Abstract of Dissertation

Keyword : ANM, New Born Care; Health Facilities; PHC, CHC, SC

Objective : • To observe the quality of care at Newborn Care Corner in four TSU focus blocks of Mirzapur district (Uttar Pradesh), and compare some parameters with FBNC Operational guidelines by Ministry of Health & Family Welfare. • To assess the knowledge of service provider (ANM & SN) regarding Newborn Health at the identified facilities.

Background : Newborn Care Corner (NBCC) is a space within the delivery room in any health facility where immediate care is provided to all newborns at birth. This area is mandatory for all health facilities where deliveries are conducted. This study will help in assessing Newborn care corner across the four TSU (Technical Supoort Unit) focus blocks of Mirzapur district on the basis of FBNC operational guidelines given by Ministry of Health and Family Welfare to identify the bottlenecks in functioning of NBCC. Four blocks were selected by TSU based on the high case load & low case load in the district. There are 69 delivery points in 4 TSU focus blocks. Out of 68, there are 52 SC, 9 PHC (L1), 3 PHC (L2), 3 CHC and one FRU-CHC. Ten Delivery points of each focus would be selected randomly. Knowledge of ANM’s at the identified NBCC’s will also be assessed on the basis of prepared questionnaire.

Methodology : This was an observational study (to assess NBCC based on checklist given by MoHFW) & descriptive cross sectional study (to assess the knowledge of ANM/SN posted at identified facilities). Simple random sampling was done. Ten Delivery point of four focus blocks were randomly selected. All ANM’s & SN’s of randomly selected delivery points were interviewed. Sample Size – 40 checklist for Facility Assessment & all SN/ANM’s (55) of identified selected were interviewed based on questionnaire.

Findings : Fifty three percent of the respondents were NSSK trained. 62 percent of the respondents said neonatal period is from birth to 28 days. When asked about the major causes of Neonatal Mortality, 54 percent said birth asphyxia, 82 percent said neonatal sepsis and 62 percent said prematurity. None of the SN or ANM have complete knowledge about Vit. K, its dose & route of administration. 78 percent ANM said they know how to manage Asphyxia, but when they were asked to demonstrate on dummy, only 7 percent were able to tell the correct technique to be followed with all the necessary steps mentioned in the interview manual. Knowledge of SN and ANM regarding danger signs of newborns was assessed. Eleven percent said grunting as the danger sign, 21 percent said Chest Indrawing, 14 percent said Fast Breathing, 21 percent said Nasal Flaring, 67 percent said Cyanosis, 78 percent said Hypothermia, 5 percent said Skin Pustules, 65 percent said Jaundice, 49 percent said Low birth weight and 51 percent said Baby not crying as the Danger signs in Newborns. About 89 percent of the respondents said they know about referral management of Newborns. When asked about signs & symptoms to refer newborns, 96 percent said newborn weighing less than 1800gms, 85 percent said premature newborns, 4 percent said Asphyxiated Newborn, 2 percent said Unstable newborn after Resuscitation, and none of them said Newborns with Blood infections. When asked about steps followed immediately after birth, about 82 percent of Service providers said Place Baby on mother’s Abdomen, 58 percent said Dry & cover mother & baby, 98 percent said Clamp and cut the cord, 87 percent said provide warmth, 94 percent said Early initiation of Breastfeeding and 62 percent said maintenance of Skin to skin contact. About 12 percent Delivery Points have Radiant Warmer, 65 percent have Bag and Mask, all have Baby weighing machine, 20 percent have IV Cannula, all have Mucous Extractor and Cord Clamp, 15 percent have towels for drying or wrapping the baby and 65 percent have sterile gloves. About 20 percent Delivery points have designated NBCC, with 20-30 ft space for Radiant Warmer, and only 12 percent delivery points have appropriate power connection for plugging for Radiant Warmer. About 62 percent delivery points have Electricity Supply, only 7 percent have power backup or generator and none of them have fuel in their generator. About 25 percent Delivery points have running water supply, none of them have elbow operated hand washing station. The results of the study may be useful in planning and developing suitable strategies for improving the quality of care at NBCC, which includes the knowledge of SN and ANM. This might include training as well as refresher training. Hence, there is a need to enhance the knowledge of SN and ANM, as well as need to equip the delivery points with better facilities, which will ultimately improve the quality of care & the outcomes.