Neonatal Mortality- A

Community Approach
Dr Neeraj
Dr Shankar
Dr Jalam Singh
Dr Devendra
Dr Sameer
Neonatal mortality rate

Neonatal mortality rate: The number of children

dying under 28 days of age divided by the number
of live births that year
Back ground
 44 countries mothers from the richest quintile are
three times more likely to have a birth attendant
than those in the poorest quintile
 In north India, three fifths of rural women do not
have any antenatal care
 four million infants die in the neonatal period, and
a similar number are stillborn

Reducing maternal and neonatal mortality in the poorest communities,Anthony Costello, David Osrin,
Dharma Manandhar, BMJ2004;329:1166doi:10.1136/bmj.329.7475.1166
 Primary causes of neonatal deaths in
India

Others
11% Diarrhoea
20%
Prematurity
8%

Asphyxia
10%

ARI
25%

Sepsis
26%

(Source: National Neonatology Forum

and Saving Newborn’s lives, 2004)
Early Childhood Mortality Rates
80 74

70
57
60

50
39
40

30
18 18
20

10

0
Ne onatal Pos tne onatal Infant Child Unde r-five
m ortality m ortality m ortality m ortality m ortality
Childhood Mortality Rates by Sex
90
79
80
70
70
58 56
60
50
41
40 37

30 23
21
20 15 14
10
0
Ne onatal Pos tne onatal Infant M ortality Child M ortality Unde r-five
M ortality M ortality M ortality

Fe m ale M ale
Infant Mortality Rates by Demographic
Characteristics

PREVIOUS BIRTH INTERVAL

< 2 ye ars 86
2 ye ars 50
3 ye ars 30
4 ye ars or m ore 37

BIRTH ORDER
1 64
2-3 47
4-6 62
7 or m ore 80

M OTHER'S AGE AT BIRTH

< 20 77
20-29 50
30-39 56
40-49 72

0 10 20 30 40 50 60 70 80 90 100
Infant Mortality Rates in India -
Rural Urban divide

120 119
114 114 114 114 113
110
107
105 105 104 105 104
102
100
97 98
96 95 94
91
86 87
85
Total
82 82 Rural
80 80 80 80 79 80 80
77 77 77
74 74 74 75 74 Urban
72 71 72 72
70 69
68
65 66 66
64
62 62 61 62
60 59 60
58
53 53 52
50
48
45 46 45 44 44
42
40 40

2
80

82

83

85

86

88

89

91

92

95

97

98

99
81

84

87

90

93

94

96

'0
'0

'0
19
Child Health strategy
Newborn &
Child Health

Care Prevn Tx
at

Immunization
& serious
birth
Tx illness
mild
illnessCommunity
Facility

Outpatient
Inpatient
Home

Home

Functioning Health System

BCC & Community mobilization

Some Approaches……
 Improving the health and nutrition of mothers-to-be
and providing quality reproductive health services
 improving access to antenatal care during pregnancy
 Improved management of normal delivery by skilled
attendants
 Access to emergency obstetric and neonatal care
(EmOC) when needed
 Timely post natal care for both mothers and
newborns
Community Approach
- The Essential Interventions
 Drying the newborn and keeping the baby warm.
 Initiating breastfeeding as soon as possible after
delivery and supporting the mother to breastfeed
exclusively.
 Giving special care to low-birth weight infants
 diagnosing and treating newborn problems like
asphyxia and sepsis.
Community Approach
- The Essential Interventions...
 Visit by Community health worker with follow up
(with in 24 Hr & 2-3 in 1st wk)
 Co-ordination of Community and Facility based
care
 intersect oral coordination with other departments
Ray of hope…..
 BCC & Community Mobilization
 Increasing partnership – Ownership and
accountability