BASIC NEW BORN CARE & RESUSCITATION PROGRAM AN OVERVIEW “AADIGURU” Early Intervention Centre Wright Town - Jabalpur

Worldwide distribution of child deaths Each dot represents 5000 deaths Lancet 2003 India is epicenter of Childhood Mortality

 9.7 million < 5 yrs deaths annually world over India 2.1 million (21%) 1 million newborns die annually in India

Neonatal deaths and the Millennium Development Goal 4 Millennium Development Goal 4 can only be achieved if neonatal deaths are addressed - missing from current programmes Global mortality per 1000 births Year Under-5 mortality rate Late neonatal mortality Early neonatal mortality Target for MDG-4

RankState Neonatal mortality rate (per 1,000 live births) 1Chattishgarh51.1 2Jharkhand48.6 3Uttar Pradesh47.6 4Assam45.5 5Orissa45.4 6Madhya Pradesh44.9 7Rajasthan43.9 8Andhra Pradesh40.3 9Bihar West Bengal37.6

The first days of life are the riskiest Up to 50% of all NB deaths are on the first day of life (500,000 babies in India dying on their birth day) 75% of NB deaths are in the first week

Leading causes of NB death  Severe Infections (36%)  Pre-Term Births (25%)  Birth asphyxia (23%).  Other Neonatal Causes (6%)  Neonatal Tetanus (4%) Source: WHO World Health Statistics 2007 (India)

What can be done to save these newborn lives now?

 Neonatal Resuscitation:6-42%  Breastfeeding :55-87%  Prevention and management of hypothermia :18-42%  Kangaroo Mother Care (LBW):incidence of infection:51% (7-75%) Post Neonatal interventions - efficacy for reducing all cause of neonatal mortality

Birth Asphyxia  Major cause of “Mortality” and “Stillbirth”  Major cause of short and long term morbidity  Substantially treatable Estimated Deaths due to Birth Asphyxia in India is 3 lacs per year

1 million children who survive birth asphyxia each year go onto suffer cerebral palsy and other disabilities

 Birth Asphyxia – Decreased 60%  Mortality in delivery room - Decreased by 40% Courtesy: Keenan W J for providing the slide

 In rural Gadchiroli India interventions by the trained VHW in basic newborn resuscitation reduced case fatality in severe asphyxia by nearly 50% and asphyxia specific mortality rate by 65% in comparison to management by TBA alone* *Bang AT. Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitation with mouth-to-mouth, tube-mask or bag-mask. J Perinat 2005; S82-91.

 Aim to have one NRP trained person attending every delivery ( > 27 millions deliveries /year in India )  Joint venture of IAP-AAP-LDSC  Johnson and Johnson, India has agreed to provide academic grant to train More than > 200,000 health professionals and workers in private sector in next 4 years IAP’s initiative NRP FIRST GOLDEN MINUTE PROJECT

 NRP FGM is not restricted to resuscitation only  IAP has adopted NSSK manual of GOI “Basic New born Care and Resuscitation Program” which focuses on Resuscitation, Prevention of Infection, Thermal Protection, Feeding and Transport of Newborn

Participants like you are....  Learned  Experienced  Responsible  Catering to NB care daily  Science is ever evolving / keeping abreast is the need of the hour

 A new programme on Basic Newborn Care and Resuscitation, has been launched nationally by GoI to address important interventions of care at birth Navjaat Shishu Suraksha Karyakram (NSSK) GOI and IA P have signed a MoU for training

Lives can be saved now If the all essential interventions in “The Lancet Newborn Survival series” reached 90% of Indian women and babies then 36-67% of newborn deaths could be prevented Additional cost of $1.39 per capita per year

 If we train more than 90% health personnel attending institutional deliveries (41%) in essential interventions,an estimated 15 – 30 % reduction in NMR can be expected  There will be greater impact in states with higher neonatal mortality

Primary causes of neonatal deaths in India * Birth weight <750 g, hyaline membrane disease, intraventicular hemorrage

1 million children who survive birth asphyxia each year go onto suffer cerebral palsy and other disabilities Averting neonatal death is pivotal to reduce child mortality

IAP’s Initiative For improving Child Survival, Neonatal resuscitation Program (NRP) with emphasis on management of First minute after birth is crucial.

Approach followed  Government Sector – Named as Navjat Shishu Surakhsha Karyakram (NSSK) in partnership with GOI  Private Sector – Named as First Golden Minute (FGM). Supported by J & J.

NSSK  Launched on 15 Sep, 09 at Jaipur by hon’ble minister of Health Mr Ghulam Nabi Azad  Besides NRP, NSSK also includes Essential Newborn Care Breast Feeding Thermal Control – KMC Prevention of Sepsis  IAP is playing Key Role

Evaluation Documents

Journey so far…  Delhi  Bihar  Orissa  Jharkhand  Rajasthan  Madhya Pradesh  Uttar Pradesh  J & K  Haryana  Now Uttarakhand

Performance Evaluation - Overall Performance Evaluation Overall show improvement in skill levels to 94% for health experts from their pre training levels of 40%.

Basic Steps in Neonatal Resuscitation Rarely Needed Needed less frequently Always needed 1% 10% 100% Meds Intubation and Chest compressions Ventilation with bag and mask Initial steps to stimulate the baby to breathe Assessment of baby and routine care Basic Advanced

Not only a project.. But …… …. a mission NRP FGM