LABOUR ROOM & NEW BORN CARE SERVICES ASSESSMENT REPORT PATNA,BHOJPUR AND BUXAR Dr Priyanka Singh Dept of Community Medicine, Nalanda Medical College, Patna Dr Manpret Singh Khurmi UNICEF Bihar, Patna

BACKGROUND The majority of newborn problems are specific to the perinatal period. They cause not only deaths but also substantial morbidity and disability. These problems are the result of poor maternal health, inadequate care during pregnancy, inappropriate management and poor hygiene during delivery, lack of newborn care and discriminatory care.

cont…. Life expectancy of the neonates is increasing with the help of advances in neonatology, new life support techniques and new treatment modalities. But despite all these measures and the management of the nosocomial neonatal sepsis ,birth asphyxia and hypothermia is a big problem. The solution left is to control by implementing preventive measures in labour room and immediate newborn care services after birth at Health facilities.

OBJECTIVE To assess availability of labour room facilities and new born care sevices at Primary Health Centre.

METHODOLOGY An assessment of labour room and new born care services was conducted at PHCs of Patna,Bhojpur,Buxar by assessment team based on structured proforma designed.

PARAMETERS FOR LABOUR ROOM ASSESMENT ►Cleanliness of labour room. ► Toilet close to labour room. ► Labour room register is available. ► Labour room register is being filled correctly (all columns) ► Elbow operated tap is available. ► Bag and Mask is available. ► Glass on window.

CONT….. Curtains on window available. Duty roster displayed. Is ambulance available in working condition. Oxygen cylinder available in ambulance. Weighing Machine available. BP apparatus available. Movable blinds available. Partograph available and being filled regularly for each delivery Delivery drug tray,trolley with medicines and vaccines available.

PARAMETERS FOR NEWBORN CARE SERVICES Is newborn being immunised with BCG and OPV at birth. Radiant warmer installed. Oxygen source available. Suction Machine available. % of infants in whom breastfeeding has been initiated within 1hr .

LABOUR ROOM AND NEW BORN CARE SERVICES ASSESSEMENT: PATNA NAME OF PHC NAME OF MONITOR Approx size of Labour room No. of beds in Labour ward Cleanliness of Labour room Toilet close to Labour room Labour room register is available Labour room register is being filled correctly (All coloumns) Elbow operated tap is available Bag and Mask is available Glass on window Curtain on windows available Duty roster displayed Is Ambulance available in working condition Oxygen Cylinder available in Ambulance Weighing Machine available BP Apparatus Moveable blinds available Partograph avaiable and is being filled regularly for each delivery No. of SBA Trained ANM posted in Labour room JBSY Payment paid upto….. Delivery drug tray, trolley with medicines and vaccines available Discharge Afer delivery takes place Is Newborn being immunized with BCG and OPV 0 at birth Radiant warmer installed Oxygen source available Suction Machine available % of infants in whom Breastfeeding has been intiated with in 1 hr in this month (No. of deliveries in which breast feeding has been initiated with in 1 hr / Total No. of deliveries in this month X 100) NRIPENDRA BAKHTIYARPUR 24x14 6 Good Yes No Unbroken 2 NOV - 2010 after 24 hrs 98 DHANARUA 12x12 broken 1 OCT - 2010 same day 100 KHUSRUPUR 24X12 4 Poor NA Na no 95 MASAURHI 18X14 yes Same Day PALIGANJ 16x10 10 DEC - 2010 BIVISHAN JHA BARH 20x20 8 Broken   MOKAMA 17x11 97 PANDARAK 12x10 PHULWARISHARIF 10x18 3 PUNPUN 8X10 NO MANOJ KR RAO DANIAWAN 12X8 5 SEPT - 2010 99 FATUHA (10X6)X2 MANER AUG 2010 SAMPAT CHAK 20X20 DEC 2010 RANWIR KUMAR BIHTA 16X11 BIKRAM 14X12 DANAPUR 15X10 16 SEP 2010 NAUBATPUR 25 Dec-10

LABOUR ROOM AND NEW BORN CARE SERVICES ASSESSEMENT: BUXAR NAME OF PHC NAME OF MONITOR Approx size of Labour room No. of beds in Labour ward Cleanliness of Labour room Toilet close to Labour room Labour room register is available Labour room register is being filled correctly (All coloumns) Elbow operated tap is available Bag and Mask is available Glass on window Curtain on windows available Duty roster displayed Is Ambulance available in working condition Oxygen Cylinder available in Ambulance Weighing Machine available BP Apparatus Moveable blinds available Partograph avaiable and is being filled regularly for each delivery No. of SBA trained ANMs posted in labour room at PHC JBSY Payment paid upto Delivery drug tray, trolley with medicines and vaccines available Discharge after delivery takes place Is Newborn being immunized with BCG and OPV 0 at birth Radiant warmer installed Oxygen source available Suction Machine available % of infants in whom Breastfeeding has been intiated with in 1 hr in this month (No. of deliveries in which breast feeding has been initiated with in 1 hr / Total No. of deliveries in this month X 100) Nripendra Kumar Nawanager 10X12 5 Good Yes Unbroken No 3 10 DEC 2010 Same day 90 Chougai 2 1 10 NOV 2010 After 24 Hrs 95 Ranwir Kumar Chousa 14X20 6 12 DEC 2010 98 Rajpur 7 15 DEC 2010 96 M.K. Rao Simri 12X14 Brahmpur 12X20 100 Bivishan Jha Dumraon 14X16 Ithari 30 NOV 2010 SDH 16X25 20 22 DEC 2010

LABOUR ROOM AND NEW BORN CARE SERVICES ASSESSEMENT: BHOJPUR DATED NOV 30 - DEC 1, 2010 NAME OF PHC NAME OF MONITOR Approx size of Labour room No. of beds in Labour ward Cleanliness of Labour room Toilet close to Labour room Labour room register is available Labour room register is being filled correctly (All coloumns) Elbow operated tap is available Bag and Mask is available Glass on window Curtain on windows available Duty roster displayed Is Ambulance available in working condition Oxygen Cylinder available in Ambulance Weighing Machine available BP Apparatus Moveable blinds available Partograph avaiable and is being filled regularly for each delivery No. of SBA trained ANMs posted in labour room at PHC JBSY Payment paid upto Delivery drug tray, trolley with medicines and vaccines available Discharge after delivery takes place Is Newborn being immunized with BCG and OPV 0 at birth Radiant warmer installed Oxygen source available Suction Machine available % of infants in whom Breastfeeding has been intiated with in 1 hr in this month (No. of deliveries in which breast feeding has been initiated with in 1 hr / Total No. of deliveries in this month X 100) Barhara Manoj 16 X 20 6 good yes No Yes unbroken 2/1 1 Oct - 10 same day 99 Sandesh 6 X 10 poor No(Adult) no 4/3 3   Sahar 14X 12 Yes(Non functional) broken 3/3 94 Koelwar 14 X 16 Yes (but not available in labour room) 7/6 after 24 hrs 95 Shahpur Bivishan Jha 9 8/2 2 100 SDH Arrah 24X30 18 NA 14/12 12 y Behiya 14X14 8 4/4 4 Jagdishpur Ranwir 18X10 Udwantnagar 15X12 98 Trari Nripendra 24x16 average Charpokhri 24X18 na FEB 09 Piro 12X15

BHOJPUR LABOUR ROOM AND NEW BORN CARE SERVICES ASSESSEMENT IN (%)

INFERENCE - Mean of Different Parameters of Three Districts.

INFERENCE-Mean of Different Parameters of Three Districts.

RECCOMENDATION FOR NEWBORN CARE SERVICES- Low birth babies are at higher risk of the mortality and morbidity.Weighing machine should be made available at all centres. Breastfeeding is one of the main pillars of newborn care. Promotion of early initiation and exclusive of breast feeding through trainings,BCC,Campaign in community through media,advertisement etc.

CONT… Community sensitization for availing regular immunization through ANM,AWW, ASHA and NGO. Regular and sufficient supply of vaccines at all health centers. Regularization of RI card. Provision for supply and availability of all requisite equipment and adequate supplies like; Baby warmer, Incubator, Ambubag, Suction Machine etc .

MATERNAL HEALTH- Despite the WHO recommendation that it be used to monitor all labours, the partograph is still not widely used . Basic Equipment for Labour Room / Delivery Room should be available. Adequate supply of essential drugs. Provision of All Labour room to have an attached toilet with water.

INFRASTRUCTURE Provision of All Labour room to have an attached toilet with water. Availability of ambulance (outsource or otherwise) 24 hrs at the PHC. Maintainance of proper cleanliness in delivery/labour room. i. Basic Equipment for Labour Room / Delivery Room in place . New Born Corner in every facility

TRAININGS AND CAPACITY BUILDING- Capacity building on : IMNCI, FP, SBA,FIMNCI,HBNCC,RI etc. Organizing regular orientation and refresher trainings for Doctors, ANMs, AWWs, ASHAs, and TBAs.

REFERENCES Indian Public Health Standards (IPHS) for Primary Health Centre. National Facility Report RCH 11. ASHAs Involvement in Newborn Care: A Feasibility Study. Stalin P, Krishnan A, Rai SK, Agarwal RK. The Partograph: An Essential Tool for Decision-Making during Labor, USAID. Use of the Partograph: What do we know, what do we need to find out ?Findings from a Literature Review Dr. Jeanne d’Arc Kabagema and Karen Levin Why Invest in Newborn Health? Population Reference Bureau and Saving Newborn Lives.

“Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India.” Lancet 1999;354:1955-61.