Newborn Thesis Neel Kamal 102802004

7/30/2019 Newborn Thesis Neel Kamal 102802004

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A Dissertation Submitted to Manipal University in

Partial Fulfilment for the Award of

AUGUST 2012

By

Neel Kamal BPT, FAGE

Under the guidence of

Dr. Ramachandra KamathProfessor and Head

Department of Public Health

Manipal University

Co-guides

Dr. Leonard Machado, MD Dr. Lesley Lewis, DCH, DNB

Associate Professor Professor

Department of Public Health Department of Paediatrics

Manipal University Manipal University


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Certificate

This is to certify that the Reserch Project entitled Availability of Neonatal

care Services in Udupi Taluk - A Cross-Sectional Study prepared by

Neel Kamal (102802004) under our supervision in partial fulfilment of the

requirement for Masters in Public Health, Manipal University has not

previously formed the basis for the award of any Degree or Diploma by this or

any other University and that, this work is a record of the candidates personal

work.

Guide



Date: / / 2012

Place: Manipal

Co-guides


Associate professor Professor

Depart of Public Health Department of Paediatrics


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Certificate


Date: / /2012 Date: / /2012

Place: Manipal Place: Manipal

This is to certify that the dissertation entitled, Availability of Neonatal

care Services in Udupi Taluk, Karnataka, India is a bonafide work

done by Neel Kamal in the Department of Public Health, Manipal University,

under our direct supervision and guidance.

Guide



Date: / / 2012

Place: Manipal

Co-guides


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Associate professor Professor

Depart of Public Health Department of Paediatrics


Date: / / 2012 Date: / / 2012

Place: Manipal Place: Manipal

DECLARATION

I hereby declare that the project entitled a study on Availability of Neonatal

care Services in Udupi Taluk, Karnataka, India has been submitted during

the year 2012-2013 under the valuable guidance and supervision of

Dr. Ramachandra Kamath, Professor and Head, Department of Public

Health in partial fulfilment of the requirements of the Master of Public Health

(MPH) degree of Manipal University. Further I extend my declaration that this

report is my original work and has not previously formed the basis for the award

of any degree or diploma.


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I am also gratified by the kind support from my colleague Smiksha Babbar.

Last but not the least I affectionately thank my family and friends for their prayers,

inspiration, guidance and support and to the God Almighty for everything and more.

Neel Kamal

CONTENTS

CHAPTER NO. CONTENTS PAGE NO:

1 Introduction 11-15

2 Aim and Objectives 16-17

3 Literature Review 18-24

4 Materials and Methods 25-28

5 Results and Discussion 29-57

6 Summary 58-59

7 Conclusions 60-61

8 Limitations 62-63

9 References 64-66


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10 Appendix 67-94

TABLES AND FIGURE

TABLES & FIGURE DESCRIPTIONS PAGE NO.

Table: 1 Types of Health Care Facilities 29

Figure: 1Distribution of Health Care Facilities 29

Tables: 2 Newborn Care Services 30

Table: 3AInfrastructure for Newborn Care 34

Table: 3B

Infrastructure for Newborn Care 35

Table: 3CInfrastructure for Newborn Care 35

Table: 4AEquipment for Management: 39

Table: 4BEquipment for Monitoring 40

Table: 4CEquipment for Investigation 42

Table: 4DEquipment for Resuscitation 44

Table: 4E Equipment for Disinfection 45

Table: 5A Human Resource for Newborn Care 49

Table: 5B Human Recourses with Training status 51


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Table: 6 Records of deliveries from last 3-months 54

Table: 7 Registers maintained for Newborns 55

LIST OF ABBREVIATIONS

NMR: Neonatal Mortality Rate

IMR: Infant Mortality Rate

MDGS: Millennium Developmental Goals

U5MR: Under Five Mortality Rate

SRS: Sample Registration System

LBW: Low Birth Weight

NBCC: Newborn Care Corner

NBSU: Newborn Stabilization Unit

SNCU: Special Newborn Care Unit

NICU: Neonatal Intensive Care Unit

CSSM: Child Survival & Safe Motherhood

RCH: Reproductive and Child Health

IMNCI: Integrated Management of Neonatal & Childhood Illness

F-IMNCI: Facility Based IMNCI

SC: Sub-Centre

PHC: Primary Health Centre

CHC: Community Health Centre

FRU: First Referral Unit

DH: District Hospital


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PH: Private Hospital

ENBC: Essential Newborn Care

FBNC: Facility Based Newborn Care

UNICEF: United Nation International Children Emergency Fund

TT: Tetanus Toxoid

IRC: International Rescue Committee

BEMOC: Basic Emergency Obstetric Care

EMOC: Emergency Obstetric Care

NGOS: Non-Governmental Organizations

AVD: Assisted Vaginal Deliveries

HCPS: Health Care Facilities

NNF: National Neonatal Forum

EAG: Empowered Action Group

IPHS: Indian Public Health Standard

OB/GYN: Obstetrician and Gynaecologist

OT: Operation Theatre

ECG: Electro Cardio Gram

24*7: 24 Hours Round The Clock

NSSK: Navjaath Shishu Suraksha Karyakram

SBA: Skilled Birth Attendant

ANM: Auxiliary Nurse Mid-Wife

MoHFW: Ministry of Health and Family Welfare

PIP: Project Implementation Plan

MCH: Maternal Child Health

NRHM: National Rural Health Mission


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HBNC: Home Based New born Care

GOI: Government of India

INTRODUCTION


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INTRODUCTION

Mortality rates are social indicators to determine the health status of any

country. Infant mortality is globally an important indicator of health as well as

standard of living of people in the community and the country 1 which indicates

the social and economic progress made by the nation and level of health care

available for the needy people. It also reflects the status of health programme &

policies implemented in the country2.

Though IMR is declining globally, but Neonatal mortality is being constant at

all levels. As compared to post neonatal infant deaths, there is 10-15 fold higher

risk of newborn dying in first month of life and neonates have approximately 30

fold greater risk of dying than young children (13-60 months). Inequality exists

for Neonatal mortality among various countries up to 30 folds, being highest in

sub-Saharan Africa. Though, regional average is low in Asia but it accounts for

almost 60% of global NMR. So, in order to get a sustained improvement for

neonatal health, care must be prioritized in these regions3.

To achieve Millennium Development Goal IV, Infant and Neonatal deaths

across the globe need to be reduced. Infant mortality showed an appreciable

decline during the 1980s and early 1990s. Thereafter, its pace of decline has

slackened considerably4. However, a special session was conducted to submit a

report for children in United Nations at New York in 2002, to high-lighten the

acceleration of MDGs for enduring child survival, Neonatal health

improvement, particularly in late foetal & neonatal period3.

Neonatal mortality accounts for almost 40% of under- five child mortality

worldwide i.e. four million deaths annually in the first month of life, out of

which, approximately 99% are occurring in low and middle income countries. 2

India contributes 20% of newborns to the World every year but accounts for 25-

30% of Neonatal deaths yearly and among those 45% die within first two days

of life5.

In India, nearly 50% of under-five (U5) mortality is contributed by Neonatal

deaths. Currently, Infant mortality rate of India is 50 per 1000 live births 5. Since,


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last many years, Neonatal mortality rate of India had been showing slow

decline, as in 2005, it was 37per 1000 live births (SRS 2005) and 34 (68%) per

1000 live births in 2009(SRS 2009); Whereas Karnatakas Infant mortality is 41

per 1000 live births4 and Neonatal mortality is 28.9(70.48%) per 1000 live

births6. Infant mortality of Udupi district is 8 per 1000 live births followed by

neonatal mortality of 4.5 (56.25%) per 1000 live births.7

So, from the above mentioned situation, we can infer that today also a greater

proportion of Infant deaths are accounted by neonatal deaths at all levels. A

review of ages at death during the first 28 days of life reveals that two-third of

deaths occur in the first week of life and two-third of these within the first 2

days of life4.

The major causes of death during this period are birth asphyxia, trauma,

problems related to low birth weight (LBW) (such as hypothermia, respiratory

problems, feeding and peri-partum infections) and malformations. Most of these

problems occur due to inadequate care during the antenatal period and during

labour. Inadequate care immediately after birth and inadequate care of LBW

infants within the first 48 hours may be contributing to the rest4. So, it is

important to focus on newborn care to sustain reduction in IMR & U5MR and

strengthening the care of sick, premature, LBW newborn at various levels of

health facility since birth through Neonatal period (0-28 days of life specially).

Hence, facility based newborn care at NBCC; NBSU & SNCU at all levels of

health system needs more attention8.

In India, several effective, low-cost interventions are being implemented

through various health programs like Child Survival and Safe Motherhood

(CSSM) Programme started in 1992 and Reproductive and Child Health (RCH)

Programme started in 1997. In the RCH II (2005), the IMNCI had been

incorporated in 359 Districts of India from 2010, as a major package for

intervention enabling the facilities to provide effective service to children and

neonates. By providing services through existing health facilities i.e.; PHCs,

CHCs/FRUs and District Hospitals, Essential newborn care (ENBC) and

Newborn Care Corner (NBCC) through facility based Neonatal care (F-IMNCI)

incorporated with integrated management of neonatal & childhood illness


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initiative (IMNCI) programme is expected to improve Neonatal survival.

Provision of newborn care at various levels of health facilities helps in

increasing the confidence of the community as well as the coverage of the health

services especially at the time of great emergency that is early days of life5.

Guidelines issued by Ministry of Health and Family Welfare, Govt. of

India/UNICEF toolkit for setting up SCNUs (special care newborn unit),

NBSUs (Newborn Stabilization unit), NBCCs (Newborn care corner) at District

Hospitals/Govt. Medical colleges and Hospitals, FRUs, 24*7 PHCs respectively

have been referred for establishing these facilities9.

Moreover, Siddarth Ramji has mentioned in his report on Newborn and Child

health in India: Problems and Interventions that there is a need to evaluate the

capacity of the health system and implementation of IMNCI and also

engagement of the health professionals at peripheral level to halve Neonatal

mortality and development, implementation, and monitoring of national action

plans for neonatal survival can be set as priority4.

Quality is one of the most important issues while child health concerned. Inspite

of approaching health care facilities, millions of children who need attention in

their sickness couldnt get an average level of care. Primary & secondary care

for newborn in low income or developing countries is lacking in terms of

availability of infrastructure, Human resources, basic laboratory services, drugs,

equipment & supply which makes health professionals to treat these children

with available resources10.

Though, the best possible newborn health care infrastructure is hard to

overcome several challenges regarding newborn care in terms of availability of

newborn care facility, adequate manpower, equipment & supply, yet regular

supervision and monitoring can be focused on to get better outcomes11.

Since independence, there has been a great expansion of health services through

Primary Health Centres (PHCs), Community Health Centres (CHCs) and Sub


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Centres (SCs) in India. Still the implementation and functioning of these

facilities according to the guidelines, is not up to the mark. This being so,

facility based newborn care is incorporated at primary, secondary and tertiary

levels.

Since the last 30 years, there has been significant progress in the socio-economic

development of Karnataka state and it seems to have achieved the expected

demographic goals. Udupi district in Karnataka has Infant mortality rate of 8 per

1000 live births. This is a good indicator for this district in Karnataka with

respect to other Districts and since many decades this may be a challenge for

other Districts to achieve this status. As compared to state Infant Mortality Rate

of 41 per 1000 live births (SRS2009) and country comparison of 50 per 1000

live births (SRS 2009), Udupi has a quite low IMR. Though infant mortality is

declining but the Neonatal mortality is being constant during last 10 years.

During April 2010 to March 2011, out of all infant deaths (118), Neonatal

deaths were (67) 56.77% and out of total Neonatal deaths, (52) 77.61% died

between 0-7Days7.

Moreover, a recent study in Udupi district explained that Neonatal deaths (55%)

were more as compared to post neonatal deaths (45%). Study also explained

about direct causes of mortality such as birth asphyxia (43%) was the most

common cause in early Neonatal period, sepsis (30%) contributed in late

neonatal period followed by pneumonia (13%) & prematurity (13%) whereas;

40% infants had LBW (less than 2 kg). If we look at other aspect, the same

study also focuses on indirect causes of infant mortality such as women literacy

rate of 93%, 81% registered pregnancies before 12 weeks, all mothers received

100% 2- dose of TT vaccine, & also recommended dose of Iron, folic acid &

calcium tablet, 64% were full term pregnancy, 60% had normal deliveries, 97%

institutional deliveries with 97% infants delivered by doctors, which is really

appreciable in Udupi district2

If above mentioned causes (direct) are looked carefully, it can be seen that most

of these are preventable8 despite of having support to indirect causes at greater

extent in Udupi district2. Since, implementation of facility based newborn care


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in Karnataka has already been incorporated in the health system; it can be

assumed that other causes may include gaps in availability or utilization of

resources through various levels of health care facility for newborn care.

However, valid & reliable information can give a good impact for decision

makers to undertake any intervention to improve effectiveness of the

programme; such information may be helpful for a district as well as

community. It may also give a better perception for any program planners, field

managers, researchers, field staff and organizations in the country for the

development of the programs. The external evaluation may help to find out

actual need of the program to improve its coverage at broader aspect and also to

get unbiased outcome for program managers20.

Not many studies were conducted in this regard, therefore limited literature was

available. As such, Facility based newborn care is also a new concept and the

Government of Karnataka is now looking on the same. Hence, it can be

expected that this study may contribute to knowledge in terms of Infrastructure,

Human resources, Health characteristics, Material resources, Record system &

transport facilities for Neonatal care in Udupi district.


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AIM AND OBJECTIVES

AIM

To assess the current situation of Neonatal care services in Udupi Taluk,

Karnataka.


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OBJECTIVES

Primary objectives:

To identify the available Neonatal care facilities in government &

private sectors.

To assess Human resources available for Neonatal care.

To assess the Infrastructure & Equipment available for Neonatal

care.

Secondary objective:

To find out records and registers maintained for Neonatal care.


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LITERATURE REVIEW

Global scenario:

Charles Opondo et al. (2009) 12

A study was conducted in eight first-referral level hospitals in Kenya to assess

the availability of essential basic care to newborns through direct observation,

using a checklist and self- administered questionnaire for the health care

workers. It was found that there was often lack of maintenance of safe hygienic

environment in the hospitals, poorly organized and insufficient staffing to

support the provision of care. Patient management guidelines were missing in all

sites and some key equipment, laboratory tests, drugs and consumables were not

available thus, providing insufficient newborn care.

Casey et al. (2009) 13

The study was conducted by international rescue committee (IRC) and CARE as

baseline assessments of public hospitals to evaluate their capacity to meet the

reproductive needs of the local population to determine the availability,

utilization and quality of reproductive services including emergency obstetric

care and family planning in nine general referral hospitals of democratic

republic of Congo. The information was attained through interviews,


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observations & clinical records review. It was found that most of the facilities

had shortage of staff, essential equipment, supplies and weak referral system.

Moreover, the facilities had poor infection prevention and poor monitoring of

reproductive health services related to EmOC.

Eugene J. et al. (2008) 14

Survey was conducted in all 73 health care facilities (13 hospitals and 60 health

centres) providing maternity services in central region of Malawi to establish

baseline for availability, utilization and quality of maternal and neonatal health

care services. They found that, there was a shortage of qualified staff, equipment

and supply in some facilities. Though there were adequate health facilities butthere was unequal distribution of the services.

Mike English et al. (lancet 2004, 364: 1622-29) 15

A cross sectional study to investigate the provision of paediatric care in

government district hospitals in terms of outcome of admission, infrastructure

resources, and views of hospitals staffs and caretakers of admitted children in 14

first referral level hospitals from seven of eight provinces in Kenya. It was

found that the basic laboratory services were available in at least 12 hospitals

but the bilirubin test was rarely found. Proper availability of drugs for

malnutrition, newborn feeds and anti- infective drugs were available at 11

hospitals. The staffs views regarding infrastructure and human consumable

resources indicated their dissatisfaction with the physical environment around

them.

Koyejo Oyerinde et al. (2011) 16

A needs assessment related cross-sectional study was conducted for emergency

obstetric care (EMoC) to address the maternal mortality indices. The study

included all public, private, mission and non-governmental organizations

(NGOs) hospitals providing maternal and child health services. Locally adapted

tool for data collection developed by Avertis maternal death and disability

program was used. It was found that there was adequate EmOC but it was


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poorly distributed. No hospital could be traced with basic EmOC and only few

facilities were able to provide assisted vaginal deliveries (AVD). In addition,

there was severe shortage of staff, equipment and supplies.

Youn-g Mi Kim et al. (2009) 17

A cross-sectional study was conducted in seventy eight first line referral

facilities of Afghanistan with the objective to assess the availability & utilization

of emergency obstetric and neonatal care (EMoC) facilities as defined by UN

indicators. After the study it was found that 42% of the peripheral health

facilities did not have sufficient facility to provide or deliver comprehensive

emergency obstetric and neonatal care (EMoNC) facilities and 31% of the

facilities were lacking for equipments & supplies and 77% of the facilities cited

lack of human resources. Services like c-sections were provided in 33% of

CHCs, 76% of district hospitals and all regional hospitals. Facility of blood

transfusion was reported from 33% of CHCs, 62% of district hospitals and

regional hospitals.

Charles Ameh et al. (2009) 18

A study was conducted in Somalia to provide and evaluate in service training in

(life saving skills) emergency obstructive & newborn care in order to improve

the availability of (EmoNC) in Somaliland. A total 222 health care providers

(HCPs) were trained within span of two years. Both quantitative and qualitative

methods were used for before and after evaluation of trainee reaction and

change, in knowledge, skills and behavior in addition to functionality of health

care facilities. It was found that training impacted positively on the availability

and quality of EmoNC and resulted in up skill of midwives performing skills of

medical doctors. But the lack of drugs, supplies, medical equipment and supply

policy were identified as barriers to use of new skills and knowledge acquired.


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Indian scenario:

Biswas A B et al. (2011) 19

A study was conducted in twelve first referral units of 6 Districts in West-

Bengal to assess the status of maternal and newborn care through record review,

interviews and observations using pre-designed proforma. The results showed

that there was inadequate infrastructure facilities (e.g. no sanctioned post of

specialist, no blood bank at rural hospital) and poor utilization of equipment like

neonatal resuscitation sets, radiant warmer, lack of training of service providers

were evident. Records/ registers were available but incomplete & referral

services were found to be almost non-existent. It was also reported that most of

the deliveries and immediate neonatal resuscitation was done by nurses (94.9%)

13.

B. Neogi Sutapa et al. (2011) 5

A cross- sectional study was conducted to assess the functioning of SNCU

(special newborn care unit) and availability of human resources, equipment and

quality care based on secondary data and cross sectional survey in 8 rural

districts of India that had been functioning for at least one year. The rate of

mortality among admitted neonates was taken as the key outcome to assess the

performance of the unit. It was found that the units had varying nurse to bed

ratio (1:05 to 1:1.3). Inadequate repair and maintenance of the equipment and

lack of human resources was also reported.

Srivastava V. K et al. (2009) 20

Another study was conducted for Rapid Assessment of Essential Newborn Care

Services and Rural Health Needs in National Mission Priority States of India to

see the availability of essential newborn care services and providers knowledge

and skills related to their provision in facilities at all levels of the government

health system.

The study was carried out in 10 states covering 11 districts including both EAG

and non-EAG districts. Out of 11 districts, seven had received training underNNF (in NNF districts) while four did not receive such training (in non NNF


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districts). It found that Essential newborn care infrastructure and laboratory

services were far from adequate at DHs and CHCs. PHCs were grossly deficient

for newborn care and Essential newborn care equipment was available in the

majority of DHs but CHCs and PHCs were not adequately equipped. Essential

drugs and supplies were available in most of the DHs. DHs had a pediatrician

compared to one-third of the CHCs. Staff nurses for essential newborn care

functions were available in almost all DHs and CHCs and one-half of the PHCs.

The doctors posted at DHs were more skilled compared to those posted at CHCs

and PHCs. No DH reported offering referral services since all facilities reported

providing complete essential newborn care services. The transport for referral of

patients to a higher-level health facility was available in a large number of the

CHCs and approximately half of the PHCs. Poor implementation of the program

were cited as the main reason for poor performance of the program by most of

the policy planners and state level program managers. Inadequate funds to

upgrade existing infrastructure was another reason given for the state of

newborn care services14.

Paul V.Ket al. (2000) 21

A survey was conducted in three states of India namely, Orissa, Himachal

Pradesh and Haryana. The study was carried out at district, sub-district and

primary health centres to assess status of neonatal care at these facilities. In

Orissa, the district and sub-district hospitals had median 100 and 30 deliveries

per month respectively. The study also found that most of these deliveries were

carried out by nurses and not by doctors. Neonates were generally kept for a day

in these facilities for supervision. Whereas; primary health centres seldom

admitted a sick neonate and rarely conducted any deliveries. Most of Caesarean

section deliveries were conducted at district hospital only.

D. K. Guha (1989) 22

A study was conducted on the existing facilities and concept of newborn care. A

questionnaire was sent to 135 hospitals. Most of the nurseries were found with

inadequate infrastructure for space. The nurse: baby and doctor: baby ratios
http://www.ncbi.nlm.nih.gov/pubmed?term=Paul%20VK%5BAuthor%5D&cauthor=true&cauthor_uid=10885212http://www.ncbi.nlm.nih.gov/pubmed?term=Paul%20VK%5BAuthor%5D&cauthor=true&cauthor_uid=10885212


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were improper as per recommended. Most of the NSCUs were found to have

gaps in maintenance of asepsis environment. Equipment, like incubators and

phototherapy units were inadequate. The higher morbidity and mortality was

among the LBW babies, those belonging to 1000-1500grms group.

P. R. Sodani (2011) 23

Another study was conducted in 13 community health centres of Bharathpur

District of Rajasthan, India. The main objective of study was to find out the

availability of infrastructure facility, human resources, laboratory service and

facility based newborn care service according to Indian public health standards

(IPHS). The process of data collection methods was through well- structured

questionnaire filled by service providers. Availability of infrastructure was

found to be adequate in most of CHCs but there was shortage of human

resource especially specialists. It was also observed that none of community

health centres were fully equipped to carry out facility based newborn care

service including newborn care corner (NBCC) and newborn stabilization unit

(NBSU).

Forhad Akhtar Zaman et al. (2008) 24

A cross-sectional study was carried out to find out and compare to what extent

the Indian Public Health Standards (IPHS) were followed by the PHCs of

selected EAG and non EAG states (Assam and Karnataka respectively). It was

found that all PHCs were rendering assured services of OPD, 24 hour general

emergency services and referral services but 24 hour delivery services were

provided by 80% of PHCs. Functional labor rooms were available in 90% of

PHCs and basic lab. services in 80% of them. So, the study revealed few

important deficiencies as per IPHS norms in the PHCs visited.


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Karnataka scenario:

Rao Arathi P (2011) 2

A study conducted on causes of infant mortality in Udupi District showed

Neonatal mortality of 56% of total Infant deaths, explaining that out of all places

of deliveries, 97.2% were institutional based, 30.8% of them were delivered in

private nursing homes, 20.6% were delivered in taluk hospitals, government

tertiary hospitals and private tertiary hospitals and 4.7% were delivered in health

centres (PHCs/CHCs). Out of the personnel who conducted the delivery, 97.2%

were doctors. So, after focusing on the study results, it can be assumed that there

may be lack of facility towards newborn care and trained health personnel as

well as some constraint towards availability of infrastructure and utilization to

carry out new born essential care specially immediately after birth(0-7 days) 2.

C M Lakshmanaet al. (2010) 25

A District wise analysis was done to take stock of overall healthcare

infrastructure for children in all 29 districts of Karnataka. It was found that

there were no permanent doctors at child outpatient departments in four districts.

Sixteen out of 53 posts of paediatrics were vacant. Only 5 districts had adequate

beds for children. NICU was found to be non-existent in eight districts including

Udupi. Medical equipment like fibre optics, ultrasound and microscope were

found non-existent in few of the districts. 25.


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MATERIALS AND METHODS

Study area:

Public and Private Hospitals in Udupi taluk.

District Hospital

Community Health centres

Primary Health centres


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Private Hospitals

Health Care Facilities, Udupi Taluk, Karnataka, India. Neel kamal. [internet].

[Cited 2012.August 14]. Available from:

https://maps.google.co.in/maps/ms?

msid=208588570602665024468.0004c72065bc4adb25dfb&msa=0&ll=13.37

0915,74.793549&spn=0.538431,1.347198

Study design:

Cross-sectional study.

Study population:

Public and Private Health care facilities providing delivery services in Udupi

taluk.

Sampling technique:

Complete enumeration of government & private hospitals in Udupi taluk.

Total hospitals in Udupi Taluk= 48 [(Government=26) & (Private=22)]

Total hospitals in Udupi taluk providing delivery services = 44

[(Government=26) & (Private= 18)]

Total hospitals (44 from Udupi taluk)

--------------------------------------------------------------------

Government hospitals Private hospitals

(26) (18)
https://maps.google.co.in/maps/ms?msid=208588570602665024468.0004c72065bc4adb25dfb&msa=0&ll=13.370915,74.793549&spn=0.538431,1.347198https://maps.google.co.in/maps/ms?msid=208588570602665024468.0004c72065bc4adb25dfb&msa=0&ll=13.370915,74.793549&spn=0.538431,1.347198https://maps.google.co.in/maps/ms?msid=208588570602665024468.0004c72065bc4adb25dfb&msa=0&ll=13.370915,74.793549&spn=0.538431,1.347198https://maps.google.co.in/maps/ms?msid=208588570602665024468.0004c72065bc4adb25dfb&msa=0&ll=13.370915,74.793549&spn=0.538431,1.347198https://maps.google.co.in/maps/ms?msid=208588570602665024468.0004c72065bc4adb25dfb&msa=0&ll=13.370915,74.793549&spn=0.538431,1.347198https://maps.google.co.in/maps/ms?msid=208588570602665024468.0004c72065bc4adb25dfb&msa=0&ll=13.370915,74.793549&spn=0.538431,1.347198


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PHCs District hospital CHCs

(22) (1) (3)

Inclusion criteria:

All the PHCs, CHCs, District Hospital and Private Hospitals providing delivery

services in Udupi Taluk.

Study period:

The study was conducted from March 2012 to August 2012.

Study tools:

Standard checklist for Newborn care facility assessment. (Facility based

Newborn care operational guide 2011, MoHFW, GOI)

Data collection methods:

(1) Site assessment.

(2) Interview with head of the institution or the in charge of heath care facility.

(3) Reviewing the records/registers.

Site assessment:

The process based on observation of:

Infrastructure, Equipment & supply.

Interview:

To collect information on available facilities for Newborn care.


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Human resources with their training status for providing Newborn care

services.

Reviewing the records/registers

To collect information on newborn care indicators.

Data analysis:

Analysis has been done using SPSS 15 version. Data has been expressed in

frequency and percentage.

Ethical consideration:

The proposal was approved by Institutional Ethics Committee, Kasturba

Medical Hospital, Manipal.

Written permission from District Health officer (DHO), Udupi for

Primary Health centres and Community Health centres.

Written permission from District surgeon, Udupi for District (MCH)

Hospital.

Request letter from Indian Medical Association (IMA) President, Udupi

District for Private Hospitals.


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RESULTS AND

DISCUSSION

RESULTS AND DISCUSSION


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In the overall planning of facility based care, it is important to understand the

level of care that can be provided at the various facility levels. The present study

aimed to assess the availability of infrastructure, equipment, supply and Human

resource in all Health care facilities providing delivery services in Udupi Taluk.

Table 1: Types of Health care Facilities in Udupi Taluk

Types of Health Facilities Frequency (N) Percentage (%)

Primary Health Centres (PHCs)

Community Health Centres (CHCs)

District Hospital (DH)

Private Hospitals (PHs)

22

3

1

17

51.1

6.9

2.3

39.5

Total 43100

The table above shows the distribution of Health care facilities in Udupi taluk.Among the facilities visited, there were twenty two Primary Health Centres,

three Community Health Centres, one District Hospital and seventeen Private

Hospitals.

Figure: 1


33/105

Tables 2: Table -Newborn Care Services:

S.NO VARIABLESCATEGORIES

TYPES OF HEALTH FACILITIES

PrimaryHealth Centre

(22)

N (%)

CommunityHealth Centre

(3)

N (%)

DistrictHospital

(1)

N (%)

1.

Is there 24hrs duty roster

observed andStaff present on-site?

Yes1 (4.5) 3 (100.0) 1 (100.0) 1

2.

Which type of delivery

services does the hospitalprovide?

No deliveryservice 3 (13.6) 0 (.0) 0 (.0)

Only Normal 19 (86.3) 3 (100.0) 0 (.0)

Normal, Manual,

Assisted and

C-section

0 (.0) 0 (.0) 1 (100.0) 1

3.

Does the hospital provide

essential newborn care

services?Yes

14 (63.6) 3 (100.0) 1 (100.0) 1

4.


referral services?Yes

22 (100.0) 3 (100.0) 1 (100.0) 1

5.

Does the hospital havefunctional ambulance or

other vehicle on site of

Referral?

Yes 3 (13.6) 2 (66.7) 1 (100.0)

6.


24hr coverage for deliveryand newborn care?

No 24 hr coverage 5 (22.7) 0 (.0) 0 (.0)

Only deliveries 16 (72.7) 0 (.0) 0 (.0)

both deliveries

and newborn care 1 (4.5) 3 (100.0) 1 (100.0) 1

7.

Is the person skilled inconducting deliveries

present at hospital or on call24-hrs a day including

weekend, to providedelivery care?

No skilled persons

observed 5 (22.7) 0 (.0) 0 (.0)

Yes present,schedule observed 1 (4.5) 0 (.0) 1 (100.0)

Yes, on call,schedule observed 16 (72.7) 3 (100.0) 0 (.0)

8.

Who attends the

complicated delivery at

hospital?

Obstetrician 0 (.0) 1 (33.3) 1 (100.0)

Obstetrician andPaediatrician 0 (.0) 0 (.0) 0 (.0)

Referred to higherservices 22 (100.0) 2 (66.7) 0 (.0)

9.Is there any post-partum

care offered at the hospital? Yes20 (90.9) 3 (100.0) 1 (100.0) 1

10.Does hospital immunizes

newborns?Yes 22 (100.0) 3 (100.0) 1 (100.0)

11.Does hospital have essential

laboratory services?Yes 22 (100.0) 3 (100.0) 1 (100.0)

12.Does hospital have blood

transfusion service?Yes Not applicable Not applicable 1 (100.0)


34/105


35/105

Private Hospital (PHs)

All Private Hospitals have 24*7coverage with staff present with

observed duty roster.

But only 53% of Hospitals have skilled staff present for conducting

deliveries 24hours including weekend whereas; 47% of hospitals have on

call facilities for same.

All Private Hospitals have facilities to conduct deliveries in term of

normal as well as complicated.

All Private Hospitals provide referral, essential newborn care and post-

partum services but immunization services are unavailable in 23% PHs

and onsite vehicle not present in 29% PHs.

Two Private Hospitals do not have essential lab. services and one is

without blood transfusion facility.

Koyejo Oyerinde et al.16found that no hospital could be traced with basic EmOC

and only few facilities were able to provide assisted vaginal deliveries (AVD)

among public, private, mission and non-governmental organizations (NGOs)

hospitals providing maternal and child health services.

Youn-g Mi Kim et al.17also reportedthat 42% of the peripheral health facilities

did not have sufficient facility to provide or deliver comprehensive emergency

obstetric and Neonatal care (EMoNC) facilities and services like C-sections

were provided in 33% of CHCs, 76% of District Hospitals and all regional

hospitals of Afghanistan.


36/105


37/105

Tables 3A: Table Infrastructure for Newborn Care

S.NO VARIABLES


Primary Health

Centre

(22)

Community Health

Centre

(3)

District

Hospital

(1)

Private

Hospita

(16)

Quantity N (%) Quantity N (%) N Quantity

1. Total no. of beds

0 1 (4.5)

30 3 (100.0) 79

15-50

1-3 10 (45.5) 51-100

4-6 11 (50.0) >100

2.

No. ofmaternity/postnatal

Beds

0 15 (68.2) 5 1(33.3)

50

0

1-3 6 (27.3) 6 1(33.3) 1-20

4 1 (4.5) 12 1(33.3) 21-40

3.No of newborn

beds

0 20 (90.9) 0 1(33.3)

29

0

1-4

1 2 (9.1) 1-6 2 (66.7)5-8

12

4. No. of labor room 1 22 (100.0) 1 3 (100.0) 1

1 1

2

5. No. of OT NA 1 3 (100.0) 1

1

2

3

6.No. of postnatal

ward NA 13 (100.0) 2

0

1 1

7. NBCC 1 1(4.5) 1 3 (100.0) 10

1 1

8. SNCU / NICU NA NA 1

0 1

1


38/105

In the table above, one Private Hospital has been excluded as it is a Medical College & Teaching

Hospital with maximum no. of beds.

Tables 3B: Table- Infrastructure for Newborn Care

S.NO VARIABLES CATEGORIES


Primary Health

Centre

(22)

N (%)

Community

Health Centre

(3)

N (%)

District

Hospital

(1)

N (%)

Pr

H

N

1.

Where is the deliveryand neonatal

equipment located?

Labor Room 16 (72.7) 3 (100.0) 1 (100.0) 8

Others 6 (27.3) 0 (.0) 0 (.0) 9

2.Does the hospital

have adequate light? Yes 18 (88.1) 3 (100.0) 1 (100.0) 17

3.

Which type of power

backup does thehospital have?

No powerbackup 5 (22.7) 1 (33.3) 0 (.0) 0

Generator 1 (4.5) 1 (33.3) 1 (100.0) 17

Inverter 16 (72.7) 1 (33.3) 0 (.0) 0

4.

Which type of water

source does thehospital have?

Open-well 5 (22.7) 1 (33.3) 0 (.0) 3

Bore-well 3 (13.6) 2 (66.7) 0 (.0) 1

Panchayat 9 (40.9) 0 (.0) 0 (.0) 1

Mix 5 (22.7) 0 (.0) 1 (100.0) 12


39/105

Tables 3C: Table - Infrastructure for Newborn Care



District Hospital

(1)

N (%)

Private Hospital

(17)

N (%)

1.Area for Hand

washing Yes 1 (100.0) 17(100.0)

2.Area for mixing IV

fluid Yes 1 (100.0) 17(100.0)

3.

Area for boiling &

autoclaving Yes 1 (100.0) 15 (80.2)

4. Area for laundry Yes 1 (100.0) 17(100.0)

5. Clean utility area Yes 1 (100.0) 17(100.0)

6. Soiled utility area Yes 1 (100.0) 16 (94.1)

7. Store room Yes 1 (100.0) 17 (100.0)

8. Side lab Yes 0 (.0) 2 (11.1)


Fifty percent of the PHCs are 4-6 bedded and one PHC has no beds.

Twenty seven percent of PHCs have 1-3 maternity beds and 68% PHCs

have not allotted any maternity beds whereas; only two PHCs are with

one Newborn bed. This can be explained as due to poor demand of the

services because most of the people prefer District and Private Hospitals

for birth of their children.

All PHCs have one labor room each but NBCC is available only in one

PHC.

Seventy three per cent of PHCs have placed the delivery and Neonatal

equipment in labor room whereas other 27% have kept in other than

labor room.


40/105

Adequate light for examination is available in 88% PHCs.

Seventy three per cent PHCs use invertor whereas 28% are without any

power backup.

Primary Health Centres utilize water from different sources with 41%

using water from Panchayat source.


All Community Health Centres are thirty bedded with two CHCs having

5-6 maternity beds each and only one CHC with no bed for the

Newborns.

Designated area for one labor room, OT and one NBCC each available in

all CHCs.

All CHCs have placed delivery & neonatal equipment in labor room with

adequate light for examination.

One Community Health Centre has no power back up and water source

for two CHCs is from bore-well.


District Hospital has 50 maternity beds and 29 newborn beds.

Designated area for labor room, OT, NBCC in labor room, postnatal

ward and a separate SNCU available in District Hospitals.

Delivery and neonatal equipment are placed in labor room with adequate

light for examination.

District Hospital uses Generator as power backup and has multiple

sources for water supply.


41/105

District Hospital has a separate ancillary area each for hand washing, IV

fluid mixing, autoclaving, utility and store room but no side lab.


Nineteen per cent PHs are without maternity beds and 31.3% are without

newborn beds.

All Private Hospitals have designated area for labor room and OT.

Eighty seven per cent of PHs has one post natal ward each and 69% have

one NBCC in labor room but NICU is unavailable in 69% of PHs.

Delivery and Neonatal equipment are placed in labor room with

adequate light for examination in all PHs.

All Private Hospitals use Generator as power backup and 71% use

multiple sources for water supply.

All Private Hospitals have separate ancillary area each for hand washing,

IV fluid mixing, autoclaving, utility and store room but side lab was

present only in two Private Hospitals.

According to the guidelines on Facility Based Newborn Care (2011) formulated

by Ministry of Health and Family Welfare, Government of India, Newborn Care

Corner is mandatory for all health care facilities where deliveries are conducted

and SNCU is deemed compulsory at District level and above. The study

revealed that all health facilities visited provided delivery services except four


42/105

PHCs but NBCC and SNCU/NICU services were available only at District

Hospital and few Private Hospitals (35%).

Casey et al. (2009)13 found that the facilities had poor infrastructure, infection

prevention and poor monitoring of reproductive health services related to EmOC

in a study conducted by International Rescue Committee (IRC) and CARE as

baseline assessments of public hospitals to determine the availability, utilization

and quality of reproductive services in nine general referral hospitals of

democratic republic of Congo.

Sutapa Neogi et al.5 findings concluded that the SNCUs visited in eight rural

districts of India had availability but inadequate repair and maintenance of

equipment and lack of Human resources. So, more research is still required to

evaluate the quality and monitoring of the health care facilities for a satisfactory

conclusion and planning of the programs and policies for newborn care in the

taluk.


43/105

Tables 4A: Table Equipment for Management:

S.NO VARIABLES



(22)

Community Health

centres(3)

District

Hospital(1)

Private

Hospitals(16)

Quantity N (%) Quantity N (%) N Quantity N (%)

1. Radiant warmer

0 21 (95.5) 1 2 (66.7)

9

0 6 (37.5)

1 1 (4.5) 2 1 (33.3)

1-3 9 (56.2)

5 1 (6.3)

2.Phototherapy unitsingle head high

Intensity

NA

0 2 (66.7)

6

0 1 (6.3)

2 1 (33.3)

1-2 11 (68.7)

4 4 (25.0)

3. Incubator NA NA 0

0 9 (56.2)

1 6 (37.5)

2 1 (6.3)

In the table above one Private Hospital has been excluded as it was Medical College &

Teaching Hospital had maximum number of Equipment.


Though 19 PHCs conduct deliveries (on call) but radiant warmer is

available in only one PHC.



44/105

Three radiant warmers are required in each CHC but two CHCs have one

radiant warmer each and one CHC with two radiant warmers only.

One phototherapy unit is required in each CHC but two CHCs did not

have the same.


District Hospital has nine radiant warmers, six phototherapy units and no

incubator.


Sixty nine percent Private Hospitals have radiant warmers, 94% have

phototherapy unit and 47% have incubator.

Tables 4B: Table - Equipment for Monitoring:

S.NO VARIABLES



(22)

Community Health

centres

(3)

District

Hospital

(1)

Private

Hospitals

(16)


1. Baby weighing scale 1 22 (100.0) 1 3 (100.0) 11 10 (62.5)

2 6 (37.5)

2. Thermometer 1 22 (100.0) 1 3(100.0) 8

1-3 12 (75.0)

4-6 4 (25.0)

3. Pulse oximeter NA NA 6

0 1 (6.3)

1-2 12 (75.0)

3 3 (18.7)

4. Stethoscope Neonates NA NA 13

0 1 (6.3)

1-3 12 (75.0)

4-5 3 (18.7)

5. Sphygmomanometer NA NA 1

0 2 (12.5)

1 5 (31.3)

2 9 (56.2)

6. Vital sign monitor NA NA 1

0 2 (12.5)

1 9 (56.2)2 5 (31.3)


45/105


Teaching Hospital with maximum number of Equipment.


All PHCs have one mechanical baby weighing scale and one

thermometer each.


All Community Health Centres have one electronic baby weighing scale

and one thermometer each but four thermometers are required in each

CHC.


District Hospital has one electronic baby weighing scale in SNCU, eight

thermometers, six pulse oximeters, thirteen neonate stethoscopes, one

sphygmomanometer and one vital sign monitor but four electronic baby

weighing scales, twelve thermometers and six sphygmomanometers are

required.


Fifty nine percent Private Hospitals have one baby weighing scale each

and 41% have two each.


46/105

Seventy percent of Private Hospitals have atleast one thermometer each

and 30% have atleast 4 thermometers each.

Seventy percent of Private Hospitals have atleast one pulse oximeter and

one thermometer each and 30% have three of both each.

Twenty nine percent Private Hospitals have one sphygmomanometer

each and 59% have atleast two each.

Fifty three percent of Private Hospitals have one vital sign monitor each

and 35% have atleast five each.

Tables 4C: Table- Equipment for Investigation:

S.NO VARIABLES



(22)

Community Health

centres

(3)

District

Hospital

(1)

Private

Hospitals

(16)


1.

Centrifuge,

hematocrit

benchtop, up to12000 rpm,

including rotator

0 1 (4.5) 1 2 (66.7)

2

0 2 (12.5)

1 21 (95.5) 2 1(33.3)1 5 (31.3)2 9 (56.2)


47/105

2. Microscope

1 21 (95.5) 1 2 (66.7)

2

0 2 (12.5)

2 1 (4.5) 2 1 (33.3)1-2 8 (50.0)

2-3 6 (37.5)

3.Bilirubinometer,total bilirubin,

capillary based

0 20 (90.9) 0 2 (66.7)1

0 7 (43.8)

1 2 (9.1) 1 1 (33.3) 1 9 (56.2)

4. Glucometer

0 3 (13.6) 1 2 (66.7)

2

0 2 (12.5)

1 19 (86.4) 2 1 (33.3)1-2 13 (81.2)

6 1 (6.3)

5. ECG unit portable NA NA 0 0 3 (18.7)

1 9 (56.2)

2 5 (31.3)

6. X-ray mobile NA NA 00 5 (31.3)

1 11 (68.7)

In the table above one Private Hospital has been excluded as it was Medical College

& Teaching Hospital had maximum number of Equipment.


Ninety five percent PHCs have one centrifuge and one microscope each.

Eighty six percent have one glucometer each but 91% of PHCs do not

have bilirubinometer.


All CHCs have atleast one centrifuge, one microscope and one

glucometer each but bilirubinometer is not available in two CHCs.


District Hospital has two centrifuges, two microscopes; two glucometer

(three required) and one bilirubinometer but no portable ECG (desired)

and mobile X-ray (desired) could be traced.


48/105


Fifty nine percent of Private Hospitals have atleast two centrifuges and

two PHs do not have it.

Forty seven percent of PHs have atleast one microscope each and 41%

have atleast two microscopes each.

Fifty-nine per cent have atleast one bilirubinometer and 81% have atleast

one glucometer.

Eighty eight percent have portable ECG unit and 69% have mobile X-ray

facility.


49/105

Tables 4D: Table- Equipment for Resuscitation:

S.NO VARIABLES



(22)

Community Health

centres

(3)

District

Hospital

(1)

Privat

Hospit

(16)

Quantity N (%) Quantity N (%) N Quantity

1.Resuscitator, hand

operated 500ml

0 18 (81.8)

0 3 (100.0) 11 1

1 3 (13.6)

2 1 (4.5) 2

2.Resuscitator, hand

operated 250ml

0 11 (50.0)1 3 (100.0) 4

1 1

1 11 (50.0) 2

3.Pump suction, foot

operated

0 8 (36.4) 1 2 (66.7)

1

0 1

1 13 (59.1)2 1 (33.3) 1

2 1 (4.5)

4.Suction pump

portable,

220v.w/access

NA 0 3 (100.0) 21 1

2-4

5.Laryngoscope sets,

NeonatesNA

1 2 (66.7)5

1-2 1

2 1 (33.3) 3-4




Fifty per cent of the PHCs have at least one 250ml resuscitator each and

one foot operated pump suction was available in 60% of PHCs each


50/105

whereas; resuscitator 500ml is available (1 required in each PHC) only in

18% of PHCs.


All CHCs have atleast one 250ml resuscitator each and one pump-

suction foot operated each. Whereas; resuscitator 500ml is not available

(2 required in each CHC) in any of CHCs.


District Hospitals has four resuscitator 250ml, one foot operated suction,

two portable suction pumps and five laryngoscope sets.


All PHs have at least one resuscitator 250ml, one portable suction pump

and one laryngoscope set each but foot operated suction is available only

in 31% PHs.

Tables 4E: Table- Equipment for Disinfection:

S.NO VARIABLES



(22)

Community Health

centres

(3)

District

Hospital

(1)

Private

Hospitals

(16)


1.Syringe hub cutter

1 17 (77.3) 2 1 (33.3)1

0 9 (56.3)

2-5 5 (22.7) 3 2 (66.7) 1 7 (43.7)

2.Sterilizing drum

165mm diameter

1 21 (95.5)1 3 (100.0) 5

1-3 4 (25.0)

2 1 (4.5) 4-6 12 (75.0)

3. Electric sterilizer

0 2 (9.1)

1 3 (100.0) 0

0 3 (18.7)

1 20 (90.9)1 11 (68.8)

2 2 (12.5)

4. Gowns

0 3 (13.6) 6 2 (66.7)

25

1-10 7 (43.7)

3 19 (86.4) 9 3 (33.3)11-20 7 (43.7)

21-30 2 (12.5)

5. Washable slippers 0 6 (27.3) 2 1 (33.3) 12 1-6 7 (43.7)1-3 13(59.1) 3 1 (33.3) 7-12 7 (43.7)


51/105

4 3 (13.6) 4 1 (33.3) >=20 2 (12.5)

6. Washing machine 0 22 (100.0) 0 3 (100.0) 10 8 (50.0)

1 8 (50.0)




All PHCs have at least one syringe hub cutter, one sterilizing drum and

one electric sterilizer each.

Gowns and washable slippers were not available in three and six PHCs

respectively.


All Community Health Centres have one sterilizing drum, one electric

sterilizer and atleast six gowns each.


District Hospital has one syringe hub cutter, five sterilizing drums, 25

gowns and 12 washable slippers but no electric sterilizer because it has

separate autoclave facility.



52/105

Twenty four percent Private Hospitals have atleast one sterilizing drum

each and 76% have atleast four each.

Syringe hub cutter is unavailable in 53% of PHs because waste disposal

is handled by a local based company.

All Private Hospitals have electric sterilizer, gowns and washable

slippers except no electric sterilizer in three private hospitals as these

hospitals have separate autoclaving facilities.

General Equipment:

Four syringe pumps were available in District Hospital whereas 62.5%

of Private Hospitals did not have any syringe pump. In addition, surgical

instruments were found in all Private Hospitals as well as District

Hospital.


53/105

All health care facilities had one computer with printer each except 20%

Private Hospitals.

All health care facilities were equipped with atleast one refrigerator,

stabilizer and wall clock each. In addition, air conditioner was not

present in any CHC and 12.5% of PHs.

Sixty nine percent of Private Hospitals were lacking with infanotometer

plexi and no room heater was available in any of health facilities except

one Private Hospital.

Measuring tape, kidney basin, dressing tray and infusion stand were

available in District Hospital and all Private Hospitals.

Spot lamp was available in two CHCs, District Hospital and all Private

Hospitals.

Charles Opondo et al12 also found lack of hygienic environment and some key

equipment in first referral units of Kenya, which is also a developing country.

Sara E Casey et al13 also reported shortage of equipment, essential drugs and

poor infection prevention in public hospitals of Congo.


54/105

A B Biswas et al19 showed that there was inadequate infrastructure facilities (e.g.

no sanctioned post of specialist, no blood bank at rural hospital) and poor

utilization of equipment like neonatal resuscitation sets, radiant warmer, lack of

training of service providers were evident. It was also reported that most of the

deliveries and immediate Neonatal resuscitation was done by nurses (94.9%) 19

in first referral level hospitals in six Districts of West Bengal.

Neogi Sutapa et al. (2011) 5 also reported inadequate repair and maintenance of

the equipment in eight rural districts of India. Most of the NSCUs were found to

have gaps in maintenance of asepsis environment.

D. K. Guha (1989) 22 reported that equipment, like incubators and phototherapy

units were inadequate in most of the health facilities.

Srivastava V. K et al. (2009) 20 found that Essential newborn care equipment was

available in the majority of DHs but CHCs and PHCs were not adequately

equipped. Essential drugs and supplies were available in most of the DHs. Poor

implementation of the program were cited as the main reason for poor

performance of the program by most of the policy planners and state level

program managers in eleven Districts of India.


55/105

Tables 5A: Table - Human Resource for Newborn Care


56/105

In the table above one Private Hospital has been as it was Medical College & Teaching Hospital

with maximum number of Human Recourses.


S.NO VARIABLES


Primary Health

Centre

(22)

Community Health

Centre

(3)

District

Hospital

(1)

Private

Hospital

(16)

Quantity N (%) Quantity N (%) N (%) Quantity N (%)

1 Paediatrician

Permanent NA 1 1 (33.3) 2 (100.0) 10 7 (43.7)

Contractual NA 0 (0) 0 (.0) 25 9 (56.3)

2. OB/GYN

Permanent NA 1 1 (33.3) 1 (100.0)

0 4 (25.0)

1 10 (62.5)

2-5 2 (12.5)

Contractual NA 0 (.0) 0 (.0)

0 7 (43.7)

1 4 (25.0)

2-4 5 (31.3)

1. Medical

officers

Permanent 21 21(95.5) 3 3 (100.0) 0 (0)0 3 (18.7)

1-5 13 (81.3)

Contractual 1 1 (4.5) 0 (0) 3 (100.0)0 15 (93.7)

4 1 (6.3)

2. Staff nurse

Permanent 10 10(45.5)14 3 (100.0)

0 (0)

4-8 10 (62.5)

9-16 5 (31.2)

24 1 (6.2)

Contractual 4 2 (9.1) 4 2 (66.7) 12 (100.0) 0 (0) 0 (0)

4.Lab.

Technician

Permanent 20 20(90.9) 3 3 (100.0) 1 (100.0) 36 14 (87.5)

Contractual 2 2 (9.1) 0 (.0) 0 (.0) 0 2 (12.5)

5. Data manager

Permanent 0 (.0) 3 3 (100.0) 1 (100.0) 24 13 (81.2)

Contractual 0 (.0) 0 (.0) 0 (.0) 0 3 (18.7)

6.Supporting

staff

Permanent 23 17(77.3) 10 3 (100.0) 4 (100.0) 73 15 (93.7)

Contractual 6 5 (22.7) 0 (.0) 0 (.0) 15 1 (6.2)


57/105


58/105

Three Private Hospitals do not have Medical officers and all PHs have

permanent staff nurses working in the hospitals.

All PHs have permanent Lab. technicians, Data manager and supporting

staff.

Tables 5B: Table - Human Recourses with Training status

CODES FOR TRAINING STATUS DAYS OF TRAINING ATTENDED

A. IMNCI: for medical officer/ staff nurse 8 Days

B. F-IMNCI: for medical officer/ staff nurse 11 Days

C. NSSK: for medical officer/ staff nurse/ANM 2 Days

D. Facility based newborn care: for medicalofficer/staff nurse posted in SNCU

3 Days

E. SBA for ANMs/LHVs & Staff nurse 2-3 Days

F. SBA/BEmOC for Medical officer 9 Days

G. Observership 2 Weeks

H. Neonatology 3 months

S.NO VARIABLES

TRAINING STATUS

N

o

T

r

a

i

n

i

n

g

B C F B

&

C

B

&

F

C

&

F

E

&

G

B

,

C

&

G

B

,

C

&

F

B

,

E

&

G

B

,

C

&

D

C

,

E

&

G

C

,

E

&

F

PHC

(22)Medicalofficers

Permanent(21)

2 3 0 2 9 3 0 0 0 1 0 1 0 0

Contractual

(1)1 0 0 0 0 0 0 0 0 0 0 0 0 0

Staff

nurse

Permanent(10)

1 1 0 0 1 0 0 0 1 0 2 0 0 0

Contractual(4)

1 0 0 0 0 0 0 2 0 0 0 0 0 0

CHC

(3)

Medical

officers

Permanent

(3)0 0 0 1 0 0 1 0 0 1 0 0 0 0

Staffnurse Permanent(14) 0 0 1 0 2 0 0 2 0 0 3 0 3 0


59/105

Contractual(4)

0 0 0 0 0 0 0 0 0 0 1 0 2 0

In the District hospital, out of 3 only 1 Medical Officer and all 12 staff

nurses were trained in Neonatology.

In all Private Hospitals, neither Medical officers nor Staff nurses were

trained, except two Paediatricians trained with one year fellowship in

Neonatology.


Most of the Medical officers in PHCs were trained with F-IMNCI and

NSSK.

Staff nurses in most of the PHCs were trained with F-IMNCI, NSSK,

SBA and observer-ship.


In all CHCs, Medical officers were trained with BEmOC and NSSK.


In the District Hospital, out of 3 only one Medical Officer and all 12

staff nurses were trained in Neonatology for 3 months.


In all Private Hospitals, neither Medical officers nor Staff nurses were

trained, except two paediatricians trained with one year fellowship in

Neonatology.


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Sara E Casey et al.13 also reported shortage of staff in public hospitals of Congo.

Charles Opondo reported that there was often lack of poorly organized and

insufficient staffing to support the provision of care at eight first referral level

hospitals in Kenya.

Charles Ahmeh et al.18 evaluated the baseline and after training, performance

and confidence of the Human resource for emergency obstetric and Newborn

care (lifesaving skills). They concluded that though there was improvement in

confidence, knowledge and skills of the trained staff but the training of the staff

alone cant contribute sufficiently to obstetric and newborn care if there is

inadequacy of the equipment, supply and drugs. Moreover, sufficiently available

infrastructures, equipment, supply and Human resource can be left unused if the

staffs are not trained with the knowledge and skills required for obstetric and

Newborn care.

In addition, Koyejo Oyerinde et al.16 reported that there was severe shortage of

staff, equipment and supplies in his study.

Youn-g Mi Kim et al.17 found that 77% of the facilities cited lack of Human

resources in first referral level Hospitals in Afghanistan.

Biswas A B et al.19reported that most of the deliveries and immediate Neonatal

resuscitation was done by nurses (94.9%)in six Districts of West Bengal.

Neogi Sutapa et al.5 cited lack of Human resources in 8 rural Districts of India.

Srivastava V. K et al.

20

found that

DHs had a paediatrician compared to one-thirdof the CHCs. Staff nurses for essential newborn care functions were available in


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almost all DHs and CHCs and one-half of the PHCs. The doctors posted at DHs

were more skilled compared to those posted at CHCs and PHCs in 11 Districts

of India whereas; C M Lakshmanaet al.25 cited sixteen out of 53 vacant posts of

paediatrics in 29 districts of Karnataka.

Tables 6: Table Records of deliveries from last 3-months

S.NO VARIABLESTYPES OF HEALTH FACILITIES

District Hospital

(1)

Private Hospital

(15)

N (%) N (%) COUNT N (%)

1.

Normal/ Assisted

deliveries 414 (65.0) 391 (60.6)

0 1 (6.6)

1-50 12 (80.0)

51-100 1 (6.6)>100 1 (6.6)

2. C-section deliveries 219 (35.0) 255 (39.4)1-25 10 (66.7)

26-50 5 (33.3)

3. Total deliveries 633 646

1-50 10 (66.7)

51-100 4 (26.7)

>100 1 (6.6)

4. Total newborn deaths 6 51 3 (20.0)

2 1 (6.6)

5. Total live births 627 641

1-50 10 (66.6)

51-100 4 (26.7)

>100 1 (6.6)

In the table above two Private Hospitals have been excluded as they were Medical College& Teaching Hospitals with maximum number of deliveries.


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No PHC has conducted any deliveries in last three months except one

PHC with 12 normal deliveries and one PHC with one normal delivery.


Out of three CHCs, one conducted four normal deliveries and one CHC

conducted one normal delivery.


District Hospital has conducted 65% normal & 35% C-section deliverieswith neonatal mortality of 9.57 per 1000 live births in last three months.


Private hospitals have conducted 61% normal & 39% C-section

deliveries with neonatal mortality of 7.8% per 1000 live births in last

three months.

Tables 7: Table - Registers maintained for Newborns



Primary Health

Centre

(22)

N (%)

Community

Health Centre

(3)

N (%)

District

Hospital

(1)

N (%)

Priv

Hosp

(1

N (

1.Does the hospital

maintaindelivery and type

of birthregisters?

Yes 10 (45.5) 2 (66.7) 1 (100.0) 17 (10

2.Does the hospital

maintain OT

register?Yes 0 (0) 0 (0) 1 (100.0) 16 (9

3.Does the hospital

maintainnewborn

register?

Yes 6 (27.3) 0 (0) 1 (100.0) 5 (29

4.Does the hospital

maintain wardregister? Yes 12 (54.5) 3 (100.0) 1 (100.0) 14 (8


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5.Does the hospital

maintain

monthlyreports/HMIS?

Yes 20 (90.9%) 3 (100.0) 1 (100.0) 16 (9

6.Does the hospital

maintain labor

room register?

Yes 11 (50.0) 3 (100.0) 1 (100.0) 17 (10

7.Does the hospital

maintain birthregister?

Yes 7 (31.8) 1 (33.3) 1 (100.0) 10 (5

8.Does the hospital

maintain

neonatal deathregister?

Yes 12 (54.5) 1 (33.3) 1 (100.0) 6 (35

9.Does the hospitalmaintain circular

issue?Yes 20 (90.9) 3 (100.0) 1 (100.0) 17 (10

10.Does the hospital

maintainpartogram?

Yes 10 (45.5) 3 (100.0) 1 (100.0) 4 (23

11.Does the hospital

maintain birth

charts?Yes 17 (77.3) 3 (100.0) 1 (100.0%) 4 (23

The table above shows that:

All registers enlisted in the checklist were available and maintained by

District Hospital and two Private Hospitals only.

Delivery and type of birth register, ward register, Neonatal death register

and partogram were maintained by only 50% of PHCs, all CHCs andmost of the Private Hospitals except neonatal death register and

partogram maintained only by few Private Hospitals (35.3% and 23.5%

respectively)

None of the PHCs and CHCs maintained OT register and 94% of Private

Hospitals maintained the same.


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SUMMARY

SUMMARY

Health services depend, to a large extent, on the availability of both Human

resources and properly equipped health facilities. Maternal and Newborn care

services particularly depend on health facilities with the equipment and skilled

staff to provide the essential lifesaving services required for mothers with

complicated deliveries and ill Newborns. Hence, this cross-sectional study was

conducted to assess the availability of Neonatal care services in terms ofinfrastructure, equipment and Human resource in all 43 Health care facilities


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providing delivery services in Udupi taluk of Karnataka. The data was collected

through site assessment using a standard checklist, interviews and review of

records and registers by the single investigator. Collected data was entered and

analysed separately according to the objectives, to produce the results in form of

categorised variables and respective percentages. It was found that only one

Primary Health Centre was working 24 hours and conducted maximum

deliveries in last three months. Though two CHCs had specialists but the

complicated deliveries were handled only by the District hospital and Private

Hospitals. However, satisfactory referral services, postpartum care,

immunization services and essential laboratory services were available in all the

health care facilities visited.

Infrastructure was observed to be available in most of the PHCs, CHCs, District

Hospital and Private Hospitals. Equipment for management and investigation

equipment were unavailable in most of the facilities. However, monitoring

equipment was found to be available in most of the health facilities visited.

Government health facilities had more availability of resuscitation equipment as

compared to the private hospitals. Equipment for disinfection were available in

most of the health care facilities except the syringe hub cutter being unavailable

in 50% of Private Hospitals. Syringe pump and infanotometer plexi were

unavailable in high percentage of Private Hospitals.

The permanent and trained staffs were available more in the government health

facilities than Private Hospitals. Through the records, it can be concluded that

most of the deliveries were normal and conducted in District Hospital and

Private Hospitals in last three months. Complete records and registers enlisted in

the checklist were available and maintained by only District Hospital and two

Private Hospitals.


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CONCLUSION

CONCLUSION


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The present study assessed all the forty three health care facilities providing

delivery services in Udupi taluk of Karnataka. Through the results of the survey

it was revealed that out of all 22 PHCs, only one was working 24x7 as it handled

the maximum deliveries among all Primary Health Centres in the Taluk. Though

out of three, two CHCs had specialists but complicated deliveries were handled

only by the District Hospital and Private Hospitals in the area. However,

satisfactory referral services, postpartum care, immunization services and

essential lab. Services were available in all the health care facilities visited. Only

six Primary Health Centres had allotted beds for mothers and Newborns as

compared to requirement in all of the centres.

Infrastructure in terms of no. of beds, equipment location, power back up and

water source, was observed to be available in most of the PHCs, CHCs, District

Hospital and Private Hospitals. Equipment for management of Newborns like

radiant warmers and phototherapy units and investigation equipment like

Bilirubinometerwere unavailable in most of the facilities. However, monitoring

equipment was found to be available in most of the health facilities visited.

Government facilities had more availability of resuscitation equipment as

compared to the Private Hospitals. Oxygenation facility deemed as very

important for Newborn care, was found in all health care facilities. Equipment

for disinfection were available in most of the health care facilities except the

syringe hub cutter being unavailable in 50% of Private Hospitals.

The permanent and trained staffs were available more in the government sector

than Private sector. Most of the deliveries were normal and conducted in District

hospital and Private Hospitals in last three months. Estimated Neonatal mortality

rate was found to be 9.57 per 1000 and 7.8 per 1000 in District Hospital and

Private Hospital respectively in last three months. Complete records and

registers enlisted in the checklist were available and maintained by only District

hospital and two private hospitals.

Hence, it can be concluded that the health care facilities providing delivery

services in Udupi taluk need to be strengthened and further research on the

quality of the available services is required for successful planning and

implementation of the measures planned.


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LIMITATIONS

All the private hospitals could not be covered as one private hospitals

authorities were not willing to participate in the study.

During data collection, some of the private hospitals did not allow to

observe the NICU area, therefore the collected information is based on

the interviews only.

The present study is cross-sectional therefore more of analytical studies

can provide with detailed information and associations.

Lastly, the present study focussed on the availability of neonatal care

services in the taluk. The quality of the available services can be further

assessed by continued research and thus, reliable conclusion can be

achieved.


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REFERENCES


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REFERENCES

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2. Rao A.P. Cause of Infant mortality in Udupi district a descriptive study [Maters

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Dept. of public Health: Manipal University; 2011.

3. Darmstadt G L, Lawn J Z, Costello A, Advancing the state of the Worlds

Newborns.

Bulletin of the World Health Organization 2003; 81 (4).

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Background PapersBurden of Disease in India. Available From

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Bg_P2

5. Sutapa B.N, Malhotra S, Zodpey S and Mohan P. Assessment of SpecialCare Newborn

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Ministry of health

and Family welfare, GOI; 2011

9. UNICEF: tool kit for setting up Special Care New Born Unit, Stabilization

Unit &

Newborn Care Corner.


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Walelign N et al.

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12. Opondo C, Ntoburi S, Wagai J, Wafula J, Wasunna A, Were F et al. Are

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status of

maternal and newborn care services in Sierra Leone 8 years after ceasefire.

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APPENDIX


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Annexure 2

Ethical Committee Approval Certificate

Steps March

2012

April 2012 May

2012

June

2012

July

2012

August

2012

Problem

selection

Review of

literature

Preparation of

research

proposal

Ethical

committee

clearance

Protocol

presentation

Data collection

Data Analysis

Submission of

first Draft

Submission of

final draft

Submission of

manuscript

Final

presentation

Final submission


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Annexure 3

Request letter from IMA President Udupi District


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Annexure 4

Permission Letter from District Health Officer (DHO) Udupi


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Annexure 5

QUESTIONNAIRE FOR PRIMARY HEALTH CENTRES


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Availability of Neonatal care facilities in Udupi Taluk, Karnataka

Checklist for Newborn facilities Survey:

SECTION 1

01. Types of health facility: Primary

Health centre

02. Date of the Assessment:

03. Name of facility Institution:

04. Location of the facility Institution:

...

Signature of In-charge


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SECTION: 2

AVAILABILITY OF NEWBORN CARE SERVICES

Yes No

05. Is there 24- hours delivery and newborn care coverage?

If yes, specify;

A. Yes 24-hours duty roster observed or staff present onsite

B. Yes 24-hours coverage but no duty roster observed & no staff present onsite

06. Does hospital provide following delivery service?

If yes, specify;

A. Normal deliveries B. Manual removal of Placenta

C. Assisted deliveries D. Caesarean section

(E.g. forceps/vacuum) (C- section) delivery

E. Administration of parental oxytocics/antibiotics/inj.

Magnesium sulphate/Management of PPH/others complications

07. Does hospital have essential newborn care services?If yes; specify

A. Resuscitation B. Thermal care

C. Breast feeding support services

08. Does the hospital provide referral services?

09. Does the hospital provide 24-coverage for delivery &newborn care

Services? If yes; specify

A. Only deliveries services B. Only newborn care services

C .Both deliveries & newborn care services

10. Is the person skilled in conducting deliveries present at the hospital or

on call 24-hours a day, including weekends, to provide delivery care?

A. Yes present, schedule observed B. Yes present, schedule reported, n

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