High Neonatal Mortality Rates in Rural India: What Options to Explore?

The neonatal mortality rate in India is amongst the highest in the world and skewed towards rural areas. Nonavailability of trained manpower along with poor healthcare infrastructure is one of the major hurdles in ensuring quality neonatal care. We reviewed case studies and relevant literature from low and middle income countries and documented alternative strategies that have proved to be favourable in improving neonatal health. The authors reiterate the fact that recruiting and retaining trained manpower in rural areas by all means is essential to improve the quality of neonatal care services. Besides this, other strategies such as training of local rural healthcare providers and traditional midwives, promoting home-based newborn care, and creating community awareness and mobilization also hold enough potential to influence the neonatal health positively and efforts should be made to implement them on a larger scale. More research is demanded for innovations such as “m-health” and public-private partnerships as they have been shown to offer potential in terms of improving the standards of care. The above proposed strategy is likely to reduce morbidity among neonatal survivors as well.

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Kangaroo mother care: Understanding community low birth weight baby care perceptions and practices for designing appropriate community based KMC implementation package: a formative research. (Preprint)

10.2196/preprints.30663 ◽

2021 ◽

Author(s):

Shabina Ariff ◽

Ikram Maznani ◽

Maria Bhura ◽

Zahid Memon ◽

Tayyaba Arshad ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Rural Areas ◽

Healthcare Providers ◽

Newborn Care ◽

Formative Research ◽

Kangaroo Mother Care ◽

Community Members ◽

Hospital Administrators ◽

Skin Contact

BACKGROUND Low birth weight (LBW) is a common outcome of preterm birth and increases the risk of an infant’s morbidity and mortality. About 20 million infants are born with low birth weight globally. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of Kangaroo Mother Care (KMC) (skin-to-skin contact) in communities to prevent neonatal mortality and morbidity. OBJECTIVE We conducted a formative research in order to understand the context of communities and facilities with regards to neonatal care and KMC practice, inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC, in rural areas of district Dadu, in the Sindh province. METHODS We conducted focus group discussions, in-depth interviews and key informant interviews with families of LBW babies, community members, healthcare providers and hospital administrators to identify barriers, enablers and a knowledge base for KMC interventions. RESULTS Newborn care practices in communities were subpar. Although KMC practices are not commonly practiced in communities and facilities and the method is unknown to many, family members were willing to provide KMC to LBW babies to improve their health outcomes. Community members, hospital administrators and healthcare providers widely accepted the practice for neonatal health and found it feasible and convenient. CONCLUSIONS The KMC as a method of treating low birth weight babies is widely accepted in the community. This formative research provided strategically effective ways for developing effective implementation strategies by identifying common community practices for LBW babies, and barriers and enablers to KMC practice.

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Neonatal mortality and leading causes of deaths: a descriptive study in China, 2014–2018

BMJ Open ◽

10.1136/bmjopen-2020-042654 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042654

Author(s):

Yuxi Liu ◽

Leni Kang ◽

Chunhua He ◽

Lei Miao ◽

Xiaoqiong Qiu ◽

...

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Middle Income ◽

Government Interventions ◽

Neonatal Deaths ◽

Live Births ◽

Urban And Rural Areas

ObjectiveThe present study estimated the national and urban–rural levels and causes of neonatal deaths in China annually between 2014 and 2018 to provide data support for the further end of preventable neonatal deaths for China and other low-income and middle-income countries.MethodsThe study was based on data from the National Maternal and Child Health Surveillance System. All neonates of surveillance districts (gestational week: ≥28 weeks) who died after delivery have been involved in the study. The mortality rate and the leading causes of death for neonates were analysed.ResultsThe neonatal mortality rate (NMR) of China has steadily decreased from 5.9 deaths per 1000 live births in 2014 to 3.9 deaths per 1000 live births in 2018. The NMR in 2018 of urban and rural areas was 2.2 deaths per 1000 live births and 4.7 deaths per 1000 live births, respectively. The leading preventable causes of neonatal deaths are the same in the urban and rural areas were same, which were preterm birth, intrapartum complications and pneumonia. Mortality rates of these three causes fell significantly between 2014 and 2018 but contributed to a higher proportion of deaths in rural areas than urban areas. The proportion of preventable deaths accounted for 74.6% in 2018.ConclusionsThe NMR of China has decreased steadily from 2014 to 2018. However, the inequality between urban and rural areas still exists. The goal of government interventions should be to reduce the health inequality of neonates and further take targeted measures to eliminate preventable neonatal death.

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Differentials in neonatal mortality in two adjacent rural areas of Bangladesh: Lessons for neonatal health interventions

Global Public Health ◽

10.1080/17441690701592866 ◽

2008 ◽

Vol 3 (4) ◽

pp. 366-382 ◽

Cited By ~ 5

Author(s):

A.H. Baqui ◽

S.E. Arifeen ◽

G.L. Darmstadt ◽

S. Ahmed ◽

H.R. Seraji ◽

...

Keyword(s):

Neonatal Mortality ◽

Rural Areas ◽

Health Interventions ◽

Neonatal Health

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Community And Individual Factors Associated With Maternal And Neonatal Care Practices In Low Resource Settings. A Case Of Zimbabwe

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2020.2.4.353 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

E. Chiwawa ◽

M. Mhlanga ◽

A. Munodawafa ◽

F. Mukora-Mutseyekwa

Keyword(s):

Neonatal Mortality ◽

Health Facility ◽

Breast Feeding ◽

Newborn Care ◽

Neonatal Care ◽

Care Seeking ◽

District Health ◽

Live Births ◽

Factors Associated ◽

Care Practices

Neonatal mortality has been increasing in Zimbabwe from 20/1,000 live births between 2000 and 2004 to 29 /1,000 live births between 2010 and 2014.Suboptimal newborn care practices are the predisposing factors to neonatal mortality. In Manicaland Province, care seeking behaviours for fever which is the main symptom of majority of infections in children and knowledge levels of danger signs that should cause the mother to take a child immediately to a health facility remains unacceptably lower than the national averages. A cross sectional descriptive and analytic design was carried out to explore the factors associated with the practice of the recommended newborn care practices by women of child bearing age in Mutare District. Health facilities were purposively sampled and participants were systematically sampled. Structured interviews were used to collect data which was analysed in Epi-Info version 7.2. Descriptive and multivariate analysis was performed on data collected from 349 participants. Practice of the five assessed recommended newborn care practices was high. Exclusive breast feeding (62%), early initiation of Breast feeding (74%), good code care (73%), care seeking for neonatal illness within 24hrs of onset of fever (82%) and keeping baby warm was at 58%. Statistically significant independent factors associated with the recommended newborn care practices were post-natal stay for more than 72 hours at the clinic (AOR=0.56; 95%CI: 0.12-0.87, p=0.000), and delivery at the health facility (AOR=0.43; 95%CI: 0.21-0.77; p=0.000). Cultural practices that impact negatively on neonatal care in Mutare district include; asking for permission to seek treatment for the child when ill, feeding the baby immediately after delivery and applying substances and mixed traditional herbs on the cord stump of the newborn. Improving newborn care outcomes require approaches addressing demand and supply factors to reach communities with correct information on good newborn care.

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Assessing Quality of Newborn Care at District Facilities in Malawi

10.21203/rs.2.15647/v3 ◽

2020 ◽

Author(s):

Kondwani Kawaza ◽

Mai-Lei Woo Kinshella ◽

Tamanda Hiwa ◽

Jenala Njirammadzi ◽

Mwai Banda ◽

...

Keyword(s):

Quality Of Care ◽

Assessment Tool ◽

Newborn Care ◽

Neonatal Care ◽

District Level ◽

Sub Saharan Africa ◽

Standards Of Care ◽

District Hospitals ◽

Care Assessment

Abstract Background: Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district-level facilities where most deliveries occur is warranted. Objective: The objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool. Methodology: These facility assessments were part of the “Integrating a neonatal healthcare package for Malawi” project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to assess quality of care and availability and quantity of supplies and resources. The modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017 and aspects of care were scored on a Likert scale from one to five (a score of 5 indicating compliance with WHO standards of care; one as lowest indicating inadequate care). Results: The continuum of labour, delivery and neonatal care were assessed to identify areas that required improvements to meet standards of care. Critical areas for improvements included infection control (mean score 2.9), equipment, supplies and setup for newborn care in the labor ward (2.3), in the surgical theater (3.3), and nursery (3.4 nursery facilities, 3.0 supplies and equipment), as well as for management of sick newborns (3.2), monitoring and follow-up (3.6). Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed (4.0). Conclusion: The WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district-level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.

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Telemedicine in neonatal care-Saving lives with technology!

Journal of the Pakistan Medical Association ◽

10.47391/jpma.3942 ◽

2022 ◽

Vol 71 (12) ◽

pp. 2837-2837

Author(s):

Shahamah Ahmed

Keyword(s):

Rural Areas ◽

Access To Health Care ◽

Quality Care ◽

Tertiary Care ◽

Healthcare Providers ◽

Neonatal Care ◽

Health Care Facilities ◽

World Health ◽

Junior Doctors

Madam, neonatal mortality in Pakistan i.e. death of babies within first twenty eight days of life is 49 per 1000 live births. Moreover, Pakistan contributes to 7% of global neonatal deaths. (1) Cause of mortality may be infection, intra-partum complications, prematurity or congenital birth defects but there is one thing common in all; majority of them occur in rural population due to lack of access to health care facilities. (2) With recent advances, role of tele-medicine has proved to be a milestone in field of medicine especially in underdeveloped and rural areas. According to World Health Organization (WHO), Telemedicine is defined as affordable use of Information and Communication Technology (ICT) for provision of health facilities and care. (3) A study done in Karachi in early 2020 by Ashfaq A et al showed average knowledge of telemedicine among clinicians and junior doctors, but we are still hopeful that since after the global pandemic of COVID-19, not just this knowledge has improved but also perceptions regarding telemedicine should have changed (4). In another study done in china by Makkar A. et al, they demonstrated the role of tele-medicine in not just tele-rounds of NICU but also successful e-examinations of Retinopathy of prematurity, tele-echocardiography, tele-NPR guidance to healthcare providers and family support. Moreover, home based care can be efficiently provided to preterm low birth weight babies including establishment of enteral feeding. (5) With a global shortage of physicians worldwide, lack of neonatologists is a major reason of neonatal referrals from rural areas and tele-medicine can give promising results in this regard. It can not only prevent unnecessary ambulation of tiny patients but also improve survival and quality care. Though under umbrella of private NGOs, tele-medicine is being started for satellite centers in few regions of country but obviously it doesn’t cover majority of population. It is high time to realize importance of Tele-medicine in periphery care setups. Though provision of equipment, installments of high quality ICT and infrastructure might seem a barrier in establishment of Tele-medicine but it can bring revolutionary improvement in neonatal care. It cannot just help reducing over burdening to tertiary care hospitals but also in avoiding hazards and cost of patient transfer.

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Telemental Health Use in the COVID-19 Pandemic: A Scoping Review and Evidence Gap Mapping

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.748069 ◽

2021 ◽

Vol 12 ◽

Author(s):

Amit Abraham ◽

Anupama Jithesh ◽

Sathyanarayanan Doraiswamy ◽

Nasser Al-Khawaga ◽

Ravinder Mamtani ◽

...

Keyword(s):

Scoping Review ◽

A Priori ◽

Healthcare Providers ◽

Mental Healthcare ◽

World Health ◽

Standards Of Care ◽

Telemental Health ◽

Middle Income ◽

Home Based ◽

National Quality

Background: The COVID-19 pandemic has highlighted telemedicine use for mental illness (telemental health).Objective: In the scoping review, we describe the scope and domains of telemental health during the COVID-19 pandemic from the published literature and discuss associated challenges.Methods: PubMed, EMBASE, and the World Health Organization's Global COVID-19 Database were searched up to August 23, 2020 with no restrictions on study design, language, or geographical, following an a priori protocol (https://osf.io/4dxms/). Data were synthesized using descriptive statistics from the peer-reviewed literature and the National Quality Forum's (NQF) framework for telemental health. Sentiment analysis was also used to gauge patient and healthcare provider opinion toward telemental health.Results: After screening, we identified 196 articles, predominantly from high-income countries (36.22%). Most articles were classified as commentaries (51.53%) and discussed telemental health from a management standpoint (86.22%). Conditions commonly treated with telemental health were depression, anxiety, and eating disorders. Where data were available, most articles described telemental health in a home-based setting (use of telemental health at home by patients). Overall sentiment was neutral-to-positive for the individual domains of the NQF framework.Conclusions: Our findings suggest that there was a marked growth in the uptake of telemental health during the pandemic and that telemental health is effective, safe, and will remain in use for the foreseeable future. However, more needs to be done to better understand these findings. Greater investment into human and financial resources, and research should be made by governments, global funding agencies, academia, and other stakeholders, especially in low- and middle- income countries. Uniform guidelines for licensing and credentialing, payment and insurance, and standards of care need to be developed to ensure safe and optimal telemental health delivery. Telemental health education should be incorporated into health professions curricula globally. With rapidly advancing technology and increasing acceptance of interactive online platforms amongst patients and healthcare providers, telemental health can provide sustainable mental healthcare across patient populations.Systematic Review Registration:https://osf.io/4dxms/.

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Assessing Quality of Newborn Care at District Facilities in Malawi

10.21203/rs.2.15647/v1 ◽

2019 ◽

Author(s):

Kondwani Kawaza ◽

Mai-Lei Woo Kinshella ◽

Tamanda Hiwa ◽

Jenala Njirammadzi ◽

Mwai Banda ◽

...

Keyword(s):

Quality Of Care ◽

Assessment Tool ◽

Newborn Care ◽

Neonatal Care ◽

District Level ◽

Sub Saharan Africa ◽

Standards Of Care ◽

District Hospitals ◽

Care Assessment

Abstract Background: Malawi is celebrated as one of the few countries in sub-Saharan Africa to meet the Millennium Development Goal of reducing under-5 mortality by two-thirds between 1990 and 2015. However, within this age range neonatal mortality rates are the slowest to decline, even though rates of facility births are increasing. Examining the quality of neonatal care at district level facilities where most deliveries occur is warranted. Objective: The objective of this paper is to evaluate the quality of neonatal care in three district hospitals and one primary health centre in southern Malawi as well as to report the limitations and lessons learned on using the WHO integrated quality of care assessment tool. Methodology: These facility assessments were part of the “Integrating a neonatal healthcare package for Malawi” project, a part of the Innovating for Maternal and Child Health in Africa (IMCHA) initiative. The WHO integrated quality of care assessment tool was used to comprehensively assess quality of care in addition to availability and quantity of supplies and resources. Because this study focused on neonatal care, the modules on infrastructure, neonatal care and labour and delivery were included. Facility assessments were administered in November 2017. Results: The continuum of labour, delivery and neonatal care were all assessed and areas that required improvements to meet standards of care were identified. Critical areas for improvements included the facilities for delivery, including operations and newborn care; for equipment and supplies; for neonatal case management, including sick newborns and routine monitoring and follow-up. Only one of the 12 domains, laboratory, met the standards of care with only minor improvements needed. Conclusion: The WHO integrated quality of care assessment tool is a validated tool that can shed light on the complex quality of care challenges faced by district level health facilities. The results reveal that the quality of care needs improvement, particularly for sick and vulnerable newborns.

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Effect of basic public health service project on neonatal health services and neonatal mortality in China: a longitudinal time-series study

BMJ Open ◽

10.1136/bmjopen-2019-034427 ◽

2020 ◽

Vol 10 (7) ◽

pp. e034427

Author(s):

Pengyu Zhao ◽

Xueyan Han ◽

Lili You ◽

Yu Zhao ◽

Li Yang ◽

...

Keyword(s):

Public Health ◽

Health Services ◽

Neonatal Mortality ◽

Rural Areas ◽

Public Health Service ◽

Health Management ◽

Neonatal Health ◽

Visit Rate ◽

Before And After ◽

Urban And Rural Areas

ObjectiveTo analyse the trend change and level change of neonatal health services and neonatal mortality before and after the introduction of the Basic Public Health Service (BPHS) project in 2009.Design and settingA national longitudinal study on neonatal mortality from 1991 to 2017 and neonatal health services from 2000 to 2017 was conducted based on data extracted from the National Neonatal Mortality Surveillance System and National Health Statistic Yearbook. The segmented linear regression model was used to assess the level changes and trend changes of the outcome variables before and after the introduction of BPHS project. Pearson correlation analysis as conducted to measure association between neonatal mortality rates (NMRs) and maternal health management rates (MMRs), neonatal visit rates, respectively.Primary and secondary outcome measuresThe outcome variables were national NMR, the gap of NMR between urban and rural areas, maternal health management rate and neonatal visit rate.ResultsThe annual trend change coefficient of national NMR and the gap of NMR between urban and rural areas were −0.57 (p<0.01) and −0.49 (p<0.01) after the introduction of BPHS project, while the annual trend coefficient of the MMR and the neonatal visit rate were 1.21 (p<0.01) and 0.85 (p<0.01), respectively. The negative correlations were found between NMR and MMR (r=−0.79, p<0.01) and neonatal visit rate (r=−0.76, p<0.01).ConclusionThe BPHS project was found to be associated with increased volume of neonatal health services and reduced NMR. The design and implementation of this project may provide references to other low-income and middle-income countries.

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