Neonatal Mortality rate is highest in AP, TS

One of the major challenges in the health sector has been high neonatal mortality. Only five countries account for more than half of the world’s 3.3 million newborn deaths viz., India, Nigeria, Pakistan and China and Democratic Republic of Congo. India carries the highest share of neonatal deaths in the world and contributes around a quarter of neonatal deaths. Of the 26 million babies born in India, every year one million babies die before the age of one month.

According to Sample Registration Survey,2009, Neonatal Mortality Rate (NMR) is 34/1000 live births contributes to about two-thirds of all infant deaths (Infant Mortality Rate -50/1000 live births) and about half of all under-five deaths in the country(Under Five Mortality Rate-64/1000). 56 percent of all newborn deaths in India occurs in Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan, Andhra Pradesh and Telangana.

In Telangana and Andhra Pradesh, roughly 25 and 29 infants die for every 1,000 live births respectively. The two Telugu-speaking States have the highest Neonatal Mortality Rate (NMR) in South India. In Kerala, the NMR is below 10, in Tamil Nadu, it’s between 10 and 15 and in Karnataka the number of deaths is 15 to 20 infants for 1,000 live births.

In, Andhra Pradesh, NMR rate is 29/1000 live births. Around 50,000 babies die in this State every year. The major challenge for the State of Andhra Pradesh has been a stagnating infant Mortality Rate at 53/1000 live births as per National Health Survey (NHFS-3). 70 percent of which is contributed by NMR. Most of the newborn deaths occur in the first one week of life. There is a huge urban to a rural difference in the death rates. The NMR in rural areas is almost two times that of urban areas.

In Telangana, the present NMR rate of 25 –defined as the death of newborns between births to 28 days of age per 1000 live births in a given year –happens to be highest in South India, according to government data. The national NMR rate now stands at 28.
With an aim to bring down Telangana NMR rate down to a single digit, the State unveiled Telangana Newborn Action Plan(TNAP).

Under TNAR, the central government has already sanctioned Rs.761 lakh to the State for child health in 2015-16 to government hospitals to strengthen existing newborn care facilities and set up new ones.

The State target is to bring down NMR rate to less than 10 by 2030. This target is going to be achieved by setting up three Special New Born Care Units (SNCUs) in each district and the State is the first in South India to implement an online monitoring system for all SNCUs. This has resulted in showing improvement on the NMR front as against during undivided Andhra Pradesh. Earlier the NMR rate is 27 but it has come down to 25 now. Despite two-point down last year, the State witnessed around 12000 neonatal deaths.

The common responsible for newborn deaths attributed are sepsis(50%), prematurity, low birth weight(35%) and birth asphyxia (23%). Low birth weight directly or indirectly contributes 60-80% of the neonatal deaths. All these causes influenced by perinatal care. Maternal health in general and perinatal care, in particular, is important determinants of neonatal survival, according to health specialists. Neonatal outcomes are affected by health throughout the girls’ child’s lifecycle, starting from infancy through adolescence and pregnancy.

Besides this, the health of pregnant women is an integral part of human survival as life starts from the mother’s womb and it is the intrauterine environment that shapes up the health of new off-spring. Telangana also launched death e-registry, to enable the government to know the neonatal deaths. These causes depend on health care facilities that are being given to the mother and the infant before and immediately after birth.

How does TS and AP, with a common capital that could boast of being the health capital of India with best private and government infrastructure, have such a large number of infant deaths? Public health experts here agree that the reason for neonatal deaths has to be addressed at multiple levels.

Back in 2007, the NMR in unified AP was 33/1000 live births, this has come down to 29/1000 live births and in Telangana it has come down to 25/1000 from 27/1000 live births by providing world-class care to women right from conceiving stage to delivery and post-delivery, but when compared to the Southern States of India, there are a lot of measures are needed in both states to bring down NMR rate to Zero.

In the last few years, with the funds of National Health Mission (NHM), the State government had set-up exclusive healthcare centres in Primary Health Centres (PHC), District or Area Hospitals and Tertiary or teaching hospitals in Telangana. There are New Borne Care Corners (NBCC), New Borne Stabilization Units (NBSU) and Specialty New-borne Care Units (SNCU) respectively.

Despite that, the NMR is high in both Telugu States, though there are close to 44 SNCU units in TS and AP for infants. However, the problem is that 90 percent of these units are understaffed. There are simply no takers for the policy to recruit paediatricians with MD on the contract basis with a monthly salary of Rs. 60,000.

“There is also a need for behavioural change. In Tamil Nadu, doctors in SNCU draw lesser salary than in TS, but they still turn up for duty. Here, however, speciality doctors hesitate to work in PHCs or district hospitals. Moreover, a paediatric MD can earn more in a private hospital in Hyderabad,” health specialists noted.

Another major factor is the procurement of disposables. NHM provides an unlimited budget to procure disposables like IV fluids, hand wash bottles, diapers and antibiotics. However, red tape in the procurement of disposables meant to check infection is huge. For instance, it takes, at least, two to three months for a hospital to receive fresh stock of IV fluids or alcohol-based hand wash bottles.

G.Rajendera Kumar