factors after giving appropriate weights: 24-hour ... tice of handwashing after touching every baby (2), ...... unicef.org/india/SCNU_book1_April_6.pdf, accessed.
J HEALTH POPUL NUTR 2011 Oct;29(5):500-509 ISSN 1606-0997 | $ 5.00+0.20
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Assessment of Special Care Newborn Units in India Sutapa Bandyopadhyay Neogi1, Sumit Malhotra1, Sanjay Zodpey1, and Pavitra Mohan2 1
Indian Institute of Public Health–Delhi, Public Health Foundation of India, New Delhi, India and 2
United Nations Children’s Fund, India Country Office, New Delhi, 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 2,500 g at birth was 2.3 days. Infants who weighed >1,249 g had progressively shorter hospital stay (27).
Limitations Although the study was one of the initial ones to give an evidence of feasibility of operating these district-level units, yet it has its own limitations. The information collected was based on secondary data routinely obtained by the respective units triangulated by personal observations. Reporting of morbidities and mortalities is a concern owing to lack of uniform case definitions used in different units. Much of the outcomes could have been re508
lated to birthweight and inborn/outborn status but this could not be analyzed because of absence of case-based data. Moreover, data were made available till September 2009. These were compared with data of previous years which may not be very appropriate due to seasonal variations. Although we attempted to find out the possible factors that could be associated with the CFR, it was difficult to come to a meaningful conclusion due to the small sample-size. Despite these limitations, the assessment gives an insight into the potential challenges that might not have been captured during the routine monitoring.
Conclusions The SCNUs are a critical investment to curb the neonatal mortality rate in India. Not only these are difficult to establish but it is equally important to maintain their performance. Initial results in the form of reduction in the CFRs are encouraging but there are challenges that need to be looked into before it is scaled up. Having an adequate number of personnel, right policies to facilitate timely repair of equipment, provision of an adequate number of beds, and imparting skills to maintain asepsis are the key recommendations that will circumvent the existing challenges. Replicating such a technicallyintensive model, which involves a great deal of coordination and support of various agencies and the acceptability of the implementing authorities and health personnel, is a herculean task. It is pertinent to learn from the experiences, for us to establish the success of this model in diverse settings. It is hoped that lessons learnt from this assessment would assist in scaling up of such units with quality of newborn care facilities in other similar settings.
ACKNOWLEDGEMENTS The work was supported by funding from the UNICEF. The authors acknowledge the contribution of the In-charge of the hospitals and SCNUs in providing data, the district coordinators and project officers of UNICEF who helped retrieve the data from secondary sources. They are also thankful to Ms Alka Chadha, Consultant, PHFI, who helped in data collection, management, and report writing. There is no conflict of interest. PM is employed with the UNICEF. Views presented are of the authors and not of the organizations they represent.
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