Madhya Pradesh grapples with spiralling neonatal deaths

Staff crunch, low community referrals major factors: National Health Mission

Madhya Pradesh has recorded the highest percentage of newborn deaths of 11.5% against the total admissions to government-run sick newborn care units (SNCUs) in the past three years across the country, a rate ominously spiralling since 2017, according to the National Health Mission (NHM). The country’s average is 7%.

Although admissions of neonates (under 28 days) in the State have dropped from April 2017 to December 2019 — remaining lower than West Bengal, Rajasthan and Uttar Pradesh — the percentage of deaths at 12.2% surpassed Bihar’s last year.

Meanwhile, West Bengal, where 34,344 neonatal deaths occurred in the period, the most in the country, the declining percentage of deaths from 9.2% in 2017 to 8.9% in 2019 coincided with a slump in admissions.

Several factors

Staff crunch, low community referrals, absence of a special neonatal transport service to health centres, and the non-availability of enough units to cater to increasing institutional deliveries had contributed to the spike in the percentage of deaths, said Dr. Saloni Sidana, Additional Mission Director, NHM State unit.

“We have just half of the required staff nurse strength at the units across the State. For instance, in the Jabalpur unit, there are only 14 against a required 22 nurses,” she said.

The crunch is magnified as only one against the requisite five (82% shortfall) of surgeons, gynaecologists, physicians and paediatricians is available at hospitals.

As the units are located at hospitals with the delivery load of more than 3,000 infants per year, mostly in district headquarters, transporting neonates on time is crucial. “Although there is a dedicated service to transport pregnant women to hospitals from remote areas, there is none for neonates, who are mostly dependent on the 108 ambulance service,” said Dr. Sidana.

Madhya Pradesh has also recorded an abysmal sex ratio in admissions. Even with a sex ratio of 931 as per the 2011 census, 663 girls were admitted against 1,000 boys in the three years, against the country average of 733.

Bias against girls

“In almost three fourths of the cases relating to boys, more admissions can be attributed to the prevailing bias against the girl child in society,” said an NHM official, requesting anonymity.

In Bhopal, the capital city of Madhya Pradesh, one in every five children admitted to a unit died in the three years — the highest death percentage of 19.9% in the State, ten times above the NHM’s mandated key performance indicator of below 2%.

Under-reported deaths

“Urban areas report a higher death percentage as they offer tertiary care, and admit several serious cases from peripheral districts,” said the official, who stated that several districts had under-reported deaths as well.

The issue of under-reporting is illustrated by the NHM’s Child Health Review 2019-2020, which highlights 43 districts where government officials didn’t report more than 50% of deaths of children under five, to falsely jack up their score.

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