Doctors and staff at health centres, tribal hospital not following protocol for emergency maternal and new born care; essential drugs missing
A study carried out by a team of medical experts from the United Nations International Children’s Emergency Fund (UNICEF) in May-end confirms the failure of the healthcare centres in Attappady in delivering proper care to pregnant tribal women, mothers and babies, leading to infant deaths.
According to the UNICEF report, most infant deaths reported and recorded were due to poor healthcare services before and after deliveries, delay in reporting pregnancies and delivery cases from community due to delayed access to healthcare centres and inadequate transport facilities.
Causes of infant deaths
The UNICEF team from Chennai, headed by health specialist Vandana P Bhatia, scrutinised 39 cases of infant deaths since April 2012 which have recorded by the healthcare facilities in Attappady. “The cause of deaths was recorded for 33 out of 39 cases as asphyxia, ARDS, aspiration and apnoea, preterm and low-birth weight, development growth delay and Intrauterine Growth Retardation (IUGR), congenital heart disease, pneumonia, and meningitis,” says the report.
All the recorded cases had reported low birth weight—ranging from 800 grams to 2.2 Kg. The mothers’ age in current pregnancy ranged from 19 years to 27 years. Weight of the mothers at the delivery ranged from 39 to 45 Kg. The haemoglobin levels reported was 6.1 to 8.9 gms per cent.
Out of the 39 cases, seven babies died within three days of their birth, another seven died between four to seven days, four deaths happened between eight to 14 days, three cases—15 to 30 days, eight deaths—after 30 days, and in 10 cases, the number of days the babies lived was not recorded. Deaths were equally distributed in all three gram panchayats—Agali, Pudur and Sholayur.
The report reveals that doctors and other staff at the community health centre (CHC) at Agali and the Government Tribal Speciality Hospital (GTSH) at Kottathara lacked adequate training in following the standard protocols of Essential and Emergency Maternal and New Born Care (EMONC). The report says there is need to operationalise Specialized New Born Care Units (SNCUs).
There was lack of essential drug supplies of iron folic acid tablets, mesoprestol and magsulf for care during pregnancies, points out the report. “No protocol was available for Injection Iron Sucrose IV to control and treat severe anaemia among pregnant mothers,” says the report.
Early antenatal care needed
The UNICEF report recommends standard for antenatal care in the CHC and the GTSH. It also recommends early registration of antenatal care for weight management of mothers to prevent low birth weight and Intrauterine Growth Retardation.
The report says community outreach services needs to be strengthened to identify high-risk mothers so that they would get proper services from the healthcare facilities in Attappady or get referred to other hospitals in time.
The report recommends that a community awareness building programme should be taken for early registration of pregnancy, birth spacing and family planning to prevent unwanted and frequent pregnancies, improved dietary practices for pregnant women and lactating mothers, improved breast feeding practices, prevention of anaemia among adolescent girls and pregnant mothers and preventing child marriage and early pregnancies.
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