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A proactive approach to neo-natal health

© UNICEF/2006

Group counciling in Dooni (Ram Bheragi is in blue saree).

 By Nitin Jugran Bahuguna
 
TONK (RAJASTHAN): Perpetuating antiquated practices at birth in Rajasthan’s villages seriously threaten the survival of newborns in this state.  Preventing the mother and newborn from stepping out of the home for the first 40 days is one such practice. Another, more serious, is not breast-feeding the baby for the first three crucial days. Instead, the baby is fed a guta (decoction) of honey or jaggery (gur) mixed with water. 
    
When Meena, a young health worker assisting a home delivery in Dooni, prevented a midwife from giving the newborn the customary guta, and insisted on breastfeeding (for first six months), the baby was starved for three days. When the agitated relatives complained to the Community Health Centre (CHC) they were shocked when doctors reproached them, instead. 

The family was told that colostrum, the yellowish fluid secreted prior to breast milk, was most nourishing for newborns. It was natural protection against infections.

“We have been feeding babies guta for generations”, an elderly woman in Dooni said. “It was a shock to find out that it is actually harmful as it causes dehydration.”

Overcoming old customs

Meena is one amongst a crop of young health workers in Tonk district - 140 km from Jaipur - set to rejuvenate the child healthcare system in Rajasthan.

Under UNICEF’s Integrated Management of Neo-natal and Childhood Illnesses (IMNCI), health workers’ skills are being strengthened so that they can help in reducing mortality. “Our new, proactive strategy focuses on accurate and timely identification of childhood illnesses through home visits”, observed Ms Vandana Mishra, Extender Health in Tonk District.
   
Meena, a Sahyogini since the project’s inception a year ago, says her eight-day training led her to re-evaluate her own conceptions and understanding about childcare. “For instance, the application of haldi (turmeric) or ghee (clarified butter) on the navel after birth is said to heal the skin quickly but actually this can cause infection, and it should be left to dry on its own.”

“Persuading mothers to start breast feeding about 30 minutes after birth is the biggest challenge”, remarked Shaheenabanu, another Sahyogini in Dooni. “But we have made gains in the past few months.”. Another problem is malnourishment. Mothers often leave infants for hours while they work in the fields. We’ve been advocating with them to express their breast milk.

© UNICEF/2006

Chandrakanta Aggarwal making a home visit at Juniya village

Low survival rate

75 out of every 1,000 children born alive in Rajasthan do not see their first birthday, totalling to approx. 130,000 deaths per year. Of these, approximately 40 die within a month of birth. These deaths are caused by five common conditions: acute respiratory infections (mostly pneumonia), diarrhoea, measles, malaria or malnutrition.

Tonk district’s selection for the IMNCI project was no surprise. It has the highest child mortality rate in Rajasthan. 382 deaths occur within one week of birth; 158 between one week and a month; 194 between one month to one year; and 103 between one to five years.

According to Rama Beragi, Auxiliary Midwife Nurse (ANM) at the Dooni CHC, anaemia is also very common. “We counsel mothers about iron deficiency and give them at least 100 tablets but majority of them do not consume all the iron tablets given to them. “Most houses are fragile mud structures,” she continued. “Chances of infection from dust and dirt are very high. Sometimes fires are lit inside the room for warmth, leading to asphyxiation.”
    
So far 225 people have been trained in Dooni and Aligarh blocks, said Mr Raza Sabri, District IMNCI Coordinator. “In Dooni, 156 people comprising four lady health volunteers, three lady supervisors, 46 ANMs, 97 sahyoginis and six NGOs have received the rigorous eight-day course.”

The basic challenge lies in training all health staff, follow-up training for supervisors, establishing referral linkages, and finding assured funding.