<p>Newborn period, the first month after birth and its health care has become the prime focus of the National Health Policy. This has become so because of the fact that National Population Policy 2001 has recognized the link between high Infant Mortality Rate (IMR) and population growth.</p><p>The policy statement commits the Nation to a reduction of IMR to under 30 per thousand live births by the year 2010.This necessitates a rapid reduction in neonatal death which forms the largest component of IMR.</p><p>The statistical figure through out the country depicts that more than sixty percent infant mortality is contributed by neonatal death, that is death during the first month of life (<xref ref-type="fig" rid="fig001">Fig.1</xref>). The breakup also shows that two thirds of the total neonatal death occur within the first week of life and the rest, in the remaining three weeks of the of the neonatal period (<xref ref-type="fig" rid="fig002">Fig.2</xref>). <fig id="fig001"><span>Fig. 1</span><caption><span>Breakup of infant deaths</span></caption><div className="body-img"><img width="100%" 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" /></div></fig><fig id="fig002"><span>Fig. 2</span><caption><span>Newborn deaths by age</span></caption><div className="body-img"><img width="100%" 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" /></div></fig></p><p>Infant mortality rate is a sensitive indicator for socio-economic development of any country. IMR has been reduced significantly by various national health programs like immunization for vaccinepreventable diseases, oral rehydration therapy to prevent death from diarrhea, acute respiratory tract infection control program, etc. These programs have been able to reduce infant death beyond the newborn period i.e. beyond the first month of life No significant intervention has really been taken so far to reduce the death in the first month of life, and thus resulting in static IMR since last decade. It has also been observed that following some simple guidelines (as per WHO) and bringing them in to regular practice can easily prevent many deaths in the Newborn period.</p><p>These are: <list list-type="bullet"><list-item><p>Encompass cleanliness</p></list-item><list-item><p>Thermal protection</p></list-item><list-item><p>Early initiation of breastfeeding and exclusive breast feeding for first six months</p></list-item><list-item><p>Eye care</p></list-item><list-item><p>Immunization</p></list-item><list-item><p>Management of illness</p></list-item><list-item><p>Care of low birth weight infants</p></list-item></list></p><p>This means for every family there should be preparations for: <list list-type="bullet"><list-item><p>Birth of a healthy baby</p></list-item><list-item><p>Choosing a safe place for delivery</p></list-item><list-item><p>Keeping the process clean</p></list-item><list-item><p>Avoiding heat loss in a newborn</p></list-item><list-item><p>Early initiation and Exclusive Breastfeeding practice</p></list-item><list-item><p>Understanding potential danger signs</p></list-item></list></p><p>In the process of understanding the community, limitations were found between the expected and the actual happenings at home and in our understanding how to change this behavior.</p><p>West Bengal has a slightly better picture in this parameter in comparison to many other states of India, but the existing IMR of 51 per thousand live births is really far from an acceptable one when compared with Kerala.</p><p>Situational Analysis: <table-wrap position="anchor"><caption><p>India vs West Bengal</p></caption><table><thead><tr><th/><th align="center">India</th><th align="center">West Bengal</th></tr></thead><tbody><tr><td colspan="3"><hr/></td></tr><tr><td>Area in Sq. Km</td><td align="center">32,87,263</td><td align="center">88,752(2.7%)</td></tr><tr><td>Population (Census 2001)</td><td align="center">1,02,70,15,247</td><td align="center">8,02,21,17 (7.8%)</td></tr><tr><td>IMR 1999</td><td align="center">70</td><td align="center">51</td></tr><tr><td>NMR 1999</td><td align="center">46</td><td align="center">30</td></tr><tr><td>Neonatal Morbidity</td><td align="center">?</td><td align="center">?</td></tr></tbody></table></table-wrap></p><p>The National Neonatology Forum (NNF), West Bengal and Department of Health and Family Welfare, Government of West Bengal have realized the fact that unless Neonatal Mortality Rate (NMR) is brought down, IMR cannot be reduced. Accordingly NNF, West Bengal and the State Family Welfare Bureau (SFWB) along with UNICEF Kolkata started activities since July 1998 by organizing Training of Trainers (TOT) at state level where Pediatricians from different Medical Colleges & District Hospitals have been trained in the components of Essential Newborn Care within the existing infrastructure.</p></sec><sec id="sec002"><title>Approach to improve Newborn Health in West Bengal

The approach to improve Newborn Health (NH), and thereby its survival, should be based on some basic needs for mother and baby. They are precisely:

Universal antenatal care

Advocacy for institutional delivery as much as possible (The National Population Policy 2000 has laid down the goal of an Institutional Delivery of 80 % by 2010.)

Delivery by trained personnel in case of home delivery.

Care at birth including basic resuscitation both at institution and home setup.

Thermal protection to a newborn both at institution and home.

Early initiation and promotion of exclusive breastfeeding at all facilities.

Prevention of infection in all setup.

Extra care for Low Birth Weight (LBW) babies both at home and institution.

Early detection of illness and seeking of proper care at periphery and at home at the earliest.

Home care for sick newborn and timely referral of sick babies to Referral Units, if required.

Care during transportation of sick Newborns.

Capacity building among all categories of health care providers from metropolis to the remote out reaches posts.

Keeping in mind these 12 basic components the strategies taken are:

Essential Newborn Care has to be an integral component of Primary Health Care in every set up i.e. 8126 Sub centers, 252 Block Primary Health Centers (BPHCs), 922 Primary Health Centers (PHCs) 15 District Hospitals, 39 Sub Divisional Hospitals & 15 Rural Hospitals.

Greater emphasis on Newborn Care in State Health Programmes (initially CSSM and now RCH)

Emphasize that newborn care begins during pregnancy by good antenatal care.

Promote institutional delivery and institutional strengthening for provision of newborn care (Institutional and outreach services.)

Periodic monitoring of practices.

Reorientation of training programmes.

Involvement of Panchayat Samity in promotion of newborn care practices at Gram Panchayat level with their own funding to make the program sustainable

Convergence with other organizations with similar activities

The Beginning

Two batches of Training of Trainers (TOT) were completed by Nov’98. After some pilot programs at various levels, namely Doctors, Nurses and Traditional Birth Attendants (TBAs) between Sep’98 and Feb’99, UNICEF-Kolkata office has entered into a Memorandum of Understanding (MoU) with National Neonatology Forum, West Bengal Branch, to start the project,”ImprovingContents and Coverage of Essential Newborn Carein West Bengal”with full support and approval of Department of Health & Family Welfare, Government of West Bengal, for a period of 4 (four) years from April’99 to Dec’02.

Under this project, in all the 19 (nineteen) districts of West Bengal, doctors & nurses working in the Government institutions & TBAs at the block level would be trained in all the components of Essential Newborn Care as mentioned above.

Methodology

The module for the training has been adapted from NNF & WHO Collaborating Center for Newborn Care Training & Research, AIIMS, New Delhi. Most of the trainers who were trained in TOT would now be utilized in the training programs at the district and sub-district level. This venture became easier because most of them are working in Government institutions and are also members of the NNF.

The Government of West Bengal, Department of Health & Family Welfare, took a positive step by entrusting one Nodal officer with this program. The said officer also happened to be an office bearer of NNF as well which helped in smooth sailing of the program.

Concurrent Supervision

While conducting the training programs at different districts, constant supervision of operationalisation was also being conducted by visiting different hospitals and health centers of the districts covered so far.

The parameters for supervision were based on:

Establishment of a Newborn Corner with provisions for maintaining normal temperature of a baby and thus preventing hypothermia.

Practices of five cleans of safe delivery.

No bathing of babies immediately after birth.

Abolition of Pre-lacteal feeds and promotion of Exclusive Breastfeeding up to six months of age.

Practice of resuscitation procedures, as recommended during training.

Abolition of harmful practices like holding the baby upside down etc.

Keeping mother and baby in skin-to-skin contact just after delivery and thereafter.

Keeping Newborn Care Appliances in working order and utilizing them wherever available.

Use of innovative or improvised appliances in case equipments are not supplied or out of order.

Care during transport of a sick baby from one institution to the other.

Observations

The overall observation was that the training had some mixed effects. The positive changes innewborn care practices observed are:

Advocacy on antenatal tetanus toxoid (two doses) to expectant mothers.

Advocacy on consumption of Iron and Folic acid tablets and nutrition within available sources of staple food, during antenatal period.

Advocacy on early antenatal registration and check up in hospital/health centers for at least 3 (three) times.

Use of clean linen to receive the baby during delivery.

Omission of bathing the baby just after birth and during the hospital stay.

Not wiping or cleaning the vernix either by soap water/oil/liquid paraffin which was a common practice before the training.

Placing the baby directly on mother’s abdomen or chest just after delivery (kangarooing) has been observed being practiced widely at the PHC and at some district/sub-divisional hospitals.

The same practice is also being recorded in the logbook of the PHCs.

This practice has also been observed among the TBAs during home delivery.

Hypothermia at birth is sufficiently being taken care of by using 2 to 3 dry clean linens and by discarding the initial wet linen.

Prelacteal feeding practices have been discarded from all the centers. Cross-questioning the mothers and other family members revealed this fact. However, Prelacteal feed, being an age-old practice needs constant vigilance by staffs as family members might reintroduce it due because of traditional beliefs.

All the centers have reported practicing, promoting & supporting exclusive breastfeeding for six months of age.

The umbilical stump is kept open and nothing is applied on it routinely.

Newborn Care Corner with facilities for warming (mostly with 200 watt bulb), and resuscitation of asphyxiated babies has been established in many centers.

Many PHCs, where no equipment was supplied are working with the innovative equipments demonstrated during training.

The Constraints (Lacunas)

The project activities had to pass through various shortcomings initially. However, those hurdles were crossed by the learning experience of the team as the activities progressed. Few of them, to mention are:

Base line survey could not be done properly.

Movement of the Resource Persons from various teaching institutions was a major constraint at the beginning, as there was no standing order from Director of Medical Education (DME). However, this impediment could be overcome towards the end of the project tenure. A standing order from the office of DME was issued directing the resource persons from various teaching institutions to participate in the training programmes as and when required. Their participation in the training program would be treated as on duty job.

Too many vertical ongoing programmes at the district level resulted in less working days at the district level as well as dilution of the focus.

Implementation of the recommendations through this programme needed a remarkable behavioral change through a process of unlearning the old practices and relearning thenew recommendations and bring them in to dayto- day practice. This itself being a very slow process, radical changes in practices within such a small period may not be possible. However, some changes among the participants have been observed.

Training in Composite Groups

Community Participation

A new strategy in the training program was applied in Midnapore East. In these training programs, TBAs were included along with the doctors and nurses as a composite group. The responses were overwhelming among the participants and the trained doctors were identified as the team leaders and given the responsibility of operationalisation. Working on the same plan, in the district and subdivisional hospital of some districts, the training programs were also organized amongst the composite group of nurses and doctors of the same hospitals resulting in a considerable amount of team spirit, which could be generated amongst the participants for operationalisation.

Training with

Working on this plan, the whole state of West Bengal has been covered with Essential Newborn Care training at the district and sub divisional level While working on this plan, efforts were constantly made to involve the Panchayet System in this field, so that the issue of newborn health becomes a people’s movement. The efforts were not futile one. Between Sept.2001 and Feb.2002, Block Development Officers (BDOs) and Panchayet Sabhapatis (Block Head) of four blocks came forward and organized training program for all the Traditional Birth Attendants who are regularly conducting deliveries but never attended any training in this regard, in their respective blocks. Around 200 TBAs attended the training program. All the expenditure incurred in these programs was borne by the Panchayet. This approach succeeded in involving the local administration in newborn health issues and a constant monitoring was assured. The result was reflected in the follow up study in Ramnagar I, between Nov. 2001 and April 2002 where TBAs training was conducted. Here out of a total of 440 deliveries, 361 weresuccessfully conducted by TBAs, and 79 pregnant mothers were timely referred to various institutions where all of them successfully delivered. Among 361 deliveries conducted by Trained TBAs, only 2 (Two) newborn babies died, showing a very much encouraging result, and a trend of reduction in NMR.

The role of the Quacks or the Rural Medical Practitioners in health management can never be ignored in West Bengal as with the rest of the country. The team working on newborn health in West Bengal also explored option of utilizing the services of this large group of community health workers in the issues of newborn health. With this mind frame, and with the involvement of Helan Panchayet, in Arambag sub-division in Hooghly district, about 110 Rural Practitioners were trained in essential newborn care in July 2002 and their practices are being monitored regularly. A positive change has already been noticed.

Post Training Reactions

It has been successfully observed everywhere that, immediate reaction of the participants after two days training is very much positive. Participants look confident of managing a newborn in their existing situation. The participants unanimously agreed that probably it was the best training they have ever attended in their career. This was possible because, the sessions were conducted in participatory manner and clear-cut messages were communicated in simple and interesting way even with rhymes and jingles. Innovative equipments were demonstrated, which any participant can prepare on its own in the existing situation and use them successfully. A practical hand on demonstration is another reason for its popularity.

Innovations

During this project, many innovations in training and low cost tools have been accomplished. (Table A) Table A

Innovations during training

Training of composite group (Doctors, Nurses, & TBAs where applicable) from one institution. Team spirit higher & adherence better

Development of TBA training module & sharing of this module to near by state like Assam

Use of Bengali for training specially TBA

Application of rhymes, slogans, role-plays during training like”Maye Chaye Gaye Gaye”i.e. skinto- skin contact between mother and baby etc.

Innovation (Use of low cost, easily available material for instrumental tool)

Thermocol boxes as warmer

Cut saline bottles as baby oxygen mask

Cut I.V set with the chamber as mucus sucker

Use of 200 watt bulbs for warming

Use of plastic container for mouth to box resuscitation

AchievementsImpact of training

A total of 195 (One hundred and ninety five) workshops were held covering all the districts. Number of blocks covered were 108 (38.8%). A huge number (5342) of health workers of all categories were trained (Details in Table B&C). Table B

Summary of the program

Training Of Trainers (TOT)	2
Doctors’	16
Nurses	16
Traditional Birth Attendant & Others	71 + 3^* =74
Doctors + Nurses combined	59
Doctors + Nurses + TBA & Others	21
Registered Medical Practitioners	7^*
Total No. of Training Programs	195
Conducted	17
No. of District Covered	(89%)
No. of Blocks covered	108 (42.8%)
No of Doctors trained.	965
No. of Nurses trained	2484
No. of TBAs trained	1576
Others (HA (F) + HS (F) + AWW)	1178
No. of RMPs trained	1374^*

^* Organized and funded by Panchayat and Rural Medical Practitioner’s (RMP) Association

Table C

Community Participation For Newborn Care

No. of group meetings held	98
No. of community people attended	3080

Dais were issued an identity card as”FRIENDS OF NEWBORN”to be identified in the community and become a self help group who could conduct safe delivery and give proper newborn care in the community.

Community mobilization for Newborn Care

Establishment of newborn care corners

After conducting a training program in an institution at district/sub divisional block level, a ‘Newborn Care Corner’ (NCC) was established. A total of 170 NCCs were established.

Neonatal mortality reduction in Ramnagar Block

At Ramnagar Block with the help of panchayat system, all Dais were trained. After 6 months of training, a survey showed that the number of institutional deliveries increased and Dais referred the complicated cases in due time for institutional deliveries.

Survey on Newborn Care Practices (after training) at Belda Block

A survey conducted in Belda block of Midnapur district 1 year after training period. Enormous changes were noted regarding newborn care practices.

Changes in TBA practices

A survey conducted amongst ten TBAs at Keshpur block; district Midnapur one year after training showed that their practices has improved considerably.

Future Strategies

Identification of Rural Medical Practitioners (Quacks) though Panchayat Samity and Gram Panchayat and creating awareness on Essential Newborn Care among them to reach the underserved and unserved community. These will be a step towards creating Mother Child Worker (MCW) at the grass root level.

Paying attention in the urban slum areas, where the newborn health service is no better even than that of the remote rural area.

Continue with the Newborn Care Training in an accelerated manner by creating and utilizing more local team of trainers to have a sustainable effect.

Incorporation of Essential Newborn Care Training in the TBA training program.

Advocacy with medical colleges for detailed training on newborn care among under graduate students and residents.

Advocacy with Nursing Council for incorporation of the present recommended newborn care component in the nursing curriculum

Prevention and management of infection at the community level

Community baseed research on key issues of neonatal mortality and development and validation of simple devices for better newborn health

Lessons Learned

While on one hand the project provided an opportunity to all categories of health care personnel to get a clear-cut message on newborn care at any set up, the trainers also got the opportunity to learn about many ongoing practices of newborn care especially at the community level. There are many age-old traditional practices, which have strong scientific support. To mention few of them, cutting of cord once the baby starts spontaneous respiration and placenta is out, keeping mother and baby tighter in a separate room, keeping the room warm, not bathing the baby for nine/twelve/twenty one days, allowing mother to be with the through out the day & night till bathing ceremony takes place etc. These good traditional practices were encouraged to be continued. However, some traditional practices like cutting the cord with bamboo shaving/arrowhead/sharp edge of seashell/sharp edge of broken pot, introduction of prelacteal feed in the form of plain boiled water/honey water/glucose water/goats/cows milk etc. It is interesting to note during post training follow up visit that most of these practices are abolished. This experience teaches us that messages if properly communicated without damaging the people’s sentiment; people are ready to accept your opinion.

No training or teaching becomes complete unless it is being practiced. The group of trainers undertaking the uphill task of changing the ongoing practices had put their training in to their day to day practice and thus could convincingly motivate others to follow.

Many babies like Moumita Sarder of Panchpara, Howra district can be saved by practicing these simple methods.

On a chill evening of February, Moumita, a two days old newborn, with a birth weight of 1.5 kg and born prematurely at 32 weeks had to leave a big govt. hospital in her mother’s lap with a verbal advice from the hospital to the mother to take tiny Moumita to an institution where there is facility of”INCUBATOR”as it is not available in the hospital. The hospital although equipped with the Specialist Doctor, cannot manage the tiny baby without an incubator. When the mother could not understand the meaning of Incubator she was told that it is a”Glass Box”which will keep the tiny baby warm. Of course it will require good amount of money to be spent. Poor Moumita was born in a family of hand to mouth. The mother had no other choice than to take her baby back home, close to her chest, to reach one of the professional closely associated with the training of the essential newborn care. Moumita was by that time weighing 1.3 kg and already suffering from hypothermia. She was immediately put in to skin-to-skin contact with her mother and wrapped well along with the mother with a woolen shawl. The time after next twenty minutes was the second birth time for the newborn, apart from the first one being already recorded in the hospital’s Log Book. It was around 7.30 in the evening, the mother found her baby becoming pink and warm who is searching for the breast for feeding.

Moumita was sent back to home with the advice to her mother to keep her so warm so that her sole should always remain as warm as her belly and she should be only on her mother’s milk. Being very small, if she cannot suckle at breast properly, expressed breast milk can be given to her with a spoon. She was not given any medicine. During next two days she did not loose any weight, and started gaining weight within next couple of days. Subsequently she was on exclusive breastfeeding for six months and started taking all home based semisolids along with breast milk for two years. She was given recommended vitamins and Iron from two weeks and two months of age respectively. A constant track record of Moumita was kept and at the age of 1-year 2 months she weighed 10kg. Today at the age of two and half (2.5) years she is weighing twelve (12) kg.like any other term and normal birth weight baby. Lesson learned from this experience that even very simple procedures if followed correctly could give you a big return. This also makes us rethink about many more Moumitas who are becoming victims anywhere and everywhere.

While conducting the programs at different districts, it was perceived that unless a team of resource persons are involved in the training, it will be difficult in conducting the reorientation program and regular monitoring which is very much essential for the sustainability of the program. Hence along with the state team, resource personnel from district and sub-district level doctors as well as nursing faculty viz. District Public Health Nursing Officer (DPHNO), Nursing Tutors, Block Public Health Nurse (BPHN), along with the District Administrators have been involved. This approach has proved to be effective as the district team is now ready to take the ownership of monitoring.

Recomendation:

From the experiences and the lessons learned while working on the Project, that may be shared are:

All categories of health care personnel throughout the state should be covered under this training program.

Training should be conducted in the institute at all level viz. Medical Colleges/District/Sub-Division/State General/Rural Hospital/PHC.

All categories of health care providers should be trained in one composite group.

The duration of training should be for two days.

At the block level Panchayet System should be involved in organization.

As many as possible, TBAs should be included in the training program & if needed, in more than one batch.

The RMPs/Quakes/AWWs should also be trained & their practices need to be supervised periodically at least for six months to make a sustainable impact.

Practices in the Medical Colleges/District Hospitals and other bigger hospitals should also be closely monitored.

Corporate and Private Institutions has to be brought under the perview of this program and their practices also need to be monitored very closely. Provision for punitive action has to be kept in case any institution behaving otherwise. A circular from the Health Directorate should to be issued to all concerned.

We know that for sustainability, good surveillance is very much essential. Unfortunately we often forget it and end up with either no or poor outcome. A team comprising of four to five members from the district needs to be formed for each district. The team members would be given responsibility of operationalisation and monitoring periodically some blocks. The teams in their turn assist in case any assistance required in implementation. The team also needs to submit a report every quarterly. Based on the report necessary interventions can be undertaken.

The newborn health should be the focal point of the State Population Policy and all the members of the committee should keep a vigilant eye on the activities in this field.

Conclusion

“Life”is the best gift of nature.

“Newborn”is the fountain of”Human Life”The journey for its protection has already started and still there is a long way to go.

The effort was possible because of the committed NNF members of the state who has shown an exemplary effort of teamwork to achieve the goal. The guidance and cooperation from the central NNF was also an important factor.

Newborn Health: The West Bengal Perception.