1. Naveen Thacker Past President IAP SC Member International Paediatrics Association

2. Worldwide distribution of child deaths Each dot represents 5000 deaths Lancet 2003 India is epicenter of Childhood Mortality

3.  9.7 million < 5 yrs deaths annually world over India 2.1 million (21%) 1 million newborns die annually in India

4. Every year…… … about 250,000 women die of pregnancy-related causes … about 1 million babies are stillborn of which at least 300,000 due to intra-partum causes … about 1 million neonates die Each year in India at least 26 million women become pregnant!

5. Every year 1 million newborns in India die – where, when and why? What can be done to save these newborn lives now?

6. WHERE? The 10 States in India where newborns have the highest risk of dying RankState Neonatal mortality rate (per 1,000 live births) 1Chattishgarh51.1 2Jharkhand48.6 3Uttar Pradesh47.6 4Assam45.5 5Orissa45.4 6Madhya Pradesh44.9 7Rajasthan43.9 8Andhra Pradesh40.3 9Bihar39.8 10West Bengal37.6

7. The first days of life are the riskiest Up to 50% of all newborn deaths are on the first day of life - 500,000 babies in India dying on their birth day 75% of newborn deaths are in the first week

8. The leading causes of neonatal death are: 1. Severe Infections (36%) 2. Pre-Term Births (25%) 3. Birth asphyxia (23%). 4. Other Neonatal Causes (6%) 5. Neonatal Tetanus (4%) Source: WHO World Health Statistics 2007 (India) WHY do newborns in India die?

9. What can be done to save these newborn lives now?

10. Lancet Neonatal Survival Series 2005  Neonatal Resuscitation: 6-42%  Breastfeeding : 55-87%  Prevention and management of hypothermia: 18-42%  Kangaroo Mother Care (low birth weight): incidence of infection 51% (7-75%)  Community based pneumonia case management 27% (18-35%) Post natal interventions meeting criteria for efficacy for reducing all cause neonatal mortality/major risk factors

12. Birth Asphyxia Birth Asphyxia –  Major cause of “Mortality” and “Stillbirth”  Major cause of short and long term morbidity  Substantially treatable Estimated Deaths due to Birth Asphyxia in India is 3 lacs/yr

13.  Till now focus is on live born infants only; stillbirths have largely been overlooked.  However, these deaths matter too – they matter to the mother and the family, to the society and to the health care system.

14.  Estimated no. of still births in India are 1 million  More than one third of stillbirths take place intrapartum, i.e. during delivery, and are largely preventable by the same interventions.  In Dahanu, India, the stillbirth rate dropped from 18.6% to 9% with introduction of a TBA training program in neonatal resuscitation; Similar findings from Fatehpur, Belgaum India,

15. 1 million children who survive birth asphyxia each year go onto suffer cerebral palsy and other disabilities

16.  17 M Births Per Year  Infant MR – 29.7/1000 LB  Most Deaths Occur in First Day  20-30% Birth Asphyxia  High Rate of Survivors with CP 199K/Yr Disabled 0-6, 11/1000 LB China Disabled Person’s Found 2003

17.  Low 5 minute Apgar ( Birth Asphyxia) Decreased 60%  Mortality in delivery room Decreased by 40% Courtesy: Keenan W J for providing the slide

18.  In rural Gadchiroli India interventions by the trained VHW in basic newborn resuscitation reduced case fatality in severe asphyxia by nearly 50% and asphyxia specific mortality rate by 65% in comparison to management by TBA alone* *Bang AT. Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitation with mouth-to-mouth, tube-mask or bag- mask. J Perinat 2005; S82-91.

19. Impact of Neonatal Resuscitation RegionExpected Changes References India31%Ann Trop Peds China66%Singapore MJ US39-72%Pediatrics Africa38%Expert Estimate Courtesy: Keenan W J for providing the slide

20. Evaluation Of training- pre-test and post-test Knowledge by; Written Evaluation

21. Evaluation Of training- pre-test and post- test Skills by Performance Evaluation

22.  A new programme on Basic Newborn Care and Resuscitation, has been launched nationally by GoI to address important interventions of care at birth Navjaat Shishu Suraksha Karyakram (NSSK) GOI and IA P have signed a MoU for training

23.  One trained person at Every Delivery  A sustainable system of training, retraining, certification  Follow up/ Monitoring of training  Operational Research  Study impact on mortality

24. Care at birth and newborn care Care of newborn at birth -W armth -Resuscitation if needed -Initiation of breast feeding -Identifying LBW and high risk babies (prematurity) Community PHC CHC District Hospital Specialist Medical officer Nurse ANM ProviderServices Navjaat Shishu Suraksha Karyakram Program PRIVATE SECTOR NSSK GOI FGMNSSK for Pvt. Sector FGM : NSSK for Pvt. Sector

25. How many newborns could be saved?

26. Lives can be saved now If the all essential interventions in “The Lancet Newborn Survival series” reached 90% of Indian women and babies then 36-67% of newborn deaths could be prevented Additional cost of $1.39 per capita per year

27. NFHS 3: Trends in Delivery Care Percent

28.  If we train more than 90% health personnel attending institutional deliveries (41%) in essential interventions,an estimated 15 – 30 % reduction in NMR can be expected  There will be greater impact in states with higher neonatal mortality

29. As government officials to lead As policymakers to guarantee essential interventions and equity As partners and donors to support programmes As health workers to provide high quality care and as humans to advocate for India’s newborns, mothers an children

30. Not only a project.. But …… …. a mission First Golden Minute Project

31. It’s a long road ahead... But Challenge is to ensure that every newborn counts THANK YOU