Abstract of Dissertation

Keyword : Health facilities; Health personnel; Newborn care; Health Facilities; ENBC services

Objective : ï‚· To assess the current situation of ENBC services in Mandla district, (mp). ï‚· To assess the facilities for necessary infrastructure, human resources, and equipments for rendering ENBC services. ï‚· To assess the knowledge of service providers (ANM & SN) regarding essential newborn care at the identified facilities in Mandla district.

Background : India faces a formidable burden of neonatal deaths, and quality newborn care is essential for reducing the high neonatal mortality rate. Worldwide, out of the total 133 million live births, 3.7 million die in neonatal period. Another 3 million are stillborn. Ninety-eight percent of deaths take place in the developing world, where 90% of babies are born. Of these deaths, 76% or 3 million occur in early neonatal period. The risk of deaths in the neonatal period in developing countries is over 7 times greater than in developed countries. Also, most of the neonatal deaths occur in Asian countries, more notably in India, which accounts for more than a quarter of the global neonatal mortality. The current neonatal mortality rate (NMR) in India is 31 per 1,000 live births. Infections, birth asphyxia, and prematurity/low birth weight (LBW) are major causes of deaths within this period. Interventions combining resuscitation of newborn baby, breastfeeding, prevention and management of hypothermia and kangaroo mother care (KMC) can reduce NMR by more than half.

Methodology : ï‚· Study design-Observational and Descriptive study ï‚· Study Location – Mandla District (all nine blocks) ï‚· Study sample- All selected facilities will be assessed based on checklist and doctors, Staff nurse and ANMs will be randomly selected for knowledge assessment. ï‚· Sampling Method-Simple random sampling (DH, One CHC from each block, One PHC from each block, One SHC from each block) ï‚· Sample Size-Total no. of delivery points in Mandla district is 48. Out of 48, only 33 are functional. One DH, One functional CHC from each block, One functional PHC from each block, One functional SHC from each block will be randomly selected. So total 28 checklists for facility assessment and all available ANMs/SNs of identified selected DPs will be interviewed. ï‚· Method and Instruments- Checklist for facility assessment and Semi structured questionnaire through face to face interview

Findings : The assessments showed that most of the services related neonatal care rendered at DHs. Newborn care corners existed within or adjacent to the labour room in almost all the facilities and were largely unutilized spaces in most of the 16 facilities. Resuscitation bags and masks were available in all secondary level facilities except one CHC and ten out of fifteen primary level facilities, with a predominant lack of masks of both sizes. All facilities were supplied with antibiotics and emergency drugs but essential drug such as Vitamin K is not available even in secondary level facilities except DH. The knowledge domain score for breastfeeding and Vitamin K is largely satisfactory (>75%), for hypothermia prevention/warmth and Infection prevention is moderately satisfactory (50-75%). Very few only (16%) of the health providers able to demonstrate all resuscitation steps correctly while half of them (52%) able to demonstrate KMC correctly.

Recommendations : The findings underpin the need for improving the existing ENBC services by making newborn care corners functional and enhancing skills of service providers to reduce neonatal mortality rate in India.

What is the current situation of ENBC services and knowledge of the healthcare providers regarding ENBC services in Mandla district, Madhya Pradesh?