographic factors play a role in the patronage of fast food chains. Research limitations/implications – One of the limitations of this research is the study adapts the theory and method of the trust-commitment-loyalty explanation chain and examines the consumer survey adapted from a study of Sahagun et al. (2014) on fast food for emerging markets. Only India is studied, but the addition of other countries like Brazil, China, Russia and South Africa can add value. Practical implications – Fast food managers had to illustrate the satisfaction on affective response, such as quality of food, convenient location, variety, service and value for money. Demographic variables like gender, age, education, income and ethnicity, global and local Brand will affect the perceptions. Originality/value – This is the first attempt to study the loyalty of consumers in emerging markets, which is witnessing the entry of many fast food global chains. It studies the demographic variables effect on the loyalty and the behaviour of consumers and compares to local and global brand fast food chains. The research will be use to global managers who are planning to expand in emerging markets like India.