Reducing Neonatal Mortality in Jhagadia Block, Gujarat: We Need to go Beyond Promoting Hospital Deliveries

Vr, Kutty; Shah, Pankaj; Modi, Dhiren; Shah, Shobha; Ramanathan, Mala; Archana, A M

doi:10.1093/tropej/fms043

Cited by 5 publications

(7 citation statements)

References 9 publications

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“…After collecting baseline information for 2 years from 1 April 2002 to 30 March 2004, SEWA Rural implemented a family‐centred safe‐motherhood and new‐born survival project for 7 years from 1 April 2004 to 31 March 2011 which catered to the entire Jhagadia block consisting of 168 villages with a population of 175 000, which is mainly tribal, rural and poor (SEWA Rural ; Kutty et al . ).…”

Section: Methodsmentioning

confidence: 97%

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Changing epidemiology of maternal mortality in rural India: time to reset strategies for MDG‐5

Shah

Kutty

et al. 2014

Tropical Med Int Health

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Abstractobjective To understand changes in epidemiology of maternal mortality in rural India in the context of increasing institutional deliveries and implementation of community-based interventions that can inform policies to reach MDG-5.methods This study is a secondary analysis of prospectively collected community-based data of every pregnancy and its outcomes from 2002 to 2011 in a rural, tribal area of Gujarat, India as part of safe-motherhood programme implemented by voluntary organisation, SEWA Rural. The programme consisted of community-based interventions supported by a first referral unit, and promotion of institutional deliveries. For every maternal death, a verbal autopsy was conducted. The incidence rates for maternal mortality according to place, cause and timing of maternal deaths in relation to pregnancy were computed. Annual incidence rate ratios (IRR) and 95% confidence intervals, adjusted for caste and maternal education, were estimated using Poisson regression to test for linear trend in reduction in mortality during the study period. There were significant reductions in adjusted incidence rate of maternal deaths due to direct causes, during intrapartum and post-partum periods, and those which occurred at home. However, reductions in incidence of maternal deaths due to indirect causes, at hospital and during antepartum period were not statistically significant. Most maternal deaths are now occurring at hospitals and due to indirect causes.conclusion Gains in institutional deliveries and community-based interventions resulting in fewer maternal deaths due to direct causes should be maintained. However, it would be essential to now prioritise management of indirect causes of maternal mortality during pregnancy at community and hospitals for further reduction in maternal deaths to achieve MDG-5.keywords skilled birth attendance, maternal mortality ratio, epidemiology, institutional delivery, Millennium Development Goal-5

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Section: Methodsmentioning

confidence: 97%

“…This study is based on prospectively collected communitybased data by field-based front-line workers ( Kutty et al 2013).…”

Section: Study Settingmentioning

confidence: 99%

Changing epidemiology of maternal mortality in rural India: time to reset strategies for MDG‐5

Shah

Kutty

et al. 2014

Tropical Med Int Health

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“…In a cohort of births examined in Gujarat, it was concluded that for sustaining the momentum of reduced neonatal mortality there is a need of long-term policy intervention to promote better living standards and better reproductive health. 57 Racial and Ethnic Approaches to Community Health (REACH) is an initiative promoted by the Centers for Disease Control and Prevention's (CDC), which strives to eliminate racial and ethnic disparities in health. It is a communitybased, participatory approach to identify, develop and disseminate effective strategies for addressing health disparities across a wide range of health priority areas such as cardiovascular disease, diabetes, breast and cervical cancer, infant mortality, asthma, immunization, and obesity.…”

Section: Administrative Reforms Approachmentioning

confidence: 99%

Implementation of public health practices in tribal populations of India: challenges and remedies

Shrivastava

Ramasamy

2013

Healthc Low Resour Settings

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Large inequities in health exist between indigenous and non-indigenous populations worldwide. This health divide has also been demonstrated in India, where indigenous groups are officially classified as scheduled tribes (STs). India has one of the largest tribal populations in the world. Tribal communities in general and primitive tribal groups in particular are highly disease prone and their misery is compounded by poverty, illiteracy, ignorance of causes of diseases, hostile environment, poor sanitation, lack of safe drinking water, blind beliefs, etc. As per the estimates of National Family Health Survey-3 (NFHS-3), the likelihood of having received care from a doctor is lowest for ST mothers (only 32.8% compared to India of 50.2%). While many strategies have been attempted over the years to discuss some of the economic, social, and physical factors preventing tribal population to get access to healthcare services, the ultimate outcome has remained far less than the expectations. Considering that these ST groups are culturally and economically heterogeneous, the methods to tackle their health problems should not only be integrated and multi-fold, but also specific to the individual groups as feasibly as possible. Measures like strengthening of the existing human resources, bringing health services within the reach of remote populations, promotion of health awareness, facilitation of community participation using innovative strategies, bringing about a change in the behavior of health care providers, implementation of measures for the empowerment of ethnic groups by carrying out administrative reforms and finally by ensuring the sustainability of all above recommended measures.

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“…Globally it has been estimated that there were 5.2 million under-5 years childhood deaths in 2019 1 of which 20% occurred in India. 2 In India in 2004, the mortality rates/1000 live births were U5MR (number of deaths…”

Section: Introductionmentioning

confidence: 99%

Effect of home-based childcare on childhood mortality in rural Maharashtra, India: a cluster randomised controlled trial

Satav

Bharadwaj

et al. 2022

BMJ Glob Health

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BackgroundMelghat, an impoverished rural area in Maharashtra state, India; has scarce hospital services and low health-seeking behaviour. At baseline (2004) the under-five mortality rate (U5MR) (number of deaths in children aged 0–5 years/1000 live births) was 147.21 and infant mortality rate (IMR) (number of deaths of infants aged under 1 year/1000 live births) was 106.6 per 1000 live births. We aimed at reducing mortality rates through home-based child care (HBCC) using village health workers (VHWs).MethodsA cluster-randomised control trial was conducted in 34 randomly assigned clusters/villages of Melghat, Maharashtra state, between 2004 and 2009. Participants included all under-five children and their parents. Interventions delivered through VHWs were patient–public involvement, newborn care, disease management and behaviour change communications. Primary outcome indicators were U5MR and IMR. Secondary outcome indicators were neonatal mortality rate (NMR) (number of neonatal deaths aged 0–28 days/1000 live births) and perinatal mortality rate (PMR) (number of stillbirths and early neonatal deaths/1000 total births). Analysis was by intention-to-treat at the individual level. This trial was extended to a service phase (2010–2015) in both arms and a government replication phase (2016–2019) only for the intervention clusters/areas (IA).FindingsThere were 18 control areas/clusters (CA) allocated and analysed with 4426 individuals, and 16 of 18 allocated IA, analysed with 3230 individuals. The IMR and U5MR in IA were reduced from 106.60 and 147.21 to 32.75 and 50.38 (reduction by 69.28% and 65.78%, respectively) compared with increases in CA from 67.67 and 105.3 to 86.83 and 122.8, respectively, from baseline to end of intervention. NMR and PMR in IA showed reductions from 50.76 to 22.67 (by 55.34%) and from 75.06 to 24.94 (by 66.77%) respectively. These gains extended to villages in the service and replication phases.InterpretationThis socio-culturally contextualised model for HBCC through VHWs backed up with institutional support is effective for significant reduction of U5MR, IMR and NMR in impoverished rural areas. This reduction was maintained in the study area during the service phase, indicating feasibility of implementation in large-scale public health programmes. Replicability of the model was demonstrated by a linear decline in all the mortality rates in 20 new villages during the government phase.Trial registration numberNCT02473796.

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Reducing Neonatal Mortality in Jhagadia Block, Gujarat: We Need to go Beyond Promoting Hospital Deliveries

Abstract: Although community based interventions along with promotion of hospital birth has an impact in reducing neonatal deaths in this community, sustaining this momentum may demand more long-term policy interventions to promote better living standards and better reproductive health.

Cited by 5 publications

References 9 publications

Changing epidemiology of maternal mortality in rural India: time to reset strategies for MDG‐5

Changing epidemiology of maternal mortality in rural India: time to reset strategies for MDG‐5

Implementation of public health practices in tribal populations of India: challenges and remedies

Effect of home-based childcare on childhood mortality in rural Maharashtra, India: a cluster randomised controlled trial

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