Growth Faltering Among Discharged Babies from Inpatient Newborn Care Facilities: Learnings from Two Districts of Himachal Pradesh

Objective: To determine the burden of early growth faltering and understand the care practices for small and sick babies discharged from newborn units in the district. Study design: Observational and follow-up study. Participants: 512 babies discharged from two Special Newborn Care Units (SNCUs) and four Newborn Stabilization Units (NBSUs) in two districts of Himachal Pradesh. Methods: Anthropometric assessments, interview of mothers and Accredited Social Health Activists (ASHAs) conducted between August, 2018 and March, 2019. Change in weight-forage z-score (?WAZ) of <-0.67SD between birth and assessment was used to define growth faltering. Outcomes: Proportion of growth faltering (or catch-down growth) in small and sick babies discharged from SNCUs and NBSUs, and infant care practices. Results: Growth faltering was observed in a significant proportion of both term (30%) and preterm (52.6%) babies between 1 to 4 months of age. Among babies with growth faltering (n=180), 73.9% received a home visit by ASHA, and only 36.7% received a follow-up visit at a facility. There were 71.3% mothers counselled at discharge (mostly informed about breast feeding). Most (96.7%) mothers did not perceive inadequate weight gain in their babies post-discharge. During home visits, ASHAs weighed 61.6% of the infants with growth faltering. Amongst infants who had growth faltering, only 49.6% of mothers had been provided information about their infant’s growth and 57.1% mothers had received breastfeeding counselling. Conclusion: Small and sick newborn infants (both term and preterm babies) discharged from special care newborn units are at increased risk of early growth faltering. Follow-up care provided to these infants is inadequate. There is a need to strengthen both facility-based and home-based follow up of small and sick newborn infants discharged from newborn care facilities.

Effect of a Quality Improvement Package on Reducing Newborn Mortality from 26 to 14 in a Himalayan North Indian State

Background: In India, newborn mortality remains high due to a number of factors, including poor quality of care at health facilities. The experience of executing complete neonatal care quality improvement (QI) package at selected hospitals in Himachal Pradesh and reduction in newborn mortality rate (NMR) is described in this study. Objective: The short-term objective was the participants’ retention of knowledge and skills, and the achievement of uniform QI objectives following training and after a minimum of 6 months. Overall reduction in NMR was long-term objective. Methods: Newborn care QI package was implemented according to India Newborn Action Plan over a period of 48 months from 2013 to 2016, through infrastructure, trainings, and supportive supervision. Results: Total 13 health facilities were upgraded; 350 staff nurses and medical officers were trained. The mean posttraining knowledge score was 75% compared to 29% in the pretraining test, and 63% 1 year later. The competencies of health workers in the care of high?risk babies and 12 QI targets had improved, resulting in a 46% reduction in neonatal mortality in the state across all gestations and weights based on sample registration survey. Conclusion: Implementation of a bundle of evidence-based practices in low-resource setting for health system strengthening for intrapartum and neonatal care was linked to changed care behaviors among health-care providers, and reduction in NMR.

Institutional births analysis from labour room registries in North Indian hilly state

Background: India is the second most populous country in the world contributing to one fifth of global deaths among under 5-year-old children. Of these under 5 deaths, Infant mortality contributes to more than 89% and neonatal mortality is responsible for 70% of IMR. Of the many proximal determinants of neonatal mortality, inadequate utilization of health services and poor skills of health care providers contribute significantly. The lack of data constrains targeted interventions for these. This study is an attempt to analyze the existing data quality along with gaps in the reporting system to initiate timely course correction for improved programmatic outcomes.Methods: The labour room birth registries from 12 District hospitals and two Government Medical Colleges in the state of Himachal Pradesh (India) were analyzed. The data was extracted from archives in the State Child health Nodal Officer for the year 2017-2018 and 2018-2019.Results: Over these two years the proportion of institutional delivery has improved. The number of newborns resuscitated remained constant at 4.5%.' There was an improved coverage of birth dose immunization. Improvement in Antenatal Corticosteroids coverage among preterm laboring mothers was also observed.Conclusions: Continuous data analysis for improving its quality to take evidence informed decisions is needed.' Hands on skill improvement for staff is need of the hour to ensure timely and maximum returns on investment in reproductive and Child Health program.