Tracking babies treated in Special Care Newborn Units at District Level to see survival at one year of age
The exercise was done in two phases. The first phase involved desk review of existing data and telephonic follow up based on available information. Phase two involved visit to community by block monitors with a frontline worker to cross verify and track those who were missed out during the first phase.
The study was able to track 88% of the babies who received treatment and were discharged from the two sample SNCUs.
The key findings were as follows:
• Overall survival after successful completion of treatment was 90% at one year of age
• The survival rate was less in newborns who were discharged against medical advice and tertiary referrals.
• More than 60 % deaths occurred in the first month after discharge.
• Deaths were higher in excluded and rural population.
• Survival at one year in birth weight < 1500 gm birth was 62 % while 93% in birth weight > 2500gm.
Based on the findings, a system has been put in place in Guna and Shivpuri for prospective follow up of discharged newborns with linkage between community and facility. The specific elements of the system are:
• Vital information on admission recorded by data operator in specified software.
• At time of discharge patient and caretaker are counseled and provided with the contact number of IMNCI trained workers along with a community follow-up card.
• An IMNCI-trained worker visits discharged newborns on Day 1, 3, 7, 14, 21, 28 and examines as per the IMNCI protocol. At the same time, SNCU follow-up takes place at Month 1, 3, 6 and 12 or upon observing complications.
• Software generates a daily SMS alert to the parent and worker about the newborns to be followed up.
In addition, necessary budgetary and human resource provisions have been included under the NRHM plan for 2010-11 to scale up the above system in all the existing 20 SNCUs in the state with technical support from UNICEF.
· Survival rate of 90% at one year of age amongst the cohort of newborn discharged after successful completion of treatment from these units justifies continued investments in facility based care for new born.
· For maximizing gains there is a strong need to have a tracking system in place for all the new born after discharge from SNCU with well-defined protocols for follow up having both community and facility linkages. (Extending Continuum of Care )
· The tracking and community follow up can be made easy if all the vital information about the patient is recorded on admission in customized software with use of SMS for periodic alerts.
First month after discharge is most critical with need to focus on follow up of very low birth wt babies with birth weight < 2000 gm.
As many countries across the globe are showing improving trends of institutional delivery need for investing in facility based care for new born becomes more relevant.
While SNCU as well as the tracking exercise themselves are experiences that are worth sharing, this case validates the importance of evidence-based advocacy
About 940,000 new born die in India every year. Neonatal mortality at 36 per 1000 accounts for half of the under five deaths. The decline in the infant mortality in the country has been hampered by nearly static neonatal mortality rates from 2003 to 2007 (Sample Registration System of India). Facility based interventions can contribute to reduction of neonatal mortality by 23-50%. Investment in facility based new born care has become more relevant with marked increase in institutional delivery (73%, CES 2009) and in referrals under Integrated management of Neonatal and Childhood Illness (IMNCI).
To fully optimize the effectiveness of these SNCUs and ensuring survival of new born even after discharge especially for low birth weight this tracking system with community follow up would be important especially in the regions where front line workers have the skills for new born care.
There are plans to replicate the software and tracking system in SNCUs across different states in the country in a phased manner.
In addition in M.P a system of on line monitoring of data is being developed with technical support of UNICEF to ensure effective monitoring from the State.