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HEALTH-INDIA: Infant Units Go A Long Way in Saving Babies

Manipadma Jena

BHUBANESWAR, India, Aug 13 2010 (IPS) - Banita’s heart sank when she first saw her prematurely born twin girls. One weighed 500 grammes and the other 700 grammes, both way below the 2.5-kilogramme benchmark for low-birthweight newborns. But their clenched, coin-sized fists seemed to show they were clinging to life. “There is hope,” said the local doctor.

The babies were referred to the Sick Newborn Care Unit (SNCU) of Bhubaneswar Capital Hospital here in India’s eastern state of Orissa.

Nurse Saudamini Tripathy recalls of the 500-gramme infant: “So tiny were her vital organs that none were able to function properly. Her lungs could not maintain oxygen intake, neither did she have the strength to breastfeed.”

Her 14 years of experience told her that this baby’s chances for survival were almost zero, but ironically it was this tinier infant that survived long enough to make it to the newborn care unit. Her twin sister did not.

Twenty-five-year old Banita Behera is not the only Indian woman to lose a newborn baby due to a lack of proper medical care in remote areas. Every year, about one million children die within four weeks of birth in the country.

In fact, such neonatal deaths account for two-thirds of all infant deaths in India, according to the Sample Registration System (SRS) 2008 of the Registrar General of India under the Ministry of Home Affairs.

About two-thirds of newborn deaths occur in five Indian states – Madhya Pradesh, Uttar Pradesh, Rajasthan, Andhra Pradesh and Orissa. Most are populous, underdeveloped and home to indigenous communities living in inaccessible areas.

“Low birthweight combined with acute respiratory distress due to infection or excess water in lungs (which Banita’s surviving baby had) causes over 70 percent neonatal deaths in Orissa,” says government paediatrics specialist Chhayakanta Gouda of the district hospital in Koraput, home to many of Orissa’s ethnic communities.

Other causes of death are birth asphyxia or suffocation due to prolonged labour, septicemia and jaundice, he adds.

There are some 200 SNCUs in the five states where most newborn deaths occur, reflecting concern about India’s slow progress in reducing these. From 2004 to 2008, the number of neonatal deaths inched down just one notch from 37 to 36 per 1,000 live births.

SNCUs like the one here in Bhubaneswar are equipped with oxygen concentrators, radiant warmers, impulsion pumps, apnea monitors. The temperature in cribs, which are scrupulously disinfected, is kept at 36 degrees Celsius. There is one nurse for every three patients. Each SNCU has a step-down nursery where the mothers are taught how to breastfeed low-weight, fragile newborns.

Poorer mothers like Banita have virtually free access to SNCUs at 10 rupees (25 U.S. cents) instead of the 2,000 rupees (40 dollars) that others pay at subsidised government facilities.

Scaling up SNCUs is the latest of the Indian government’s efforts to reduce infant mortality – the number of infants dying before reaching one year of age for every 1,000 live births – to meet both its own targets and the Millennium Development Goal to reduce this figure by two-thirds between 1990 to 2015.

Infant mortality in India now stands at 53 per 1,000 live births, and the government aims to bring this down to 28/1000 by 2012. The U.N. Human Development Reports 2009 ranks India 134th for infant mortality among 182 countries, compared to the global average of 46.

Orissa’s infant death rate of 69 per 1,000 live births and neonatal death rate of 47 is the second highest in India after Madhya Pradesh. While the state’s infant mortality rates have declined 28 points from 97 in 2001, its neonatal mortality rate still ranges between 53 and 47.

In response, Orissa is scaling up its provision of infant intensive care units. It plans to have 58 of the basic units and 30 of the more specialised ones over the next three years.

But high costs are also slowing this scale-up effort, officials say. SNCU units with eight to 16 beds cost 50 to 90 lakh rupees (10,000 to 20,000 dollars).

Still, these units have been showing good results. From March to September 2009, 90 percent of 448 critical newborns admitted in the Bhubaneswar SNCU survived. In Orissa’s tribal-dominated Mayurbhanj, such units saved 85 percent of 3,500 newborns admitted from 2007 to 2009, according to the state government data.

SNCUs are at the heart of a larger infant survival strategy called the Integrated Management of Neonatal and Childhood Illnesses. In this community, home and facility-based programme, grassroots workers are trained in resuscitation, hypothermia management, infection prevention. They also encourage early breastfeeding.

Both programmes are part of the federal government’s National Rural Health Mission, which aims to provide accessible, affordable and effective primary healthcare facilities to the poor and vulnerable in 18 states.

“Every child who does not cry or feed from its mother right after birth, has less than 2,500 grammes birthweight needs special medical care. That is the only way to ensure infant survival,” says Nirmala Dei, head of the paediatrics department at the Bhubaneswar Capital Hospital.

“My child would never have lived without the didis’ (‘elder sisters’, as nurses are addressed) care,” says Banita with tears of gratitude. As of end-July, her surviving daughter had gained 50 percent of her birth weight at 870 grammes and was wailing when she wanted milk from her mother’s breasts.

Banita and the nurses are busy discussing a suitable name for the baby. So far, the name ‘Champion’ has the most votes.