Impact of Neonatal Resuscitation Capacity Building of Birth Attendants on Stillbirth Rate at Public Health Facilities in Uttar Pradesh, India

Objective: To document the impact of neonatal resuscitationcapacity building of birth attendants at district and sub-districtlevel on fresh stillbirth within the public health system in India.Design: An implementation research using pre-post studydesign.Setting: 3 high-infant and neonatal mortality districts (Gonda,Aligarh and Raebareli) of Uttar Pradesh, India.Participants: Pregnant women who delivered at the healthfacilities and their newborns.Interventions: An intervention package with (i) training onessential newborn care resuscitation; (ii) skill laboratoriesestablishment for peer-interactive learning; (iii) betterdocumentation; and (iv) supportive supervision was implementedat all health facilities in the districts.Main outcome measures: Impact on fresh stillbirth rates andresuscitation practices were documented at 42 health facilities(Gonda-17, Aligarh-8 and Raebareli-17) over 12-18 months.Results: Out of the 3.3% (4431/133627) newborns requiringresuscitation, 58.5% (n=2599) were completely revived, 19%(n=842) had some features of hypoxic insult after birth and 1.4%(n=62) were stillbirths. There was 15.6% reduction in still birth ratein the three districts with the intervention package.Conclusion: The reduction in still birth rate and improvement innewborn resuscitation efforts in the three districts indicatedfeasibility of implementation and scalability of the interventionpackage. However sustenance of the impact over longer periodneeds documentation

Comparative study of the effect of esmolol, fentanyl and their combination for attenuating haemodynamic responses of laryngoscopy and intubation.

Background&Objectives: Laryngeal, tracheal and bronchial receptors are stimulated by mechanical and chemical irritants during laryngoscopy, intubation and extubation. The reflex increases in sympathoadrenergic activity caused by these manipulations leads to an increase in catecholamine release, arterial blood pressure and heart rate. The aim of present study was to evaluate the efficacy of Fentanyl (2 mcg/kg), Esmolol (1mg/kg) and their combination in half the dose(fentanyl 1 mcg/kg +esmolol 0.5mg/kg) in attenuating the pressure response during laryngoscopy and tracheal intubation. Methods: This is a prospective double blind study comprising ninety patients between 21-60 yrs and ASA grade I and II scheduled for elective surgery under general anesthesia. Patients were randomly divided into group E (injection Esmolol 1mg/kg iv), group F (inj.Fentanyl 2mcg/kg iv) and group C (inj.Esmolol 0.5mg/kg and inj.Fentanyl 1mcg/kg). The study drug was given 2 minutes before induction of anaesthesia. All the vital parameters of patients were observed during intra operative and postoperative period .Values of heart rate and mean blood pressure were recorded at pre-induction, after giving study drug, after induction, immediately after intubation and at 1 min, 3 min, 5 min, 7 min and 10 min. after intubation. Results: Inter group comparison of groups E, F & C showed greater attenuation of heart rate in group F as compared to group C and group E. Inter group comparison of groups E, F & C in attenuating increase in MAP showed greater attenuation of MAP in group F as compared to group E ( p=0.880) and group C (p=0.0005). Conclusion: Among the fentanyl (2 mcg/kg), esmolol (1 mg/kg) and their combination drug in half doses, injection fentanyl is best in attenuating haemodynamic responses to laryngoscopy and tracheal intubation.

Eye donation – Awareness and willingness among attendants of patients at various clinics in Melaka, Malaysia.

Aim: Corneal blindness accounts for 3.42% of blindness in Malaysia; the rate of eye donation is low. The aim of the study was to assess the awareness about eye donation and willingness to donate eyes among attendants of patients at various clinics in Melaka, Malaysia. Materials and Methods: This observational study was conducted on attendants who accompanied patients (n = 400) visiting various outpatient departments of the General Hospital and two peripheral clinics in Melaka between August and October 2007. The participants answered a questionnaire (Malay and English versions) which included demographic profile, awareness of eye donation, knowledge regarding facts of eye donation, and willingness to donate eyes. Univariate and multivariate logistic regression was performed at 5% level of significance. Results: Awareness of eye donation was observed in 276 (69%) participants. Multivariate analysis showed that awareness was more among females when compared to males (P = 0.009). Of the 276 participants who were aware of eye donation, only 34.42% were willing to donate eyes. Willingness was more among the Indian race (P = 0.02) and males (P = 0.02). Educational status did not influence the willingness to donate eyes. Conclusions: Although majority of participants were aware of eye donation, willingness to donate eyes was poor.

Health research strengthening and operational research needs for improving child survival in India.

Health research can be utilized to improve the policies, interventions and outputs of the health systems, and ultimately the health of individuals and population. This requires systematic evaluation of evidence and its integration into national policies and programs after suitable adoption at the local level. It has been noted that there has been limited focus upon strengthening health research in India, due to weak research systems or institutional mechanisms, lack of trained human resources and enabling environment, absence of well defined priorities, perceived low quality of research, and inadequate funding. Though various vertical and integrated health programs for improving child survival in the country have been introduced, the decline in child mortality has been excessively slow. Operational research, a sub theme of health research, which uses systematic research techniques to provide evidence to the policymakers and program managers, can be used to assess programmatic issues and improve their effectiveness. This article analyzes the current situation of health research in India, describes briefly the process of operational research, and summarizes the areas of programmatic concern and priority topics for future research in five key fields of child health (Newborn health, Immunization, Malnutrition, Disease prevention and control, health systems strengthening). Finally, it outlines the immediate need of strengthening health research system in the country for improving child survival through increased funding, development of institutional mechanisms, building pool of talented researchers and provision of an enabling environment, to facilitate health and operational research in a scientifically credible manner and to ensure wider dissemination of results.

Primary health care and child survival in India.

The Primary Health Care (PHC) has been globally promoted as a comprehensive approach to achieve optimal health status and ‘Health for all’. The PHC approach, although, initially received the attention but failed to meet the expectations of the people in India. The child health programs in India had been started for long as verticals programs, which later on integrated and had been planned in a way to deliver the services through the PHC systems. Nevertheless, the last decade has witnessed many new initiatives for improving child health, specially; a number of strategies under National Rural Health Mission have been implemented to improve child survival- Skilled Birth Attendant and Emergency Obstetric Care, Home Based Newborn Care, Sick newborn care units, Integrated Management of Neonatal and Childhood Illnesses, strengthening Immunization services, setting up Nutritional rehabilitation centers etc. However, for a large proportion of rural population, an effective and efficient PHC system is the only way for service delivery, which still needs more attention. The authors note that although there have been improvements in infrastructure, community level health workers, and availability of the funding etc., the areas like community participation, district level health planning, data for action, inter-sectoral coordination, political commitment, public private partnership, accountability, and the improving health work force and need immediate attention, to strengthen the PHC system in the country, making it more child friendly and contributory in child survival, in India.

Bovine pericardium in treating large corneal perforation secondary to alkali injury: a case report.

To describe use of a locally processed bovine pericardium (BP) to cover a large central corneal perforation following alkali injury and discuss postoperative outcome. A 27-year-old Malay male patient presented two weeks after alkali splashed in his left eye while working. A clinical diagnosis of left central corneal ulcer with limbal ischemia following alkali injury with secondary infection was made. After failed medical therapy, we performed a Gunderson conjunctival flap under local anesthesia that retracted after one week and resulted in a large central corneal perforation with surrounding stromal thinning. The perforation was covered with a locally processed BP xenograft (Lyolemb) supplied by the National Tissue Bank, University Sains Malaysia. Nine months follow-up showed a well-taken graft without any exposure/dehiscence and minimal inflammation. Amniotic membrane transplantation when used as a patch graft needs an urgent tectonic graft to promote corneal stability in patients with severe corneal thinning. The use of processed BP can be a viable option in treating such cases.

The clinical risk index of babies (CRIB) score in India.

OBJECTIVE: To assess the usefulness of clinical risk index of babies (CRIB score) in predicting neonatal mortality in extremely preterm neonates, compared to birth weight and gestation. METHODS: 97 preterm neonates with gestational age less than 31 weeks or birth weight less than or equal to 1500 g were enrolled for the prospective longitudinal study. Relevant neonatal data was recorded. Blood gas analysis results and the maximum and the minimum FiO2 required by babies in first 12 hours of life were noted. Mortality was taken as death while the baby was in nursery. The prediction of mortality by birth weight, gestational age and CRIB score was done using the Logistic model, and expressed as area under the ROC curve. RESULTS: The area under the ROC curve for birth weight, gestational age and CRIB score was almost the same, the areas being 0.829, 0.819 and 0.823 respectively. Hence CRIB score did not fare better than birth weight and gestational age in predicting neonatal mortality. CONCLUSION: The CRIB score did not improve on the ability of birth weight and gestational age to predict neonatal mortality in the study.