The District Level Household & Facility Survey is one of the largest ever demography & health survey carried out in India, with a sample a size of about seven lakh household covering all the districts of the country. The ministry of Health & Family Welfare (MOHFW), Govt.of India, initiated DLHS in 1997 to provide district level estimates on health indicators to assists policy makers & program administrator in decentralized planning, monitoring & evaluation.

The DLHS-3 which is the third in the series proceeded by DLHS-1 in 1998-99 & DLHS-2 IN 200204 is designed to provide estimates on maternal & child health, family planning & other reproductive health services. For the first time, a population linked facility survey has been conducted in DLHS-3.It covers then all the District Hospitals, Community Health Centre, Primary Health Centers & all Sub Centre. Field work in Madhya Pradesh was conducted during Dec 2007 to May 2008, gathering information from 51,419 households.

Why Neonatal Care?

To prevent neonatal mortality and secure good health of the newborn, neo-natal healthcare becomes very important. Only India accounts for 1.2 million or nearly 30% of global neonatal mortality [Estimates based on the projected population of India by the Technical Group on Population Projection, RGI, India, 2008 and Vital Rates from SRS], as various reports show. Rate of neo-natal mortality in India is 39 per 1000 in 2005-06 [National Family Health Survey (NFHS III), 2005 – 06, India: Volume I, International Institute for Population Sciences, Mumbai, September 2007].

Neonatal Period

The neonatal period commences at birth and ends 28 completed days after birth.

Neonatal Mortality Rate

Number of deaths during the first 28 completed days of life per 1,000 live births in a given year or period.

The present health scenario of Madhya Pradesh makes it more important to promote neonatal health care. The neonatal mortality in Madhya Pradesh is 44.9% [National Family Health Survey (NFHS III), 2005 – 06, India]. Analysis of DLHS-3 reveals the underlying factors responsible for such a high neonatal mortality in Madhya Pradesh.

Low birth Weight accounts for 42% of all neonatal deaths as the chance of survival of such low birth weight babies within the first month of birth is very low. In the state 23.4% [National Family Health Survey (NFHS III), 2005 – 06, India], babies among the live births, born with the birth weight less than 2.5 Kg in 2005-06.

Health Indicators of NFHS-III for Madhya Pradesh

The basic reason for low birth weight babies is the prevalence of anemia among women during pregnancy. Care during pregnancy is very important this period defines development of the unborn child right from the initial embryo stage to the final birth. But only 33.8% mothers received antenatal check-up in first trimester & it is only 27.9% for the rural areas. Only 61.8% of mothers had received any antenatal check-up in 2007-08 [District Level Household & Facility Survey, India; DLHS-3 2007-08]. This means that 38.2% women do not received any antenatal check-ups necessary for timely diagnosis of any delivery complications.
 
Prevalence of anemia in women in their reproductive  age 15-49 years in the state 41% of women are affected by mild anemia & 14.1% by moderate anemia which may lead to maternal & neo-natal mortality [National Family Health Survey (NFHS III), 2005 – 06, India: Volume I, International Institute for Population Sciences, Mumbai, September 2007]. Around 58% of the pregnant women in the country suffer from anemia of different degree.

Thus the poor health status of maternal & neonates demands increased care during the neonatal period to prevent the neonatal & infant mortalities in the state.

Status of Neonatal Care & DLHS-3

Neonatal Check-up within 24 hours of birth: Medical check-up of the newborn with 24 hours of birth is very essential to diagnose any birth problem & treatment of sick newborns. But the percentage of children received check-up within 24 hours after delivery (based on last live birth) is less. About 44.4% districts (20districts) in the state have less than 35% children given check-up on the very first day of birth, which is the most critical period. In Dindori inhabited mainly by tribal population, only 13.7% children given check-up with 24 hours.

The situation is worst in rural areas of Madhya Pradesh, as 65 neonates do not survives out of every 1000 live births and die in first 28 days of their Birth in rural Madhya Pradesh. In the rural areas of the state capital Bhopal just 20% new born could receive medical check-up within 24 hours of birth. The percentage is less than 40% in rural areas of 33 districts in the state. The most glaring fact that not a single rural area in 48 districts has above 60% coverage. The very recent survey of Government of India establishes the need for very urgent interventions for new born care across the state.
 
37 Districts including Bhopal & Gwalior are the districts with less than 50% children given check-up within 10 days after delivery (based on last live birth).

New developmental policies need to address the new born care in Madhya Pradesh. Reduction in neonatal mortality is one of most important thrust area of eleventh plan document. Eleventh plan of Madhya Pradesh puts emphasis for medical facilities to cope up with the increasing demand of institutional deliveries & neonatal care by  increasing access to rural health services by way of establishing new health institutions as per population norms and to provide buildings for all the primary health care institutions. But unfortunately in spite of any sign of improvement DLHS-3 depicts the threatening status of newborn care in the state of Madhya Pradesh.

Breast Feeding Practices: Even though breast feeding is common in India & in Madhya Pradesh only 43.1% children are given breastfeed within an hour in M.P in 2007-08. But still the situation is quite vulnerable in various districts of the state. Tikamgarh & Sheopur districts has less then 25% children breastfed with an hour of birth. This shows that in these district about 75% children are not colostrum reach milk which increasing the child’s immunity against various diseases. In 38 districts of the state less than 50% children are breastfed with an hour. Only in Betul more than 60% (67.9%) children are breastfed in the first hour of birth.

CHC with 24 hours new born care: Out of the 278 CHCs serving the state only 216 CHCs are having new born care on 24 hours basis. As per the DLHS-3 report still 62 Community Health Centers are not in a position to provide new born care.

PHC having Neonatal Warmer (Incubator): In Madhya Pradesh only 8.23% Public Health Centers are equipped with the neo-natal care, such as Incubator facility. Madhya Pradesh is having 1142 Primary Health Centers but only 94 PHCs are having Neonatal incubator essential for warming up of neonates to become adjusted to temperature.

New born care provided during last one month: According to DLHS-3 finding 27672 institutional deliveries has been performed in PHCs but the number of New born care provided during last one month is only 25687.This means that 1985 children had not received any newborn care in spite of their institutional birth.

IMNCI Training for ANMs: Only out of sectioned posts 3039 ANMs, only 523 ANM has been trained in very essential Integrated Management of Neonatal and Childhood Illnesses (IMNCI) in last 5 years. It is worth mentioning that out of 3039 posts of Nurse and midwife only 901 posts are filled and other 2138 posts are lying vacant. 

Seema Jain