Analysis of neonatal deaths in Maharashtra: policy implications

Saunik, Sujata; Jaiswal, Chandrakala; Nair, Rajalakshmi; Radkar, Anjali; Patil, Ashokreddy B.; Irani, Shiraz; Phadke, Milind

doi:10.18203/2394-6040.ijcmph20175322

Cited by 4 publications

(5 citation statements)

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“…Though the majority of 0–2-day deaths occurred at the facility irrespective of the type of health facility, the proportion of public sector births dying at the facility was significantly lower than the private sector births for 3–27-day deaths. Also, as the mean days of stay were significantly lower in the former than the latter, further in-depth exploration would be useful to understand the context of duration of facility stay in relation to the delivery complications or other barriers such as costs and quality of care in addition to the treatment-seeking behaviour to develop strategies to reduce neonatal mortality [59].…”

Section: Discussionmentioning

confidence: 99%

Distinct mortality patterns at 0–2 days versus the remaining neonatal period: results from population-based assessment in the Indian state of Bihar

Dandona

Kumar

Bhattacharya³

et al. 2019

BMC Med

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Background The objectives of this study were to understand the differences in mortality rate, risk factors for mortality, and cause of death distribution in three neonatal age sub-groups (0–2, 3–7, and 8–27 days) and assess the change in mortality rate with previous assessments to inform programmatic decision-making in the Indian state of Bihar, a large state with a high burden of newborn deaths. Methods Detailed interviews were conducted in a representative sample of 23,602 live births between January and December 2016 (96.2% participation) in Bihar state. We estimated the neonatal mortality rate (NMR) for the three age sub-groups and explored the association of these deaths with a variety of risk factors using a hierarchical logistic regression model approach. Verbal autopsies were conducted using the PHMRC questionnaire and the cause of death assigned using the SmartVA automated algorithm. Change in NMR from 2011 to 2016 was estimated by comparing it with a previous assessment. Results The NMR 0–2-day, 3–7-day, and 8–27-day mortality estimates in 2016 were 24.7 (95% CI 21.8–28.0), 13.2 (11.1 to 15.7), 5.8 (4.4 to 7.5), and 5.8 (4.5 to 7.5) per 1000 live births, respectively. A statistically significant reduction of 23.3% (95% CI 9.2% to 37.3) was seen in NMR from 2011 to 2016, driven by a reduction of 35.3% (95% CI 18.4% to 52.2) in 0–2-day mortality. In the final regression model, the highest odds for mortality in 0–2 days were related to the gestation period of ≤ 8 months (OR 16.5, 95% CI 11.9–22.9) followed by obstetric complications, no antiseptic cord care, and delivery at a private health facility or home. The 3–7- and 8–27-day mortality was driven by illness in the neonatal period (OR 10.33, 95% CI 6.31–16.90, and OR 4.88, 95% CI 3.13–7.61, respectively) and pregnancy with multiple foetuses (OR 5.15, 95% CI 2.39–11.10, and OR 11.77, 95% CI 6.43–21.53, respectively). Birth asphyxia (61.1%) and preterm delivery (22.1%) accounted for most of 0–2-day deaths; pneumonia (34.5%), preterm delivery (33.7%), and meningitis/sepsis (20.1%) accounted for the majority of 3–7-day deaths; meningitis/sepsis (30.6%), pneumonia (29.1%), and preterm delivery (26.2%) were the leading causes of death at 8–27 days. Conclusions To our knowledge, this is the first study to report a detailed neonatal epidemiology by age sub-groups for a major Indian state, which has highlighted the distinctly different mortality rate, risk factors, and causes of death at 0–2 days versus the rest of the neonatal period. Monitoring mortality at 0–2 and 3–7 days separately in the traditional early neonatal period of 0–7 days would enable more effective programming to reduce neonatal mortality. Electronic supplementary material The online version of this article (10.1186/s12916-019-1372-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Distinct mortality patterns at 0–2 days versus the remaining neonatal period: results from population-based assessment in the Indian state of Bihar

Dandona

Kumar

Bhattacharya³

et al. 2019

BMC Med

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“…Few authors have pointed out the fact that these in-hospital delays (level II delays) in provision of healthcare to neonates amount to significant morbidity and contributed to as much as 40.8% of neonatal deaths. 12 WHO data has shown that these anomalies (birth defects) contribute to 8.1% of neonatal deaths. Severe forms of congenital anomalies present during neonatal period and need early surgical correction; otherwise leading to death of the affected newborn.…”

Section: Discussionmentioning

confidence: 99%

Audit of Paediatric Surgical Services in a Tertiary Care Hospital in Maharashtra, India

Bhosale¹,

Pune²

2019

jmscr

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Objective: Aim of this study is to assess the paediatric surgical caseload, spectrum of paediatric surgical conditions managed, various paediatric surgical operative procedures performed and outcome of the same in existing set-up. Methods: It is retrospective analysis of the paediatric surgical services provided by a single unit in a tertiary care hospital affiliated to State Government run Medical College in Maharashtra, India. The study period extends from January 2016 to December 2018. Data acquisition was done by compiling and cross -checking the computerized and non-computerized hospital records. Total 2577 children from day one old neonate up to 15 years of age with surgical disorders were included in this study. There were 1518 male children and 1059 female children. Among these, 986 were neonates. Results: Percentage bed occupancy averaged 90%. The most common diagnoses on admission were congenital anomalies (90.25%), surgical infections (6.2%) followed by trauma (3.4%). Forty-six different operative procedures were performed. Paediatric surgical procedures accounted for 2.5% of all operations carried out in the hospital during the study period. Overall mortality was 9.1%. Peri-operative mortality was 2.9%. Conclusions: This study aims to emphasize the spectrum of work done by paediatric surgery unit in the set up of tertiary care hospital affiliated to State Government run Medical College. It also highlights the need of strengthening the paediatric surgical services by establishing full-fledged paediatric surgery department with separate surgical ward and well-equipped surgical intensive care unit. This will ensure prompt and improved patient care and help bring down morbidity and mortality of children requiring surgical intervention.

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“…The risks experienced by Madia-Gond women starts from birth itself, with preterm births and low-birth weight babies during delivery being a prevalent phenomenon. Bhamaragadh’s neonatal mortality is high, accounting for 12.4% of Maharashtra’s total neonatal deaths ( Saunik et al, 2017 ).…”

Section: Resultsmentioning

confidence: 99%

“…The Infant Mortality Rate (IMR) among tribal children surpasses the national average of India by 30% ( Dasra, 2016 ). Bhamaragadh’s neonatal mortality is high, accounting for 12.4% of Maharashtra’s total neonatal deaths ( Saunik et al, 2017 ). Furthermore, a child born into a tribal family has a 19% higher chance of dying in the neonatal period and 45% higher risk of dying in the post-neonatal period compared with children of other social groups ( Narain, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Exploring Maternal and Child Health Among Tribal Communities in India: A Life Course Perspective

Madankar,

Kakade,

Basa

et al. 2024

GJHS

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India experiences high rates of maternal and infant mortality and morbidity, with tribal communities disproportionately affected. Tribal populations frequently live in unfavorable socio-economic conditions and deficient social health indicators, culminating in adverse health consequences. Using a life course perspective, this qualitative study explored risks over the life course that contribute to maternal and child health problems among tribal populations in India. Additionally, the study examined barriers to utilization of healthcare services during the pregnancy and postpartum periods. Data collection occurred between 2017 and 2019 through participant observation, key informant interviews (n = 7) and in-depth interviews (n = 68) and a focus group (n = 7) with tribal women from the Madia-Gond tribe in the Indian state of Maharashtra. Additionally, verbal autopsies were conducted with relatives of three deceased women and five infants from the tribe. Multiple risk factors operating at different socio-ecological levels and developmental stages of life were associated with maternal and child health problems among the tribe. These included adherence to traditional harmful practices, limited access to nutritional diet, women's health neglected due to the double burden of domestic and professional labor, and a lack of accessible and well-equipped medical facilities. Inaccesibility stemmed from factors including extreme poverty, geographical isolation, and suboptimal healthcare infrastructure. There is need for provisions to promote access to care and to promote education and awareness centered on evidence-supported healthcare, particularly targeted towards expectant mothers. The implementation of nutritional support programs may help mitigate high maternal and child mortality and morbidity rates prevalent among tribal populations.

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Analysis of neonatal deaths in Maharashtra: policy implications

Cited by 4 publications

References 5 publications

Distinct mortality patterns at 0–2 days versus the remaining neonatal period: results from population-based assessment in the Indian state of Bihar

Distinct mortality patterns at 0–2 days versus the remaining neonatal period: results from population-based assessment in the Indian state of Bihar

Audit of Paediatric Surgical Services in a Tertiary Care Hospital in Maharashtra, India

Exploring Maternal and Child Health Among Tribal Communities in India: A Life Course Perspective

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