A proactive approach to neo-natal health
By Nitin Jugran Bahuguna
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.
“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.
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.”
The basic challenge lies in training all health staff, follow-up training for supervisors, establishing referral linkages, and finding assured funding.
Bold new strategies are needed to address the challenges of maternal, newborn, and child survival. The National Rural Health Mission, Reproductive child Health II (RCH II), and the Integrated Childhood Development Scheme(ICDS) must all be effectively implemented.