The cries of newborns have transitioned from moments of uncertainty to symbols of hope. In a significant stride towards improved healthcare, Tamil Nadu has witnessed a remarkable decline in its infant mortality rate over the past 10-12 years, reflecting concerted efforts and advancements in maternal and child healthcare.
Dr S Srinivasan, former State Child Health Nodal Officer, National Health Mission Tamil Nadu says, “Bringing down the infant mortality rate to a single digit, approximately 8.2 per 1,000 live births, is an achievement along with combined support and funding from the National Health Mission and Tamil Nadu government.” Former Union Health Secretary Sujata Rao shares that the drop in infant mortality rate (IMR) is not surprising as the state is and has been a frontrunner in providing reproductive child health (RCH) services. She adds, “High priority has been given to IMR and maternal mortality rate (MMR) reduction since 1985. Political support has been consistent, irrespective of the party they belong to. Tamil Nadu and Kerala are two states that distinctly stand apart on this issue.”
Focusing on newborn babies is an important factor in reducing the IMR, says Dr C Ravichandran, retired professor of paediatrics and current expert adviser, Child Health, National Health Mission, Tamil Nadu. “75% of infant deaths occur in newborn babies. If you want to bring down IMR, you have to focus on neonatal deaths. We have set up almost 86 special newborn care units (SNCUs) across the state in all districts as well as medical colleges. The medical colleges have neonatal intensive care units (NICUs). If the number of babies born is much higher in some districts, we may have two-three SNCUs there,” he says, adding that that the services are accessible and available round-the-clock.
The state also has been at the forefront of immunisation, focusing on vaccine-preventable diseases, especially in pre-term babies which are likely to get infected with pneumococcal diseases. “Tamil Nadu was one of the earliest states to introduce pneumococcal vaccine for pre-term babies. That has helped in the survival of the pre-terms,” says Ravichandran.
Dr Srinivasan says, “The government has given a lot of healthcare in the form of medical equipment. Facilities in the neonatal units can be compared with any corporate hospital. We have more than 300 ventilators and 300 CPAP machines. The feedback mechanisms at SNCU, where there is a meeting every 15 days have also helped in the improvement. Investing and improving neonatal transport has helped reduce mortality rates in villages in the state.”
After the care in the NICU, babies should be moved to their households or primary health centres, but further monitoring is also required. Dr Srinivasan says, “According to the IMR data, 70% died in the first 30 days and another 20% in the post-neonatal stage, two or three months after the delivery. There is very minimal death after three months. But monitoring them is important.” Once the babies have gained a sufficient weight or the mother has gained confidence, they are sent back to the community.
A lot needs to be done in the community, comments Dr Ravichandran.
He says, “Now, we have this home-based newborn care where anganwadi workers are also tracking all these babies, especially those who have been discharged from SNCU and the low birth weight babies. Focus has been on these two because these two are the ones that are the highest risk factor for morbidity and mortality in newborns.”
A national app (The Poshan Tracker) has been created with a module on newborn care. The babies are tracked and anganwadi workers are incentivised for it. Praising staff nurses, Dr Ravichandran says, “This is the only department where we have dedicated staff nurses, as they will not be posted anywhere other than newborn care.”
Dr Srinivasan adds that Facility Based Newborn Care Training has been efficient in training nurses and NGOs like Ekam Foundation have helped the state in the cause. He also mentions that there is a complete link system between Directorate of Public Health, Directorate of Medical and Rural Health Services and Directorate of Medical Education in the state which has strengthened the support.
Before 2009, the state did not have a separate newborn unit. Dr Ravichandran says, “All babies were in the general paediatric ward, except for Institute of Child Health (ICH), Chennai, which had its unit but it was not recognised as a department. The recognition of ICH as a neonatology department came about in 2009. Now, in almost all the medical colleges, we have a department of neonatology. The DM (Doctorate of Medicine) courses have helped in actually giving more skilled doctors.” Neonatology units are a huge administrative reform step, which has helped in reducing neonatal mortality, he adds.
Summarising the factors that led to the drop in the IMR, Dr Gagandeep Kang, retired professor, CMC Vellore, says, “Antenatal care allows for early identification of risk, referral, and appropriate management. A focus on the quality of care during labour means that complications can be identified and managed. Overall, an awareness of the need and stronger health systems result in decreased deaths and illnesses in mothers and their babies.”
Speaking about areas where the states can improve child welfare, Dr Ravichandran says, “I think the community is not exactly ready in India to receive pre-term, low birth weight babies. If you are looking at babies above 1.8 kg, the survival rates are very good. Between 1.2 kg to 1.8 kg, the survival rates can be improved upon because the community takes care of babies. So there needs to be a supportive environment. These babies will thrive quite well in the NICU because there is a supportive environment there. But identification of danger signs would be a constant source of support. We should focus on community-based kangaroo mother care (KMC) programmes. Importance should be given to mother’s health, conditions like anemia should be highlighted and given proper care.”