The IAP study had reported that 75 per cent of the infant deaths occurred during the neonatal period

The Health Department has drawn up a road map to reduce infant mortality in the State by implementing certain clinical guidelines and quality standards that are expected to change the manner in which neonatal care is practised in major hospitals.

The department began this exercise in July with the help of Access International, a not-for-profit organisation that works with governments and provides research and training inputs to improve health care service delivery and processes.

Four working groups, including paediatricians, neonatologists, obstetricians, and infection-control experts from major tertiary care hospitals in the State, have been working on the basic premise — based on a study by the Indian Academy of Paediatrics (IAP) — that the major causes of infant deaths in Kerala were prematurity (34.6 per cent), congenital anomalies (28 per cent), sepsis (9.3 per cent), and birth asphyxia (8 per cent).

IAP study

The IAP study had reported that 75 per cent of the infant deaths occurred during the neonatal period, and that of the total neonatal deaths, 59 per cent of the deaths occurred during the first week of life.

The groups have now formulated 13 quality statements relating to antenatal, intra-partum and neonatal interventions, the practice of which is expected to make a significant dent in the neonatal mortality (NMR) in the State.

“Kerala’s IMR at present is 12 (per 1,000 live births). With the death of neonates (babies up to 28 days of birth) constituting 75 per cent of the IMR, our goal will be to bring down the NMR by 30 per cent in 24 months in 25 hospitals — six medical colleges, 14 district hospitals, and five private hospitals — which will be participating in our pilot project,” M. Beena, State Mission Director, National Health Mission, told The Hindu.

“While we have drawn up the mandatory quality standards that need to be implemented to effectively bring down the IMR, we have to fill the gaps in infrastructure, knowledge, and availability of consumables and manpower in our institutions before we can pilot these guidelines,” Health Secretary K. Ellangovan said.

The majority of deliveries in the State continue to take place in the private sector, and hence any quality improvement programme aimed at bringing down the IMR would have to include the private sector, the IAP has pointed out. However, non-reporting of neonatal and infant deaths continues to be a problem.

The Health Department has thus decided to strengthen infant death auditing and reporting in the State by creating an interfacing website, with controlled access to private hospitals, where all hospitals can register the institution names and report infant deaths.


The website and reporting format is expected to be launched by April, by which time the department hopes to chalk out the last details of the pilot launch.

“The last mile reduction of the IMR is not easy and calls for specific strategies at the micro level. We will need to do two kinds of mapping – mapping of geographic areas or health blocks where IMR rates have been high, and the mapping of institutions providing antenatal and delivery care in these areas, which will then be rated on the basis of the infrastructure, facilities, skills each has. We will also need to develop a system of scoring every antenatal case on the basis of the risks for infants and mothers. The data will have to be juxtaposed and management protocols modified appropriately for vulnerable areas,” Dr. Ellangovan said.

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