Assessment of Special Care Newborn Units in India

Abstract

The neonatal mortality rate in India is high and stagnant. Special Care Newborn Units (SCNUs) have been set up to provide quality level II newborn-care services in several district hospitals to meet this challenge. The units are located in some remotest districts where the burden of neonatal deaths is high, and access to special newborn care is poor. The study was conducted to assess the functioning of SCNUs in eight rural districts of India. The evaluation was based on an analysis of secondary data from the eight units that had been functioning for at least one year. A cross-sectional survey was also conducted to assess the availability of human resources, equipment, and quality care. Descriptive statistics were used for analyzing the inputs (resources) and outcomes (morbidity and mortality). The rate of mortality among admitted neonates was taken as the key outcome variable to assess the performance of the units. Chi-square test was used for analyzing the trend of case-fatality rate over a period of 3-5 years considering the first year of operationalization as the base. Correlation coefficients were estimated to understand the possible association of case-fatality rate with factors, such as bed:doctor ratio, bed:nurse ratio, average duration of stay, and bed occupancy rate, and the asepsis score was determined. The rates of admission increased from a median of 16.7 per 100 deliveries in 2008 to 19.5 per 100 deliveries in 2009. The case-fatality rate reduced from 4% to 40% within one year of their functioning. Proportional mortality due to sepsis and low birthweight (LBW) declined significantly over two years (LBW <2.5 kg). The major reasons for admission and the major causes of deaths were birth asphyxia, sepsis, and LBW/prematurity. The units had a varying nurse:bed ratio (1:0.5-1:1.3). The bed occupancy rate ranged from 28% to 155% (median 103%), and the average duration of stay ranged from two days to 15 days (median 4.75 days). Repair and maintenance of equipment were a major concern. It is possible to set up and manage quality SCNUs and improve the survival of newborns with LBW and sepsis in developing countries, although several challenges relating to human resources, maintenance of equipment, and maintenance of asepsis remain.

Assessment of Facility based newborn care at various health care facilities in Rajkot district

“…This study was shows that all 32(100%) NBCC were found partially functional as they were not follow five criteria for fully functional while in study chauhan et al in Bihar, India shows majority 39 (68.4%) of the NBCCs were partially functional and 5 (9%) NBCCs were nonfunctional at the time of the assessment. 10 This study revealed that some neonatal equipment were not available majority of health facility while in the study chauhan et al shows neonatal equipment were available and functional in most of the facilities and in study Neogi et al in Haryana, India shows Shortage of basic equipments and supplies at most of the special baby care units.…”

“…Pediatrician (20%) and MBBS medical officer (52%) were the least trained personnel on NSSK while in the study chauhan et al shows 66.4% medical officers, 72.7% SNs/ANMs, and 62.2% ancillary staff were trained. 10 In this study shows out of 101 health personnel, only 13 (14%) health care staff were able to provide proper resuscitation while chauhan et al revealed that 20% of the medical officers and 15% of the SNs/ANMs were not able to use essential newborn care equipment such as Ambu bag, radiant warmer, oxygen concentrator, and suction machine.…”

The cost and effective analysis of health care management of very low birth weight babies in rural areas of West Bengal, India

“…This is also corroborated by evidence from another study. 26 The basic approach of the study is to train the staff with minimum academic qualification and motivation for involvement of the work. These staff are specially trained for care of LBW and VLBW babies and they are given responsibility of these babies and no other work so that they become dedicated newborn worker.…”

Current status of neonatal intensive care in India

“…Neonates who require higher intensive care are referred to public sector specialty hospitals (teaching hospitals) or to private sector multispecialty hospitals. The first public SCNU was established in 2003, the resounding success of which has led to increased coverage to >150 districts; however, the actual number of beds is far less than what is required 2 12 13. A total of 507 SNCUs with 6408 beds were available across the country in late 2013 11 14.…”

“…The ideal nurse–patient ratio is 1:1 for ventilated babies and 1:3–4 for all other babies 16. There is a serious concern of understaffing in both government and private sectors; an analysis has shown that only 50% of units were adequately staffed 13. Many trained doctors/nurses do not wish to take further training in neonatal care, and many trained ones go abroad for better remuneration and career growth.…”