Joint initiative on infant death auditing

Attempt to clear confusion over State’s actual infant mortality rate

The Health Department and the National Health Mission will join hands with the Indian Academy of Paediatrics to launch an Infant Death Reporting, Review and Audit in Kerala. The aim is to clear the confusion on the State’s actual infant mortality rate (IMR) by tracking and analysing every infant death in the State over a fixed period.

The systematic reporting, review and auditing of infant deaths will also help the State ascertain the causes of infant death and plan appropriate interventions so that the mortality rate can be brought down.

Kerala’s IMR had been stagnating at 12 (per 1,000 live births) for a long time and efforts had been on since the past three or four years to analyse if some of these deaths were preventable through better neonatal care practices.

However, there has been much confusion regarding the State’s IMR figure of late. The National Family Health Survey (NFHS)-4 (2015) data, which was released recently, found Kerala’s IMR to be 6, while at the same time, the 2016-December bulletin of the Sample Registration System (SRS) still reported it as 12


To add to the confusion, the Directorate of Health Services, which has the system of monthly reporting on infant deaths from districts, estimates Kerala’s IMR to be between 6 and 8.

“For a long time, we have been talking about strengthening our infant death reporting system. We know that our newborn survival rates have certainly gone up, but somehow, it is not getting reflected in the figures. Our hospital mortality data of infants is fairly accurate but we think we are probably missing a lot of infant deaths in the community,” says I. Riaz, secretary of IAP, Kerala.

The death of adults invariably gets reported because people need the death certificate for settling various legal and property-related issues. But the death of an infant at home due to some illness or issues of prematurity, may not be reported, he points out.

A working group that had been constituted by the government to look at the IMR reduction strategies had unanimously pointed out that it was imperative to get all infant deaths reported and the cause of death assessed, so that the interventions to reduce mortality can be planned accordingly

Within 15 days

A clear plan of action has been now laid out wherein, ASHA workers will report all infant deaths in their field area within 15 days, in a prescribed format, to a toll-free number of the Health Department (1056-DISHA).

The data will be entered into the system by the DISHA counsellors. The PHC medical officer will follow up the case and report to the District RCH officer.

At the district-level, senior paediatricians will review all cases on a monthly basis and identify the cases to be audited by the IAP.

Infant death audit will be carried out for minimum 10% of the reported infant deaths in every district or for all cases for which exact cause of death could not be conclusively identified.

Expert group

A State expert group has been formed with the Additional Chief Secretary (Health) as the chairman and the Mission Director, National Health Mission, as the convener, which will review the district-level reports every quarter for the quality of data and for taking the necessary corrective steps.

“This is not a fault-finding exercise. We just need to identify the probable cause of death in all cases and ascertain if it had been a preventable one. The auditing will be a continuous process and an entire year’s data from across the State should give us a clear idea about the State’s IMR as well as set us on the right course on planning interventions to reduce IMR,” says Santhoshkumar, Head of Paediatrics, SAT Hospital.

IAP has now commenced the process of training its senior paediatricians in all four regions for the process.

ASHAs have already started reporting infant deaths and the actual auditing is expected to begin in July.

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Printable version | Feb 23, 2020 2:22:49 AM |

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