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A situational analysis of essential newborn care in maternity homes of Ahmedabad Municipal Corporation area.

INTRODUCTION

Newborn care and resuscitation are an important starting point for any neonatal program that is required to ensure the best possible start in life. The 1st week of life is most crucial for the survival of an infant. Childhood and infant mortality rates have been decreasing in India in the last decade, and the rate of neonatal mortality is still high. The 1st day and week of life are the most crucial for the survival of a child. The majority (75%) occur in the 1st week, particularly on the 1st day (25-50%). [1-3] The risk of deaths in the neonatal period in developing countries is over 7 times greater than in developed countries. The risk of deaths in the neonatal period in developing countries is over 7 times greater than in developed countries. Out of these 4, die in the 1st week of life, 1 of 3 dying in 1st week, and dies in the 1st day of life. About two-third infant deaths each year occur within the first 4 weeks of life, and around two-third of those occur within the 1st week. The most frequent immediate causes of newborn death include infection and birth asphyxia which causes more than half of all neonatal deaths. Complications due to premature birth and congenital anomalies are also among the top five leading causes of death among neonates. The Ministry of Health and Family Welfare of India has come up with many strategies to reduce the neonatal mortality rates in India, one of which is essential newborn care services (ENBC), which is for basic newborn care and resuscitation. The services are provided free of cost at all government health-care facilities. The health-care provider is well trained to learn all the required care at birth, identify and manage common complications, and stabilize (if necessary) and refer/ transfer newborns needing higher additional interventions.

The basic components of maintenance of ENBC are temperature maintenance, establishment of open airway and circulation, identification of newborn, Vitamin K injection, and initiation of breastfeeding. This study was done to evaluate ENBC in the maternity homes of Ahmedabad Municipal Corporation (AMC) and to find the gap in delivering the services in health-care delivery system.

Objectives

The objectives of this study are as follows:

1. To evaluate the provision of ENBC services in all maternity homes under the aegis of AMC.

2. To assess the availability of adequate human resources, infrastructure, and equipment.

MATERIALS AND METHODS

Study Design

This was a cross-sectional study.

Study Area

The study was conducted at all maternity homes in AMC.

Sampling Technique

Purposive sampling

Observation of health-care facility infrastructure under which assessment of availability of essential drugs, infrastructure and ENC equipment, Observation of type of care, eye care and umbilical cord care at birth, Infrastructure etc was done.

Ethical consideration

Written permission from the Institutional Review Board, NHLMMC, was taken. Permission of Medical Officer of Health, AMC, Dean, was also taken.

Verbal permission from medical officer of respective maternity homes was done.

RESULTS

In this study, a total number of rooms ranged from 3 to 20 and total number of beds ranged from 8 to 36. In this study, only two maternity homes had cesarean section facilities. Sabarmati maternity home had 0.75% and Khokhara had 25 % cesarean, until birth percentage was from 0 to 5 in different maternity homes [Table 1].

In our study, all the maternity homes had 100% availability of the medical officers and 50% of the maternity homes had no staff nurse vacancy. All the maternity homes had required class III and class IV workers [Table 2].

In our study, all the maternity homes had 24 x 7 electricity supply washbasin with soap and water, and newborn care corner (NBCC), all the maternity homes were providing the had separate labor room and necessary laboratory services, phone call service, 1maternity hospital did not have phone services. In our study, all the maternity homes had birth register, all the maternity [Table 3].

In this study, resuscitator was present in 75% of the maternity homes, 100% maternity homes were equipped with radiant warmers, 91.67% of maternity homes had pump suction, weight scale was present in 100% maternity homes, cotton swabs, bag mask, gloves, mucus extractor, and needle syringe were present in all maternity homes, blankets were present in 66.67%, feeding tubes were present in 75%, and blood collection vials were present in 91.67% maternity homes [Table 4].

The minimum score was 5 and maximum was 9. Mean score of service satisfaction is 7.02 [+ or -] 0.94. Most of the service provider gave score between 6 and 8 [Figure 1].

DISCUSSION

All maternity homes are providing sufficient ENBC, with a few problem areas like only two maternity homes are providing cesarean section delivery, less staff nurse. Essential infrastructure and service facilities are provided in all maternity homes except a few minor things. NBCC is present in all the maternity homes.

In this study, only two maternity homes had cesarean section facilities. Sabarmati maternity home had 0.75% and Khokhara had 25% cesarean, District Level Household And Facility Survey -III (2007-2008) Gujarat showed that 74.1% Community Health Centers designated as first referral units (FRUs), and among them, 17.8% FRUs offer cesarean section and 86% FRUs have newborn care services on 24 h basis. [4] In our study, all the maternity homes had 100% availability of the medical officers and 50% of the maternity homes had no staff nurse vacancy. In a study by Shah et al., similar findings were observed that post of medical officer was filled in 80% PHCs, in Gujarat. [5] In a study done by Zaman and Laskar in Assam and Karnataka, the presence of nurse was found in 80% of PHCs in Assam and 50% of PHCs in Karnataka, but only 30% had class IV workers. [6] In our study, all the maternity homes had 24 x 7 electricity supply and water while report on evaluation study of NRHM in seven states (2011). 79.1% PHCs had availability of electricity [7] and 24 x 7 water supply, while a study done by Kumar and Dansereau found out that only 64% health facilities had 24% running water supply, [8] washbasin with soap and water, and NBCC. Only one maternity hospital did not have functional phone services. In a study done by Sodani and Sharma in Bharatpur districts of Rajasthan [9] and report on evaluation study of NRHM in seven states (2011), phone call service was found to be present only in 55%. [7] In our study, all the maternity homes had birth register, and Biswas et al. carried out a study in West Bengal for the status of maternal and newborn care at FRU and found that records/registers were available but incomplete. [9] It was observed that all the maternity homes had separate labor room available and necessary laboratory services available. Sodani and Sharma reported that 75% of the 24 x 7 PHCs have laboratory at the Bharatpur districts of Rajasthan, [10] and Kumar and Dansereau showed that 69% of facilities had a separate labor room to provide delivery services to women. In this study, resuscitator was present in 75% of the maternity homes, while a study done in Sodani and Sharma observed that labor room was available at almost all the 24 x 7 PHCs, while none of the 24 x 7 PHCs have fully equipped newborn corner. [10] In this study, 100% maternity homes were equipped with radiant warmers, 91.67 % of maternity homes had pump suction, weight scale was present in 100% maternity homes, 83.33% maternity homes had thermometer, and 91.67% had Hub Cutter. Sodani and Sharma, in their study, found radiant warmers at 15.8% of the 24 x 7 PHCs, newborn resuscitators at 26.3% of the 24 x 7 PHCs, suction pump at 52.6% of the 24 x 7 PHCs, weighing scale at 57.9% of the 24 x 7 PHCs, thermometers at 76.3% of the 24 x 7 PHCs, and Hub Cutter at 84.2% of the 24 x 7 PHCs [10] In this study, cotton swabs, bag mask, gloves, mucus extractor, and needle syringe were present in all the maternity homes in our study, blankets were present in 66.67%, feeding tubes were present in 75%, and blood collection vials were present in 91.67% maternity homes. All maternity homes are providing sufficient ENBC, with a few problem areas like only 2 maternity homes are providing cesarean section delivery, less staff nurse. Essential infrastructure and service facilities are provided in all maternity homes except a few minor things. NBCC is present in all the maternity homes.

The strength of this study is that all the maternity homes working under the aegis of AMC area were covered, and the limitation of this study is that the private maternity homes are not covered under the study which are higher in number than the municipal corporation maternity homes.

CONCLUSION

All maternity homes are providing sufficient ENBC, with a few problem areas, such as only two maternity homes are providing cesarean section delivery, so service in maternity that can improve if all the maternity homes provide assisted deliveries and cesarean section services. There is less staff nurse, so all the vacancy for nurses should be filled. All maternity homes should have all the NBCC equipment which should be present at all the times. All the general equipment such as air conditioner, refrigerator, voltage stabilizer, spot lamp, computer, and printer should be available at all the times.

REFERENCES

[1.] Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S. 3.6 million neonatal deaths-what is progressing and what is not? Semin Perinatol 2010;34:371-86.

[2.] Oestergaard MZ, Inoue M, Yoshida S, Mahanani WR, Gore FM, Cousens S, et al. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: A systematic analysis of progress, projections, and priorities. PLoS Med 2011;8:e1001080.

[3.] Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005;365:891-900.

[4.] District Level Household and Facility Survey, Gujarat (200708). Available from: http://www.rchiips.org/pdf/INDIA_REPORT_DLHS-3. [Last accessed on 2018 Jul 12].

[5.] Shah R, Bhavsar B, Nayak S, Goswami M. Availability of services and facilities at primary health centres in Ahmedabad District, Gujarat. Natl J Community Med 2010;1:24-6.

[6.] Zaman FA, Laskar NB. An application of Indian public health standard for evaluation of primary health centers of an EAG and a Non-EAG state. Indian J Public Health 2010;54:36-9.

[7.] Evaluation Study of National Rural Health Mission (NRHM) in 7 States. Programme Evaluation Organization. New Delhi: Planning Commission GOI; 2011. p. 1-153.

[8.] Kumar S, Dansereau E. Supply-side barriers to maternity care in India: A facility-based analysis. PLoS One 2014;9:e103927.

[9.] Biswas AB, Nandy S, Sinha RN, Das DK, Roy RN, Datta S. Status of maternal and new born care at first referral units in the state of West Bengal. Indian J Public Health 2004;48:21-6.

[10.] Sodani PR, Sharma K. Assessing Indian public health standards for 24x7 primary health centers: A case study with special reference to new born care services. J Natl Accredit Board Hosp Healthcare Prov 2014;1:12-6.

Niyati Harshadkumar Zaveri (1), Bala D V (2)

(1) Department of Community Medicine, Zydus Medical College, Dahod, Gujarat, India, (2) Department of Community Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India

Correspondence to: Niyati Harshadkumar Zaveri, E-mail: niyati0903@gmail.com

Received: September 04, 2018; Accepted: September 29, 2018

DOI: 10.5455/ijmsph.2019.0927929092018
Table 1: Distribution of maternity homes according to infrastructure
and deliveries

Name             Total   Total       Normal        Assisted
                 rooms   beds    deliveries (%)   deliveries%

Danilimda         11      12          100              0
Khokhara           5      36         60.10             0
Behrampura         6       8         99.33             0
Vatva              3      12          100              0
Sabarmati          3      15          100             1.4
Sarkhej           20      20          100              0
Shahpur new        3      15          100              0
Shahpur Chakla     3       8          100              0
Gomatipur          5      12          100              0
Naroda             5       5          100              0
Chandkheda         9      12           80              0
Bardolpura         6       8          100              1

Name             Cesarean   Still birth %
                 section

Danilimda           0             0
Khokhara            0           4.98
Behrampura          0           1.33
Vatva               0           0.33
Sabarmati           0           1.44
Sarkhej             0           4.69
Shahpur new         0           2.20
Shahpur Chakla      0             0
Gomatipur           0             0
Naroda             4.8          0.44
Chandkheda          0           1.25
Bardolpura          25            0

Table 2: Distribution of maternity homes
according to availability of staff nurse

Maternity        Staff nurse   Staff nurse
home               number        vacancy

Danilimda             5             1
Khokhara              8             0
Behrampura            4             2
Vatva                 8             1
Sabarmati             6             0
Sarkhej               8             0
Shahpur new           4             1
Shahpur Chakla        4             2
Gomatipur             5             2
Naroda                5             0
Chandkheda            7             0
Bardolpura            5             0

Table 3: Distribution according to availabilities
of utilities and various services

Utilities                             Frequency (%)

Electricity 24x7                        12 (100)
Washbasin with soap and water 24x7      12 (100)
NBCC                                    12 (100)
Clean water supply 24x7                 12 (100)
Labor room                              12 (100
Laboratory services                     12 (100)
Immunization                            12 (100)
Vitamin K prophylaxis                   12 (100)
Birth register                          12 (100)
Functional phone call service           11 (91.7)
AC                                       7 (58.33)
Generator                                3 (25)
Refrigerator                             6 (50)
Voltage stabilizer                       2 (16.67)
Room heater                              2 (16.67)
Computer and printer                     8 (66.67)
Spot lamp                                9 (75)

AC: Air conditioner, NBCC: Newborn care corner

Table 4: Distribution according to NBCC
equipment availability

NBCC equipment          Frequency (%)
availability

Radiant warmer            12 (100)
Resuscitator               9 (75)
Weight scale              12 (100)
Pump suction              11 (91.67)
Thermometer               10 (83.33)
Examination light         10 (83.33)
Syringe cutter            11 (91.67)
Pre-warmed towel           3 (25)
Cotton swabs              12 (100)
Mucus extractor           12 (100)
Bag mask                  12 (100)
Gloves                    12 (100)
Needle syringe            12 (100)
Blankets                   8 (66.67)
Feeding tubes              9 (75)
Blood collection vial     11 (91.67)

NBCC: Newborn care corner

Figure 1: Distribution according to essential newborn
care service satisfaction by the service provider
(out of 10) (n = 67)

Service satisfaction score

0-2     0
2-4     0
4-6    32.8
6-8    59.7
8-10    7.5

Note: Table made from bar graph.
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Article Details
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Title Annotation:Research Article
Author:Zaveri, Niyati Harshadkumar; Bala, D.V.
Publication:International Journal of Medical Science and Public Health
Article Type:Report
Geographic Code:9INDI
Date:Jan 1, 2019
Words:2345
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