Burden of morbidities and the unmet need for health care in rural neonates--a prospective observational study in Gadchiroli, India.

BACKGROUND: Majority of the neonates in developing countries are born and cared for in rural homes but the available information is mostly hospital based. OBJECTIVES: To estimate: (i) the incidence of various neonatal morbidities and associated case fatality in home-cared rural neonates, (ii) proportion of neonates with indications for health care, and (iii) the proportion who actually receive it. DESIGN: Prospective observational study. SETTING: Rural homes. METHODS: Neonates in 39 study villages in the Gadchiroli district (Maharashtra, India) were observed during one year (1995-96) by 39 trained female village health workers at birth and during neonatal period (0-28 days) by making eight home visits. A physician checked the data and the morbidities were diagnosed by a computer program. Vital statistics in these villages was independently collected. RESULTS: Out of 1016 live births, 95% occurred at home and 763 (75&%) neonates were observed. The agreement between observations by health workers and physician was 92%. Total 48.2& neonates suffered high risk morbidities (associated case fatality >10%), 72.2% suffered low risk morbidities, and 17.9% gained inadequate weight (less than 300 g). Seventeen percent neonates developed clinical picture suggestive of sepsis. Though 54.4% neonates had indications for health care and 38 out of total 40 neonatal deaths occurred in these, only 2.6% received medical attention. The neonatal mortality rate was 52.4/1000 live births. CONCLUSION: Nearly half of the neonates in rural homes developed high risk morbidities ten times the neonatal morbidity rate and needed health care but practically none received it. The magnitude of care gap suggests an urgent need for developing home-based neonatal care to reduce neonatal morbidities and mortality

Breath Counter: a new device for household diagnosis of childhood pneumonia.

Illiterate Traditional Birth Attendants (TBAs) were trained to diagnose pneumonia in children using their visual judgement of tachypnoea. This method resulted in 41% wrong diagnosis in the cases with borderline respiratory rate. A simple device, named 'Breath Counter' was designed and TBAs were trained to diagnose pneumonia in children using this instrument. The agreement of TBAs' diagnosis, with diagnosis using WHO criteria of respiratory rate improved from unaided 60% (30/50) to 82% (41/50) by the use of Breath Counter (p less than 0.05). Breath Counter is simple, cheap, effective and can be used even by illiterate persons to diagnose pneumonia in children. It has the potential of becoming a household diagnostic aid.