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2. Saving Newborn Lives in Uttar Pradesh CS-28 USAID Saving Newborn Lives in Uttar Pradesh through Improved Management of Birth Asphyxia: Situational Analysis Facility Readiness for Knowledge and Skill of Coverage of Emergency Obstetric Care Providers Interventions for and Newborn Care Mothers and Newborns 2014 Newborn and Maternal Health Care at Facilities in Gonda and Aligarh Districts of Uttar Pradesh T H E INCLEN T R U S T I NTERNATIONAL 1 CS-28 USAID Saving Newborn Lives in Uttar Pradesh through Improved Management of Birth Asphyxia: Situational Analysis Report Prepared by The INCLEN Trust International F1/5, Okhla Industrial Area, Phase I, New Delhi, India-110020 For Save The Children- Bal Raksha Bharat 2 Disclaimer: This report is made possible by the support of the American people through the United States Agency for International Development (USAID). The content of this document are the sole responsibility of The INCLEN Trust International and do not necessarily reflect the views of USAID or the United States Government or Save The Children. 3 ACKNOWLEDGEMENTS We are greatly indebted to the support and encouragement extended by the following partners Department of Medical Health and Family Welfare, Government of Uttar Pradesh District Health Officials, District Gonda and Aligarh. All the staff posted at selected health facilities in Aligarh and Gonda All stakeholders who agreed to share their perception and views about the maternal and new born care All the heads (Gram Pradhans/Sarpanchs/Ward Members) of selected clusters (villages/wards) for extending their help. All the mothers and their families for sparing their valuable time to answer the questions asked by the community assessment team. Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi Department of Community Medicine, Jawahar Lal Nehru Medical College, Aligarh Muslim University, Aligarh 4 INVESTIGATORS PRINCIPAL INVESTIGATOR Dr Manoj Kumar Das Director Projects The INCLEN Trust International New Delhi CO-INVESTIGATOR Ms Vaishali Deshmukh Program Officer The INCLEN Trust International New Delhi STATE INVESTIGATORs Prof S C Mohapatra Prof Najam Khalique Professor of Community Medicine Professor of Community Medicine Institute of Medical Sciences Jawaharlal Nehru Medical College Banaras Hindu University Aligarh Muslim University Varanasi, Uttar Pradesh Aligarh, Uttar Pradesh STATE CO-INVESTIGATOR Dr Anees Ahmad Associate Professor of Community Medicine Jawaharlal Nehru Medical College Aligarh Muslim University Aligarh, Uttar Pradesh CHIEF MENTOR Dr N K Arora Executive Director The INCLEN Trust International F1/5, Okhla Industrial Area Phase –I, New Delhi REPORT WRITING TEAM Dr Manoj Kumar Das Dr Ritesh Sharma 5 CENTRAL COORDINATING TEAM (CCT) MEMBERS Dr Sanjay Rai Dr Harish Chellani Associate professor Consultant & Associate Professor Department of Community Medicine Department of Pediatrics All India Institute of Medical Sciences Vardhman Mahavir Medical College & New Delhi Safdarjung Hospital, New Delhi Dr Renuka Sinha Dr Arti Maria Professor and Head, Associate Professor Department of Obstetrics and Gynecology, Department of Neonatology Rama Medical College, Ghaziabad Post Graduate Institute & RML Hospital, New Delhi Dr Amir Maroof Khan Dr Ashish Jain Assistant Professor, Assistant Professor, Department of Community Medicine, Department of Neonatology, University College of Medical Sciences, Maulana Azad Medical College, New Delhi New Delhi Dr Surender Bisht Dr Sushil Srivastava Senior Specialist, Pediatrics, Head of Paediatrics & Deputy CMS, SDN Hospital, Jag Pravesh Chandra Hospital, New Delhi Shastri Park, New Delhi Dr Ajay Dudeja Dr Sunita Bhatia Assistant Professor, Head of the Department, Pediatrics, Department of Pediatrics Kasturba Hospital, Lady Hardinge Medical College, Daryaganj, New Delhi New Delhi RESEARCH TEAM INCLEN EXECUTIVE OFFICE, NEW DELHI Dr. Ritesh Sharma Program Officer New Delhi Mr. Saurabh Bajpai Research Assistant 6 Field Team Members Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh (Gonda district) Name Designation Dr Hari Shankar Senior Investigator Dr Awdesh Kumar Senior Investigator Dr Braja Kishore Das Senior Investigator Dr Deepak Pippal Senior Investigator Dr Anil Baghel Senior Investigator Mr Ramakant Mishra Field Supervisor & Team Manager Mr Tej Bali Singh Field Supervisor Mr Inder Jeet Singh Field Supervisor Mr Darp Narayan Singh Field Supervisor Mr Madhu Shyam Field Supervisor Mr Ram Chandra Mishra Research Assistant Mr Swapnil Upadhyay Research Assistant Mr Sanjay Upadhyay Research Assistant Mr Atul Shukla Research Assistant Mr Omprakash Mishra Research Assistant Mr Shashi Kant Research Assistant Mr Navin Kumar Research Assistant Mr Anand Bihari Research Assistant Mr Ausaf Ahmad Research Assistant Mr Ardhundu Shekhar Mishra Research Assistant Mr Ravi Kumar Chaurasia Research Assistant Mr Kaushal Dubey Research Assistant Mr Piyush Mishra Research Assistant Mr Neeraj Sonkar Research Assistant Mr Manish Kumar Research Assistant Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh (Aligarh district) Name Designation Suyesh Shrivastava Senior Investigator Mohd Shibly Khan Senior Investigator Ashraf Ali Khan Field Supervisor Wasimullah Khan Research Assistant Mohd Maroof Senior Investigator S Nasir A Hashmi Research Assistant Humail Khan Senior Investigator Mohd Najmul Aqib Khan Senior Investigator Istiaq Ahmad Field Supervisor Mohammad Atif Research Assistant Samreen Khan Senior Investigator 7 Glossary AD syringes Auto Disable syringes AMU Aligarh Muslim University AMTSL Active management of Third Stage of Labour ANC Ante natal care ANMs Auxiliary Nurse Midwife ASHA Accredited Social Health Activist AWW Anganwadi Worker BCG Bacillus Calmette Guerin BF Breast Feeding BHU Banaras Hindu University BPL Below Poverty Line BP Blood Pressure CCT Central Coordinating Team CHC Community Health Centre CMO Chief Medical Officer DH District Hospital EAG Empowered Action Group ENC Essential Newborn Care FRUs. First Referral Unit GOI Government of India Hep B V Hepatitis B Vaccine HIV Human Immunodeficiency Virus HMSC Health Ministry Screening Committee ICMR Indian Council for Medical Research ID Identification IDIs In-depth interviews IFA Iron Folic Acid IMR Infant Mortality Rate IMS Institute of medical Sciences Inj Injections IPHS Indian Public Health Standard IV Intra Venous JLNMC Jawaharlal Nehru Medical College JSY Janani Suraksha Yojana KPC Knowledge Practice Coverage LBW Low Birth Weight LHV Lady Health Visitor NMR Neonatal Mortality Rate NB New Born NRHM National Rural Health Mission NSSK Navjaat Shishu Suraksha Karyakram OPV Oral Polio Vaccine 8 PHC Primary Health Centre PMTCT Prevention of Mother to Child Transmission PNC Post Natal Care PPC Post partum checkups PPH Post Partum Hemorrhage PPS Population proportionate to size PPV Positive Pressure Ventilation SBA Skilled Birth Attendants SC Sub centre SC Schedule Caste SDH Sub District Hospital ST Schedule Tribe TT Tetanus Toxoid U5MR Under-Five Mortality Rate UP Uttar Pradesh USAID United State Agency for International Development WHO World Health Organization 9 List of Contents Executive Summary 12 1. Introduction and background 1.1. Infant Mortality in India and Uttar Pradesh 15 1.2. Asphyxia as a cause of infant mortality in India and UP 15 1.3. Recent efforts by India 15 2. Context of this study 2.1. The overall package of the project 16 2.2. Phases of the project 16 2.3. The current study 17 3. Study Objectives 17 4. Methodology 4.1. Study design 18 4.2. Study Area 18 4.3. Sample size and selection 19 4.4. Study tools 20 4.5. Training of Study Teams 21 4.6. Survey implementation 22 4.7. Data management and analysis 23 4.8. Research ethics and regulatory approvals 23 4.9. Timeline 23 5. Health Facility Assessment Observations 5.1. Characteristics of the health facilities surveyed 24 5.2. Status of signal functions for maternal and newborn health service delivery 24 5.3. Infrastructure, availability of equipment and supplies 27 5.4. Manpower 29 5.5. Availability of guidelines and protocols 30 5.6. Supervision at health facilities 35 5.7. Availability of guidelines and protocols 36 5.8. Supervision at health facilities 36 6. Knowledge and skill assessment of service providers 6.1. Characteristics of health care providers participated in knowledge assessment 36 6.2. Knowledge level 37 6.3. Skill level 39 6.4. Observation of skill during conducting delivery 42 6.5. Knowledge-skill gap 43 7. Demonstration sites in Gonda 44 8. Community and household survey 8.1. Cluster characteristics 45 8.2. Characteristics of households and women 45 8.3. Care during pregnancy 46 8.4. Intra-partum care 50 10 8.5. Post-partum care 54 8.6. Neonatal morbidity and mortality 57 8.7. Characteristics of households with stillbirth 58 9. Discussion 61 10. Limitations 65 11. Next steps 65 12. References 66 13. Annexure 67 11 CS-28 USAID Saving Newborn Lives in Uttar Pradesh through Improved Management of Birth Asphyxia: Situational Analysis Executive Summary Newborn survival continues to be a challenge in India. With annual estimate of 779,000 newborn deaths, India leads the chart of global burden of newborn deaths. It is also estimated that a quarter of global still births occur in India, and the rates are higher in rural areas than urban. Newborn deaths contribute to 55% of all under-five deaths In India. Almost 50% of newborn deaths occur in the first day after birth and 19% are due to birth asphyxia. The Government of India’s Janani Suraksha Yojana (JSY) - a
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