The Tribune, Chandigarh, India

HEALTH

BODY & MIND
Effective interventions needed to check
neonatal deaths
Ravi Bhatia

ON an average two out of every three births take place at homes in India attended by untrained personnel. This is one of the major reasons for the neonatal mortality rate (NMR) in the country being as high as 64 per cent. Such casual handling at the time of birth leads to Birth Asphyxia (inability to breathe at birth) and neonatal sepsis (infections at birth), which cause most deaths in this group. Poor healthcare facilities for mother and child, and lack of awareness, and false beliefs and rituals followed largely, are the other major reasons for this high mortality rate. Each year, almost 26 million (2. 62 crores) infants are born in India, amounting to approximately 20% of the world’s births. Out of these, a whopping 1.2 million (12 lakhs) new born die before attaining the age of 4 weeks!

These perturbing facts surfaced recently at the “Symposium on Newborn health in India” organized in the Capital by the National Neonatology Forum of India (NNF). Mr. Prasana Hota, Secretary, Department of Family Welfare, was the chief guest on the occasion, which coincided with the beginning of the New Born Week held every year between 15 and 21 November.

The thrust of the symposium was to deliberate on the achievements, needs and future perspectives in New Born Health, and formulate a comprehensive and common strategy to deal with high neo-natal mortality (NMR). The symposium was attended by senior neonatologists from across the country, and also participants from Ministry of Health and Family Welfare, NIHFW, NIPPCD, ICMR, IGNOU, Indian Academy of Pediatricians (IAP) and Indian Medical Association (IMA). Representatives from international bodies, including WHO, UNICEF, SNL, UNFPA, CARE, World Bank, DFID and USAID, also shared their global perspective and targets at the symposium.

Stressing on the imminent need to implement effective interventions to check neonatal deaths, Dr. J.P. Dadhich, Secy, NNF, says, “Whereas infant mortality rate (IMR) has declined gradually over the past 50 years, NMR still remains static at around 60%. Most of them from easily preventable causes. Although the 10th Five year Plan has laid special emphasis on providing a better health for newborns in the country, we need to now chart out a concrete implementation strategy and define roles of all involved bodies, taking cognizance of the perspective of international agencies.”

Detailed regional profiles of the status of neonatal health in each state was one of the important presentations at the symposium, which embarked upon even the minute details of the broader strategy outline. The symposium called for a greater role of various other professional bodies like the Breastfeeding Promotion of India, Federation of Gynecologic Society of India (FOGSI), Trained Nurses Association of India (TNAI), and many NGOs working in this area.

Many startling facts also emerged out of the discussions. Says Dr. Satish Saluja, Jt. Secy, National Neonatology Forum, and also consultant Neonatologist at Sir Ganga Ram Hospital, “Contrary to the general perception that the healthcare infrastructure in urban areas is better, it is just the opposite in case of neonatal health facilities! Whereas we do have a well-established infrastructure in rural areas for delivery of healthcare, we lack a similar thrust on infrastructure in urban areas.” Elaborating further on the despicable and sorry state of affairs in neonatal care in India, Dr. Dadhich says, “According to the National Family Health Survey II report submitted in 2000 by the Mumbai-based Indian Institute of Population Sciences, the utilization of health services in India is a meager 12%. Putting up infrastructure will not help unless the focus is on improving its implementation by charting out effective interventions in neonatology. This symposium has helped develop a better understanding among the professionals, professional bodies, government and NGOs. Similar symposia shall be rolled out to various parts of the country by all the state branches of National Neonatology Forum, to further augment support from all allied bodies at the grass root levels.”

Among the speakers from international agencies, prominent were Dr. A.K. Patwari (WHO), Dr. Marzio Bibille, UNICEF, and Ms. Anne Tinker from Washington. The national speakers included Dr. B. Kishore, Asst. Commissioner (Child Health), and Dr. S. Sarkar, Deputy Commissioner (Child Health) in Ministry of Health and Family Welfare, Prof. A.K.Agarwal from IGNOU, Dr. Deepika Deka (FOGSI), Dr. H.P.S. Sachdev (IAP), besides various speakers from the NNF state branches.

Corporate vision

Encouraged by last year’s fund raising which benefited 260 children with much needed vision correction surgeries, McDonald’s India this year too celebrated the World Children’s Week (November 14 to November 20) by engaging young Bollywood actress Riya Sen and designer Raghvendra Rathore as honorary crew members at their Janpath outlet. The two not only served the children but also interacted with them, emphasising the need for pediatric eye care. The entire proceeds from sales during this one hour of interaction has been earmarked for helping the economically disadvantaged children in restoring their vision or going in for correction surgery in association with Orbis International, a non profit, humanitarian organisation.

With almost 25 per cent of the world’s blind population being in India, the need for sight saving exercises is all the more urgent and through this initiative “ we hope to make a difference to the lives of at least a fraction of the visually disadvantaged children” says Vikram Bakshi, joint venture partner and managing director of McDonald’s India .

McDonald’s association with eye care started in 2001 when the Ronald McDonald House Charities volunteered to fund the Children’s Building of Dr. Shroff’s Charitable Eye Hospital here and its outreach in Alwar, Rajasthan.

Eco-friendly

Paramount Surgimed Limited (PSL), one of the largest manufacturer and exporter of stainless steel and carbon steel surgical blades, skin graft knives, stitch cutters and disposable scalpers, has attained the distinction of becoming the first Indian company to bag the Eco Friendly Management Systems Certificate for its products.

A host of seminars

With the opening up of the health sector to private entrepreneurs there has been an increasing emphasis on informing the general public about various diseases that could prove fatal to them. Awareness campaigns apart, the specialists are now getting together by forming associations and forums so that they can collectively educate the public which for years has been blissfully unaware of some of the serious diseases and their causes.

The Capital has been a host to such seminars and symposia on regular basis for the simple reason that the nation’s Capital boasts of the largest number of specialists in almost every field of medicine and the concentration of national media which helps in disseminating the information. According to the doctors, the seminars and symposia not only help the participants to exchange views and educate themselves but at the same time educate the public by disseminating the conclusions widely.

Heart mapping

A new technique for investigation and treatment for cardiac rhythm disorders has been launched in Delhi Heart and Lung Institute, Panchkuian Road, for the first time in the country. By means of 11 special ultrasound transducers mounted on specially designed catheters which are positioned in various chambers of the heart, it is possible to get a three dimensional cast of the heart. Known as Real Time Position Management system, the equipment allows measurement of electrical activation times as well as activation (propagation) sequence at hundreds of points in the chamber under investigation, so as to precisely identify the site of origin of abnormal cardiac rhythms.

The abnormal “focus” can then be ablated (destroyed) by local application of radio frequency current, and the patient can be permanently cured.