Kerala’s achievement of consistently maintaining a single digit infant mortality rate (IMR) and bringing it down from 7 in 2018 to 6 (as per latest Sample Registration System bulletin for 2019) is a result of the State’s single-minded initiatives and investment in the area of neonatal care.
Among bigger States, Kerala is the lone one with a single digit IMR (per 1,000 live births), far ahead of other States — the closest being Delhi with an IMR of 11 — and against the national average of 30.
It is commendable that the State has managed to close the gap between the IMR in rural (9) and urban areas (5) in 2018 to 7 and 5 in 2019. It was in 2018 that the State first achieved the distinction of the single digit IMR of 7.
“Single digit IMR” had been a project that the State’s Health Department and the State branch of the Indian Academy of Paediatrics had been determinedly pursuing since 2010, as for long, the State’s IMR had been stagnating at 12.
About 4.7-5 lakh births take place in the State annually. A study conducted by the State IAP in 2013 found that 75% of the infant deaths occurred during the neonatal period and of this, 59% occurred during the first week. Prematurity accounted for 35% of the deaths while congenital anomalies, especially critical congenital heart diseases, accounted for 28%.
The State began by strengthening infant death reporting and auditing; drawing up clinical guidelines and quality standards for improving antenatal, intrapartum and neonatal interventions; investing heavily on improving newborn care nurseries, ICUs and delivery points; and in training obstetricians and newborn nursery care personnel.
“Kerala’s success was in identifying the issues correctly and effectively implementing focussed interventions to improve neonatal care. The interventions were aimed at ensuring the survival of premature babies, even those with very low birth weight of 1,000-1,100 gm. Tribal mothers were given special attention. All our investments seem to have paid off,” P.K. Jameela, member, State Planning Board and former Director of Health Services, said.
The State also launched a comprehensive newborn screening programme. All newborns undergo screening for visible birth defects, congenital anomalies, hearing and vision screening and metabolic disorders.
This was followed by the launch of Hridyam in 2017, a mega public-private initiative wherein infants with critical congenital heart anomalies were identified early and treated without delay. The project has saved the lives of hundreds of neonates and infants.
“Kerala’s consistent and concerted efforts over the years for improving infant survival and ensuring quality of life beyond survival has been phenomenal. All our long-term strategies were supported by the Government with infrastructural investments, personnel and training,” points out I. Riaz, national executive member of the IAP.