Goa and Manipur may have knocked Kerala off the pedestal, but at 12 deaths among children less than one year of age per 1,000 live births, Kerala still has an enviably low infant mortality rate (IMR); it is far below India’s average of 42. Yet, for years, the southern State has been unable to reduce the mortality rate further to a single-digit figure to become comparable with the developed countries. Kerala has always been at the forefront in setting the benchmark for almost all the health indices. It therefore comes as no surprise that the State has initiated steps to further beat down IMR. A survey done by the National Rural Health Mission and the Indian Academy of Paediatrics found that about 75 per cent of infant deaths occurred during the first four weeks of birth (or neonatal deaths). The first week alone accounted for 59 per cent of the total neonatal deaths. Hence a pilot project is set to begin in 25 hospitals, including five private hospitals, to lower the neonatal mortality rate by 30 per cent in 24 months. It is planning a targeted approach to tackle the four major causal factors — prematurity, congenital anomalies, sepsis and birth asphyxia — for neonatal deaths.
Pre-term births (between 24 and 37 weeks of gestation) combined with low birth weight account for the lion’s share of about 35 per cent of neonatal mortality in Kerala. India has the highest number — 3.5 million — of pre-term births in the world, according to a June 2012 paper in The Lancet . Though the causes for pre-term births cannot be ascertained in a vast majority of cases, it is still possible to identify using techniques like ultrasound a certain percentage of mothers who are very likely to deliver such babies. Aside from improving the nutritional status of pregnant mothers, and keeping their blood pressure and diabetes under check, delaying pre-term labour through medical intervention and administration of two doses of steroid before delivery greatly improve neonatal survival. The steroid improves the three major parameters that are essential for survival — lung maturity, preventing haemorrhage of brain blood vessels and avoiding intestinal problems due to immaturity. While sterile hospital conditions can prevent sepsis (9.3 per cent), the importance of the mothers’ genital hygiene is often missed or overlooked. Vaginal and urinary tract infections are quite likely to cause pre-term labour and sepsis. Mortality due to birth asphyxia in Kerala is 8 per cent. Improving the quality of care during the delivery process, including by preventing prolonged labour, can further cut birth asphyxia mortality.
