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AVAILABILITY OF NEONATAL CARE SERVICES IN UDUPI TALUK

A Cross-Sectional Study

CARE SERVICES IN UDUPI TALUK A Cross-Sectional Study A Dissertation Submitted to Manipal University in Partial
CARE SERVICES IN UDUPI TALUK A Cross-Sectional Study A Dissertation Submitted to Manipal University in Partial
CARE SERVICES IN UDUPI TALUK A Cross-Sectional Study A Dissertation Submitted to Manipal University in Partial

A Dissertation Submitted to Manipal University in Partial Fulfilment for the Award of

to Manipal University in Partial Fulfilment for the Award of Masters in Public Health (MPH) By

Masters in Public Health (MPH)

By
By

AUGUST 2012

the Award of Masters in Public Health (MPH) By AUGUST 2012 Neel Kamal BPT, FAGE Under
the Award of Masters in Public Health (MPH) By AUGUST 2012 Neel Kamal BPT, FAGE Under

Neel Kamal BPT, FAGE

Under the guidence of

By AUGUST 2012 Neel Kamal BPT, FAGE Under the guidence of Dr. Ramachandra Kamath Professor and

Dr. Ramachandra Kamath

Professor and Head

Department of Public Health

Manipal University

Co-guides

Department of Public Health Manipal University Co-guides Dr. Leonard Machado, MD Associate Professor Department of
Department of Public Health Manipal University Co-guides Dr. Leonard Machado, MD Associate Professor Department of

Dr. Leonard Machado, MD Associate Professor Department of Public Health Manipal University

Dr. Lesley Lewis, DCH, DNB Professor Department of Paediatrics Manipal University

Certificate Certificate This is to certify that the Reserch Project entitled “ Availability of Neonatal
Certificate Certificate
Certificate Certificate
Certificate Certificate This is to certify that the Reserch Project entitled “ Availability of Neonatal care

This is to certify that the Reserch Project entitled “Availability of Neonatal care Services in Udupi Taluk - A Cross-Sectional Study” prepared by Neel Kamal (102802004) under our supervision in partial fulfilment of the requirement for Masters in Public Health, Manipal University has not previously formed the basis for the award of any Degree or Diploma by this or any other University and that, this work is a record of the candidate’s personal work.

this work is a record of the candidate’s personal work. Guide Dr. Ramachandra Kamath Professor and
this work is a record of the candidate’s personal work. Guide Dr. Ramachandra Kamath Professor and
this work is a record of the candidate’s personal work. Guide Dr. Ramachandra Kamath Professor and
Guide
Guide
work is a record of the candidate’s personal work. Guide Dr. Ramachandra Kamath Professor and Head
work is a record of the candidate’s personal work. Guide Dr. Ramachandra Kamath Professor and Head

Dr. Ramachandra Kamath

Professor and Head Department of Public Health Date: / / 2012 Place: Manipal

Co-guides

of Public Health Date: / / 2012 Place: Manipal Co-guides Dr. Leonard Machado, MD Associate professor
of Public Health Date: / / 2012 Place: Manipal Co-guides Dr. Leonard Machado, MD Associate professor
of Public Health Date: / / 2012 Place: Manipal Co-guides Dr. Leonard Machado, MD Associate professor

Dr. Leonard Machado, MD

Associate professor

Depart of Public Health

Dr. Lesley Lewis, DCH, DNB

Professor

Department of Paediatrics

Manipal University

Date:

/

/2012

Place: Manipal

Manipal University

Date:

/

/2012

Place: Manipal

Certificate Certificate
Certificate Certificate
Date: / /2012 Place: Manipal Certificate Certificate This is to certify that the dissertation entitled, “
Date: / /2012 Place: Manipal Certificate Certificate This is to certify that the dissertation entitled, “
Date: / /2012 Place: Manipal Certificate Certificate This is to certify that the dissertation entitled, “
Date: / /2012 Place: Manipal Certificate Certificate This is to certify that the dissertation entitled, “

This is to certify that the dissertation entitled, Availability of Neonatal

the dissertation entitled, “ Availability of Neonatal care Services in Udupi Taluk, Karnataka, India ” is

care Services in Udupi Taluk, Karnataka, India” is a bonafide work

done by Neel Kamal in the Department of Public Health, Manipal University, under our direct supervision and guidance.

University, under our direct supervision and guidance. Guide Dr. Ramachandra Kamath Professor and Head Department

Guide

University, under our direct supervision and guidance. Guide Dr. Ramachandra Kamath Professor and Head Department of
University, under our direct supervision and guidance. Guide Dr. Ramachandra Kamath Professor and Head Department of
University, under our direct supervision and guidance. Guide Dr. Ramachandra Kamath Professor and Head Department of
University, under our direct supervision and guidance. Guide Dr. Ramachandra Kamath Professor and Head Department of

Dr. Ramachandra Kamath

Professor and Head

Department of Public Health

Date:

/

/

2012

Place: Manipal

Co-guides

Guide Dr. Ramachandra Kamath Professor and Head Department of Public Health Date: / / 2012 Place:

Dr. Leonard Machado, MD

Associate professor

Depart of Public Health

Dr. Lesley Lewis, DCH, DNB

Professor

Department of Paediatrics

Manipal University

Manipal University

Date:

Place: Manipal

/

/ 2012

Date:

Place: Manipal

/

/ 2012

Date: Place: Manipal / / 2012 Date: Place: Manipal / / 2012 D ECLARATION I hereby
Date: Place: Manipal / / 2012 Date: Place: Manipal / / 2012 D ECLARATION I hereby

D ECLARATION

Manipal / / 2012 Date: Place: Manipal / / 2012 D ECLARATION I hereby declare that
Manipal / / 2012 Date: Place: Manipal / / 2012 D ECLARATION I hereby declare that

I hereby declare that the project entitled a study on “Availability of Neonatal care Services in Udupi Taluk, Karnataka, India” has been submitted during the year 2012-2013 under the valuable guidance and supervision of ‘Dr. Ramachandra Kamath’, Professor and Head, Department of Public Health in partial fulfilment of the requirements of the Master of Public Health (MPH) degree of Manipal University. Further I extend my declaration that this report is my original work and has not previously formed the basis for the award of any degree or diploma.

that this report is my original work and has not previously formed the basis for the
that this report is my original work and has not previously formed the basis for the
that this report is my original work and has not previously formed the basis for the
that this report is my original work and has not previously formed the basis for the
that this report is my original work and has not previously formed the basis for the

Place: Manipal

Neel Kamal

Date:

(102802004)

Place: Manipal Neel Kamal Date: (102802004) ACKNOWLEDGEMENT It guidance, advice and encouragement in my

ACKNOWLEDGEMENT

It

guidance, advice and encouragement in my endeavour.

gives me immense pleasure to acknowledge and thank all those who have given consistent

to acknowledge and thank all those who have given consistent would like to thank our Professor
to acknowledge and thank all those who have given consistent would like to thank our Professor

would like to thank our Professor and Head of the Department, Dr. Ramachandra Kamath, for giving me an opportunity to undertake this project.

I

for giving me an opportunity to undertake this project. I I of Public Health, Manipal University.

I

of Public Health, Manipal University. My humble and sincere thanks go for his valuable advice, motivation, constant supervision, critical evaluation, timely advice and invaluable support throughout the study.

am ever grateful to my co-guide, Dr. Leonard Machado, Associate professor, Department

Dr. Leonard Machado, Associate professor, Department gratefully acknowledge my sincere gratitude to Dr. Leslie
Dr. Leonard Machado, Associate professor, Department gratefully acknowledge my sincere gratitude to Dr. Leslie
Dr. Leonard Machado, Associate professor, Department gratefully acknowledge my sincere gratitude to Dr. Leslie

gratefully acknowledge my sincere gratitude to Dr. Leslie Lewis, Professor, Department of Paediatrics, KMC Manipal, Manipal University, My co guide for his kind guidance and helpful suggestions in every stage of the preparation of this report.

I

would also like to thank Dr. Ramachandra Biary, District Health Officer, Udupi, for I spending

would also like to thank Dr. Ramachandra Biary, District Health Officer, Udupi, for

I

spending his valuable time, required permissions and support while preparing this project.

I I
I
I

am greatly indebted to Dr. Anand Naik, District Surgeon, District Hospital, Udupi, Karnataka.

am gratefully acknowledged and extend my sincere thanks to Dr. K. Satish Kamath,

President, (IMA) Udupi District for his invaluable help and support for this study.

I am grateful to Dr.Shreemathi S Mayya for her kind guidance with data analysis.

Heartfelt thanks to all Medical Officers & Staff Nurses of Primary Health Centres, Community Health Centres, District Hospital and administrative heads of Private Hospitals of Udupi taluk for assisting me with the data collection.

I am also gratified by the kind support from my colleague Smiksha Babbar.

Last but not the least I affectionately thank my family and friends for their prayers, inspiration, guidance and support and to the God Almighty for everything and more.

Neel Kamal

CONTENTS CHAPTER NO. CONTENTS PAGE NO: 1 Introduction 11-15 2 Aim and Objectives 16-17 3
CONTENTS
CHAPTER NO.
CONTENTS
PAGE NO:
1
Introduction
11-15
2
Aim and Objectives
16-17
3
Literature Review
18-24
4
Materials and Methods
25-28
5
Results and Discussion
29-57
6
Summary
58-59
7
Conclusions
60-61
8
Limitations
62-63
9
References
64-66

10

Appendix

67-94

TABLES AND FIGURE TABLES & FIGURE PAGE NO. DESCRIPTIONS Table: 1 29 Types of Health
TABLES AND FIGURE
TABLES & FIGURE
PAGE NO.
DESCRIPTIONS
Table: 1
29
Types of Health Care Facilities
Figure: 1
Distribution of Health Care Facilities
29
Newborn Care Services
Tables: 2
30
Table: 3A
Infrastructure for Newborn Care
34
Table: 3B
Infrastructure for Newborn Care
35
Table: 3C
Infrastructure for Newborn Care
35
Table: 4A
Equipment for Management:
39
Table: 4B
Equipment for Monitoring
40
Table: 4C
Equipment for Investigation
42
Table: 4D
Equipment for Resuscitation
44
Table: 4E
Equipment for Disinfection
45
Table: 5A
Human Resource for Newborn Care
49
Table: 5B
Human Recourses with Training status
51

Table: 6

Table: 7

Records of deliveries from last 3-months

Registers maintained for Newborns

54

55

3-months Registers maintained for Newborns 54 55 LIST OF ABBREVIATIONS NMR: Neonatal Mortality Rate IMR:

LIST OF ABBREVIATIONS

NMR: Neonatal Mortality Rate

IMR: Infant Mortality Rate

MDGS: Millennium Developmental Goals

U5MR: Under Five Mortality Rate

SRS: Sample Registration System

LBW: Low Birth Weight

NBCC: Newborn Care Corner

System LBW: Low Birth Weight NBCC: Newborn Care Corner NBSU: Newborn Stabilization Unit SNCU: Special Newborn
System LBW: Low Birth Weight NBCC: Newborn Care Corner NBSU: Newborn Stabilization Unit SNCU: Special Newborn
System LBW: Low Birth Weight NBCC: Newborn Care Corner NBSU: Newborn Stabilization Unit SNCU: Special Newborn
System LBW: Low Birth Weight NBCC: Newborn Care Corner NBSU: Newborn Stabilization Unit SNCU: Special Newborn
System LBW: Low Birth Weight NBCC: Newborn Care Corner NBSU: Newborn Stabilization Unit SNCU: Special Newborn

NBSU: Newborn Stabilization Unit

NBCC: Newborn Care Corner NBSU: Newborn Stabilization Unit SNCU: Special Newborn Care Unit NICU: Neonatal Intensive

SNCU: Special Newborn Care Unit

NICU: Neonatal Intensive Care Unit

Special Newborn Care Unit NICU: Neonatal Intensive Care Unit CSSM: Child Survival & Safe Motherhood RCH:

CSSM: Child Survival & Safe Motherhood

RCH: Reproductive and Child Health

SC: Sub-Centre
SC: Sub-Centre

IMNCI: Integrated Management of Neonatal & Childhood Illness

F-IMNCI: Facility Based IMNCI

PHC: Primary Health Centre

CHC: Community Health Centre

FRU: First Referral Unit

DH: District Hospital

PH: Private Hospital

ENBC: Essential Newborn Care

FBNC: Facility Based Newborn Care

UNICEF: United Nation International Children Emergency Fund

TT: Tetanus Toxoid

International Children Emergency Fund TT: Tetanus Toxoid IRC: International Rescue Committee BEMOC: Basic Emergency

IRC: International Rescue Committee

BEMOC: Basic Emergency Obstetric Care

EMOC: Emergency Obstetric Care

NGOS: Non-Governmental Organizations

AVD: Assisted Vaginal Deliveries

HCPS: Health Care Facilities

NNF: National Neonatal Forum

EAG: Empowered Action Group

NNF: National Neonatal Forum EAG: Empowered Action Group IPHS: Indian Public Health Standard OB/GYN: Obstetrician and
NNF: National Neonatal Forum EAG: Empowered Action Group IPHS: Indian Public Health Standard OB/GYN: Obstetrician and
NNF: National Neonatal Forum EAG: Empowered Action Group IPHS: Indian Public Health Standard OB/GYN: Obstetrician and
NNF: National Neonatal Forum EAG: Empowered Action Group IPHS: Indian Public Health Standard OB/GYN: Obstetrician and
NNF: National Neonatal Forum EAG: Empowered Action Group IPHS: Indian Public Health Standard OB/GYN: Obstetrician and

IPHS: Indian Public Health Standard

Empowered Action Group IPHS: Indian Public Health Standard OB/GYN: Obstetrician and Gynaecologist OT: Operation Theatre

OB/GYN: Obstetrician and Gynaecologist

OT: Operation Theatre

ECG: Electro Cardio Gram

ECG: Electro Cardio Gram

24*7: 24 Hours Round The Clock

ECG: Electro Cardio Gram 24*7: 24 Hours Round The Clock NSSK: Navjaath Shishu Suraksha Karyakram SBA:

NSSK: Navjaath Shishu Suraksha Karyakram

SBA: Skilled Birth Attendant

ANM: Auxiliary Nurse Mid-Wife

MoHFW: Ministry of Health and Family Welfare

PIP: Project Implementation Plan

MCH: Maternal Child Health

NRHM: National Rural Health Mission

HBNC: Home Based New born Care

GOI: Government of India

HBNC: Home Based New born Care GOI: Government of India INTRODUCTION
HBNC: Home Based New born Care GOI: Government of India INTRODUCTION
HBNC: Home Based New born Care GOI: Government of India INTRODUCTION
HBNC: Home Based New born Care GOI: Government of India INTRODUCTION
HBNC: Home Based New born Care GOI: Government of India INTRODUCTION
HBNC: Home Based New born Care GOI: Government of India INTRODUCTION
HBNC: Home Based New born Care GOI: Government of India INTRODUCTION
HBNC: Home Based New born Care GOI: Government of India INTRODUCTION
HBNC: Home Based New born Care GOI: Government of India INTRODUCTION

INTRODUCTION

INTRODUCTION

Mortality rates are social indicators to determine the health status of any country. Infant mortality is globally an important indicator of health as well as standard of living of people in the community and the country 1 which indicates the social and economic progress made by the nation and level of health care available for the needy people. It also reflects the status of health programme & policies implemented in the country 2 .

programme & policies implemented in the country 2 . Though IMR is declining globally, but Neonatal
programme & policies implemented in the country 2 . Though IMR is declining globally, but Neonatal

Though IMR is declining globally, but Neonatal mortality is being constant at all levels. As compared to post neonatal infant deaths, there is 10-15 fold higher risk of newborn dying in first month of life and neonates have approximately 30 fold greater risk of dying than young children (13-60 months). Inequality exists for Neonatal mortality among various countries up to 30 folds, being highest in sub-Saharan Africa. Though, regional average is low in Asia but it accounts for almost 60% of global NMR. So, in order to get a sustained improvement for neonatal health, care must be prioritized in these regions 3 .

health, care must be prioritized in these regions 3 . To achieve Millennium Development Goal IV,
health, care must be prioritized in these regions 3 . To achieve Millennium Development Goal IV,
health, care must be prioritized in these regions 3 . To achieve Millennium Development Goal IV,
health, care must be prioritized in these regions 3 . To achieve Millennium Development Goal IV,

To achieve Millennium Development Goal IV, Infant and Neonatal deaths across the globe need to be reduced. Infant mortality showed an appreciable decline during the 1980s and early 1990’s. Thereafter, its pace of decline has slackened considerably 4 . However, a special session was conducted to submit a report for children in United Nations at New York in 2002, to high-lighten the acceleration of MDGs for enduring child survival, Neonatal health improvement, particularly in late foetal & neonatal period 3 .

particularly in late foetal & neonatal period 3 . Neonatal mortality accounts for almost 40% of
particularly in late foetal & neonatal period 3 . Neonatal mortality accounts for almost 40% of
particularly in late foetal & neonatal period 3 . Neonatal mortality accounts for almost 40% of

Neonatal mortality accounts for almost 40% of under- five child mortality worldwide i.e. four million deaths annually in the first month of life, out of which, approximately 99% are occurring in low and middle income countries. 2 India contributes 20% of newborns to the World every year but accounts for 25- 30% of Neonatal deaths yearly and among those 45% die within first two days of life 5 .

In India, nearly 50% of under-five (U5) mortality is contributed by Neonatal deaths. Currently, Infant mortality rate of India is 50 per 1000 live births 5 . Since,

last many years, Neonatal mortality rate of India had been showing slow decline, as in 2005, it was 37per 1000 live births (SRS 2005) and 34 (68%) per 1000 live births in 2009(SRS 2009); Whereas Karnataka’s Infant mortality is 41 per 1000 live births 4 and Neonatal mortality is 28.9(70.48%) per 1000 live births 6 . Infant mortality of Udupi district is 8 per 1000 live births followed by neonatal mortality of 4.5 (56.25%) per 1000 live births. 7 So, from the above mentioned situation, we can infer that today also a greater proportion of Infant deaths are accounted by neonatal deaths at all levels. A review of ages at death during the first 28 days of life reveals that two-third of deaths occur in the first week of life and two-third of these within the first 2 days of life 4 .

two-third of these within the first 2 days of life 4 . The major causes of
two-third of these within the first 2 days of life 4 . The major causes of

The major causes of death during this period are birth asphyxia, trauma, problems related to low birth weight (LBW) (such as hypothermia, respiratory problems, feeding and peri-partum infections) and malformations. Most of these problems occur due to inadequate care during the antenatal period and during labour. Inadequate care immediately after birth and inadequate care of LBW infants within the first 48 hours may be contributing to the rest 4 . So, it is important to focus on newborn care to sustain reduction in IMR & U5MR and strengthening the care of sick, premature, LBW newborn at various levels of health facility since birth through Neonatal period (0-28 days of life specially). Hence, facility based newborn care at NBCC; NBSU & SNCU at all levels of health system needs more attention 8 .

at all levels of health system needs more attention 8 . In India, several effective, low-cost
at all levels of health system needs more attention 8 . In India, several effective, low-cost
at all levels of health system needs more attention 8 . In India, several effective, low-cost
at all levels of health system needs more attention 8 . In India, several effective, low-cost
at all levels of health system needs more attention 8 . In India, several effective, low-cost

In India, several effective, low-cost interventions are being implemented through various health programs like Child Survival and Safe Motherhood (CSSM) Programme started in 1992 and Reproductive and Child Health (RCH) Programme started in 1997. In the RCH II (2005), the IMNCI had been incorporated in 359 Districts of India from 2010, as a major package for intervention enabling the facilities to provide effective service to children and neonates. By providing services through existing health facilities i.e.; PHCs, CHCs/FRUs and District Hospitals, Essential newborn care (ENBC) and Newborn Care Corner (NBCC) through facility based Neonatal care (F-IMNCI) incorporated with integrated management of neonatal & childhood illness

through facility based Neonatal care (F-IMNCI) incorporated with integrated management of neonatal & childhood illness
through facility based Neonatal care (F-IMNCI) incorporated with integrated management of neonatal & childhood illness

initiative (IMNCI) programme is expected to improve Neonatal survival. Provision of newborn care at various levels of health facilities helps in increasing the confidence of the community as well as the coverage of the health services especially at the time of great emergency that is early days of life 5 .

Guidelines issued by Ministry of Health and Family Welfare, Govt. of India/UNICEF toolkit for setting up SCNUs (special care newborn unit), NBSUs (Newborn Stabilization unit), NBCCs (Newborn care corner) at District Hospitals/Govt. Medical colleges and Hospitals, FRUs, 24*7 PHCs respectively have been referred for establishing these facilities 9 .

Medical colleges and Hospitals, FRUs, 24*7 PHCs respectively have been referred for establishing these facilities 9
have been referred for establishing these facilities 9 . Moreover, Siddarth Ramji has mentioned in his
have been referred for establishing these facilities 9 . Moreover, Siddarth Ramji has mentioned in his

Moreover, Siddarth Ramji has mentioned in his report on Newborn and Child health in India: Problems and Interventions that there is a need to evaluate the capacity of the health system and implementation of IMNCI and also engagement of the health professionals at peripheral level to halve Neonatal mortality and development, implementation, and monitoring of national action plans for neonatal survival can be set as priority 4 .

plans for neonatal survival can be set as priority 4 . Quality is one of the
plans for neonatal survival can be set as priority 4 . Quality is one of the
plans for neonatal survival can be set as priority 4 . Quality is one of the

Quality is one of the most important issues while child health concerned. Inspite of approaching health care facilities, millions of children who need attention in their sickness couldn’t get an average level of care. Primary & secondary care for newborn in low income or developing countries is lacking in terms of availability of infrastructure, Human resources, basic laboratory services, drugs, equipment & supply which makes health professionals to treat these children with available resources 10 .

to treat these children with available resources 1 0 . Though, the best possible newborn health
to treat these children with available resources 1 0 . Though, the best possible newborn health
to treat these children with available resources 1 0 . Though, the best possible newborn health

Though, the best possible newborn health care infrastructure is hard to overcome several challenges regarding newborn care in terms of availability of newborn care facility, adequate manpower, equipment & supply, yet regular supervision and monitoring can be focused on to get better outcomes 11 .

Since independence, there has been a great expansion of health services through Primary Health Centre’s (PHCs), Community Health Centre’s (CHCs) and Sub

Centre’s (SCs) in India. Still the implementation and functioning of these facilities according to the guidelines, is not up to the mark. This being so, facility based newborn care is incorporated at primary, secondary and tertiary levels.

Since the last 30 years, there has been significant progress in the socio-economic development of Karnataka state and it seems to have achieved the expected demographic goals. Udupi district in Karnataka has Infant mortality rate of 8 per 1000 live births. This is a good indicator for this district in Karnataka with respect to other Districts and since many decades this may be a challenge for other Districts to achieve this status. As compared to state Infant Mortality Rate of 41 per 1000 live births (SRS2009) and country comparison of 50 per 1000 live births (SRS 2009), Udupi has a quite low IMR. Though infant mortality is declining but the Neonatal mortality is being constant during last 10 years. During April 2010 to March 2011, out of all infant deaths (118), Neonatal deaths were (67) 56.77% and out of total Neonatal deaths, (52) 77.61% died between 0-7Days 7 .

Neonatal deaths, (52) 77.61% died between 0-7Days 7 . Moreover, a recent study in Udupi district
Neonatal deaths, (52) 77.61% died between 0-7Days 7 . Moreover, a recent study in Udupi district
Neonatal deaths, (52) 77.61% died between 0-7Days 7 . Moreover, a recent study in Udupi district
Neonatal deaths, (52) 77.61% died between 0-7Days 7 . Moreover, a recent study in Udupi district
Neonatal deaths, (52) 77.61% died between 0-7Days 7 . Moreover, a recent study in Udupi district

Moreover, a recent study in Udupi district explained that Neonatal deaths (55%) were more as compared to post neonatal deaths (45%). Study also explained about direct causes of mortality such as birth asphyxia (43%) was the most common cause in early Neonatal period, sepsis (30%) contributed in late neonatal period followed by pneumonia (13%) & prematurity (13%) whereas; 40% infants had LBW (less than 2 kg). If we look at other aspect, the same study also focuses on indirect causes of infant mortality such as women literacy rate of 93%, 81% registered pregnancies before 12 weeks, all mothers received 100% 2- dose of TT vaccine, & also recommended dose of Iron, folic acid & calcium tablet, 64% were full term pregnancy, 60% had normal deliveries, 97% institutional deliveries with 97% infants delivered by doctors, which is really appreciable in Udupi district 2

by doctors, which is really appreciable in Udupi district 2 If above mentioned causes (direct) are
by doctors, which is really appreciable in Udupi district 2 If above mentioned causes (direct) are
by doctors, which is really appreciable in Udupi district 2 If above mentioned causes (direct) are
by doctors, which is really appreciable in Udupi district 2 If above mentioned causes (direct) are

If above mentioned causes (direct) are looked carefully, it can be seen that most of these are preventable 8 despite of having support to indirect causes at greater extent in Udupi district 2 . Since, implementation of facility based newborn care

in Karnataka has already been incorporated in the health system; it can be assumed that other causes may include gaps in availability or utilization of resources through various levels of health care facility for newborn care.

However, valid & reliable information can give a good impact for decision makers to undertake any intervention to improve effectiveness of the programme; such information may be helpful for a district as well as community. It may also give a better perception for any program planners, field managers, researchers, field staff and organizations in the country for the development of the programs. The external evaluation may help to find out actual need of the program to improve its coverage at broader aspect and also to get unbiased outcome for program managers 20 .

also to get unbiased outcome for program managers 2 0 . Not many studies were conducted
also to get unbiased outcome for program managers 2 0 . Not many studies were conducted
also to get unbiased outcome for program managers 2 0 . Not many studies were conducted

Not many studies were conducted in this regard, therefore limited literature was available. As such, Facility based newborn care is also a new concept and the Government of Karnataka is now looking on the same. Hence, it can be expected that this study may contribute to knowledge in terms of Infrastructure, Human resources, Health characteristics, Material resources, Record system & transport facilities for Neonatal care in Udupi district.

Health characteristics, Material resources, Record system & transport facilities for Neonatal care in Udupi district.
Health characteristics, Material resources, Record system & transport facilities for Neonatal care in Udupi district.
Health characteristics, Material resources, Record system & transport facilities for Neonatal care in Udupi district.
Health characteristics, Material resources, Record system & transport facilities for Neonatal care in Udupi district.
Health characteristics, Material resources, Record system & transport facilities for Neonatal care in Udupi district.
Health characteristics, Material resources, Record system & transport facilities for Neonatal care in Udupi district.

AIM AND OBJECTIVES

AIM AND OBJECTIVES AIM To assess the current situation of Neonatal care services in Udupi Taluk,
AIM AND OBJECTIVES AIM To assess the current situation of Neonatal care services in Udupi Taluk,
AIM AND OBJECTIVES AIM To assess the current situation of Neonatal care services in Udupi Taluk,
AIM AND OBJECTIVES AIM To assess the current situation of Neonatal care services in Udupi Taluk,
AIM AND OBJECTIVES AIM To assess the current situation of Neonatal care services in Udupi Taluk,
AIM AND OBJECTIVES AIM To assess the current situation of Neonatal care services in Udupi Taluk,
AIM AND OBJECTIVES AIM To assess the current situation of Neonatal care services in Udupi Taluk,
AIM AND OBJECTIVES AIM To assess the current situation of Neonatal care services in Udupi Taluk,
AIM AND OBJECTIVES AIM To assess the current situation of Neonatal care services in Udupi Taluk,

AIM

To assess the current situation of Neonatal care services in Udupi Taluk, Karnataka.

OBJECTIVES

Primary objectives:

To identify the available Neonatal care facilities in government & private sectors.

To assess Human resources available for Neonatal care.

To assess the Infrastructure & Equipment available for Neonatal care.

Infrastructure & Equipment available for Neonatal care. Secondary objective: ∑ To find out records and registers
Infrastructure & Equipment available for Neonatal care. Secondary objective: ∑ To find out records and registers
Infrastructure & Equipment available for Neonatal care. Secondary objective: ∑ To find out records and registers

Secondary objective:

available for Neonatal care. Secondary objective: ∑ To find out records and registers maintained for Neonatal

To find out records and registers maintained for Neonatal care.

available for Neonatal care. Secondary objective: ∑ To find out records and registers maintained for Neonatal
available for Neonatal care. Secondary objective: ∑ To find out records and registers maintained for Neonatal
available for Neonatal care. Secondary objective: ∑ To find out records and registers maintained for Neonatal
available for Neonatal care. Secondary objective: ∑ To find out records and registers maintained for Neonatal
available for Neonatal care. Secondary objective: ∑ To find out records and registers maintained for Neonatal
LITERATURE REVIEW
LITERATURE REVIEW
LITERATURE REVIEW
LITERATURE REVIEW
LITERATURE REVIEW
LITERATURE REVIEW
LITERATURE REVIEW

LITERATURE REVIEW

LITERATURE REVIEW
LITERATURE REVIEW
LITERATURE REVIEW Global scenario: Charles Opondo et al. (2009) 1 2 A study was conducted
LITERATURE REVIEW Global scenario: Charles Opondo et al. (2009) 1 2 A study was conducted

LITERATURE REVIEW

LITERATURE REVIEW Global scenario: Charles Opondo et al. (2009) 1 2 A study was conducted in
LITERATURE REVIEW Global scenario: Charles Opondo et al. (2009) 1 2 A study was conducted in

Global scenario:

LITERATURE REVIEW Global scenario: Charles Opondo et al. (2009) 1 2 A study was conducted in

Charles Opondo et al. (2009) 12

REVIEW Global scenario: Charles Opondo et al. (2009) 1 2 A study was conducted in eight

A study was conducted in eight first-referral level hospitals in Kenya to assess the availability of essential basic care to newborns through direct observation, using a checklist and self- administered questionnaire for the health care workers. It was found that there was often lack of maintenance of safe hygienic environment in the hospitals, poorly organized and insufficient staffing to support the provision of care. Patient management guidelines were missing in all sites and some key equipment, laboratory tests, drugs and consumables were not available thus, providing insufficient newborn care.

not available thus, providing insufficient newborn care. Casey et al. (2009) 1 3 The study was
not available thus, providing insufficient newborn care. Casey et al. (2009) 1 3 The study was
not available thus, providing insufficient newborn care. Casey et al. (2009) 1 3 The study was

Casey et al. (2009) 13

The study was conducted by international rescue committee (IRC) and CARE as baseline assessments of public hospitals to evaluate their capacity to meet the reproductive needs of the local population to determine the availability, utilization and quality of reproductive services including emergency obstetric care and family planning in nine general referral hospitals of democratic republic of Congo. The information was attained through interviews,

observations & clinical records review. It was found that most of the facilities had shortage of staff, essential equipment, supplies and weak referral system. Moreover, the facilities had poor infection prevention and poor monitoring of reproductive health services related to EmOC.

Eugene J. et al. (2008) 14

services related to EmOC. Eugene J. et al. (2008) 1 4 Survey was conducted in all

Survey was conducted in all 73 health care facilities (13 hospitals and 60 health centres) providing maternity services in central region of Malawi to establish baseline for availability, utilization and quality of maternal and neonatal health care services. They found that, there was a shortage of qualified staff, equipment and supply in some facilities. Though there were adequate health facilities but there was unequal distribution of the services.

but there was unequal distribution of the services. Mike English et al. (lancet 2004, 364: 1622-29)
but there was unequal distribution of the services. Mike English et al. (lancet 2004, 364: 1622-29)
but there was unequal distribution of the services. Mike English et al. (lancet 2004, 364: 1622-29)

Mike English et al. (lancet 2004, 364: 1622-29) 15

Mike English et al. (lancet 2004, 364: 1622-29) 1 5 A cross sectional study to investigate

A cross sectional study to investigate the provision of paediatric care in government district hospitals in terms of outcome of admission, infrastructure resources, and views of hospitals staffs and caretakers of admitted children in 14 first referral level hospitals from seven of eight provinces in Kenya. It was found that the basic laboratory services were available in at least 12 hospitals but the bilirubin test was rarely found. Proper availability of drugs for malnutrition, newborn feeds and anti- infective drugs were available at 11 hospitals. The staff’s views regarding infrastructure and human consumable resources indicated their dissatisfaction with the physical environment around them.

dissatisfaction with the physical environment around them. Koyejo Oyerinde et al. (2011) 1 6 A needs
dissatisfaction with the physical environment around them. Koyejo Oyerinde et al. (2011) 1 6 A needs
dissatisfaction with the physical environment around them. Koyejo Oyerinde et al. (2011) 1 6 A needs
dissatisfaction with the physical environment around them. Koyejo Oyerinde et al. (2011) 1 6 A needs

Koyejo Oyerinde et al. (2011) 16

A needs assessment related cross-sectional study was conducted for emergency obstetric care (EMoC) to address the maternal mortality indices. The study included all public, private, mission and non-governmental organizations (NGOs) hospitals providing maternal and child health services. Locally adapted tool for data collection developed by Avertis maternal death and disability program was used. It was found that there was adequate EmOC but it was

poorly distributed. No hospital could be traced with basic EmOC and only few facilities were able to provide assisted vaginal deliveries (AVD). In addition, there was severe shortage of staff, equipment and supplies.

Youn-g Mi Kim et al. (2009) 17

A

facilities of Afghanistan with the objective to assess the availability & utilization

of

indicators. After the study it was found that 42% of the peripheral health facilities did not have sufficient facility to provide or deliver comprehensive emergency obstetric and neonatal care (EMoNC) facilities and 31% of the facilities were lacking for equipments & supplies and 77% of the facilities cited lack of human resources. Services like c-sections were provided in 33% of CHCs, 76% of district hospitals and all regional hospitals. Facility of blood transfusion was reported from 33% of CHCs, 62% of district hospitals and regional hospitals.

cross-sectional study was conducted in seventy eight first line referral

study was conducted in seventy eight first line referral emergency obstetric and neonatal care (EMoC) facilities

emergency obstetric and neonatal care (EMoC) facilities as defined by UN

and neonatal care (EMoC) facilities as defined by UN Charles Ameh et al. (2009) 1 8
and neonatal care (EMoC) facilities as defined by UN Charles Ameh et al. (2009) 1 8
and neonatal care (EMoC) facilities as defined by UN Charles Ameh et al. (2009) 1 8
and neonatal care (EMoC) facilities as defined by UN Charles Ameh et al. (2009) 1 8
and neonatal care (EMoC) facilities as defined by UN Charles Ameh et al. (2009) 1 8
and neonatal care (EMoC) facilities as defined by UN Charles Ameh et al. (2009) 1 8

Charles Ameh et al. (2009) 18

A study was conducted in Somalia to provide and evaluate in service training in (life saving skills) emergency obstructive & newborn care in order to improve the availability of (EmoNC) in Somaliland. A total 222 health care providers (HCPs) were trained within span of two years. Both quantitative and qualitative methods were used for before and after evaluation of trainee reaction and change, in knowledge, skills and behavior in addition to functionality of health care facilities. It was found that training impacted positively on the availability and quality of EmoNC and resulted in up skill of midwives performing skills of medical doctors. But the lack of drugs, supplies, medical equipment and supply policy were identified as barriers to use of new skills and knowledge acquired.

supplies, medical equipment and supply policy were identified as barriers to use of new skills and
supplies, medical equipment and supply policy were identified as barriers to use of new skills and

Indian scenario:

Biswas A B et al. (2011) 19

A study was conducted in twelve first referral units of 6 Districts in West- Bengal to assess the status of maternal and newborn care through record review, interviews and observations using pre-designed proforma. The results showed that there was inadequate infrastructure facilities (e.g. no sanctioned post of specialist, no blood bank at rural hospital) and poor utilization of equipment like neonatal resuscitation sets, radiant warmer, lack of training of service providers were evident. Records/ registers were available but incomplete & referral services were found to be almost non-existent. It was also reported that most of the deliveries and immediate neonatal resuscitation was done by nurses (94.9%) .

13

neonatal resuscitation was done by nurses (94.9%) . 13 B. Neogi Sutapa et al. (2011) 5
neonatal resuscitation was done by nurses (94.9%) . 13 B. Neogi Sutapa et al. (2011) 5
neonatal resuscitation was done by nurses (94.9%) . 13 B. Neogi Sutapa et al. (2011) 5
neonatal resuscitation was done by nurses (94.9%) . 13 B. Neogi Sutapa et al. (2011) 5

B. Neogi Sutapa et al. (2011) 5

by nurses (94.9%) . 13 B. Neogi Sutapa et al. (2011) 5 A cross- sectional study

A cross- sectional study was conducted to assess the functioning of SNCU (special newborn care unit) and availability of human resources, equipment and quality care based on secondary data and cross sectional survey in 8 rural districts of India that had been functioning for at least one year. The rate of mortality among admitted neonates was taken as the key outcome to assess the performance of the unit. It was found that the units had varying nurse to bed ratio (1:05 to 1:1.3). Inadequate repair and maintenance of the equipment and lack of human resources was also reported.

the equipment and lack of human resources was also reported. Srivastava V. K et al. (2009)
the equipment and lack of human resources was also reported. Srivastava V. K et al. (2009)
the equipment and lack of human resources was also reported. Srivastava V. K et al. (2009)
the equipment and lack of human resources was also reported. Srivastava V. K et al. (2009)

Srivastava V. K et al. (2009) 20

Another study was conducted for Rapid Assessment of Essential Newborn Care Services and Rural Health Needs in National Mission Priority States of India to see the availability of essential newborn care services and provider’s knowledge and skills related to their provision in facilities at all levels of the government health system. The study was carried out in 10 states covering 11 districts including both EAG and non-EAG districts. Out of 11 districts, seven had received training under NNF (in NNF districts) while four did not receive such training (in non NNF

districts). It found that Essential newborn care infrastructure and laboratory services were far from adequate at DHs and CHCs. PHCs were grossly deficient for newborn care and Essential newborn care equipment was available in the majority of DHs but CHCs and PHCs were not adequately equipped. Essential drugs and supplies were available in most of the DHs. DHs had a pediatrician compared to one-third of the CHCs. Staff nurses for essential newborn care functions were available in almost all DHs and CHCs and one-half of the PHCs. The doctors posted at DHs were more skilled compared to those posted at CHCs and PHCs. No DH reported offering referral services since all facilities reported providing complete essential newborn care services. The transport for referral of patients to a higher-level health facility was available in a large number of the CHCs and approximately half of the PHCs. Poor implementation of the program were cited as the main reason for poor performance of the program by most of the policy planners and state level program managers. Inadequate funds to upgrade existing infrastructure was another reason given for the state of newborn care services 14 .

given for the state of newborn care services 1 4 . Paul V.K et al. (2000)
given for the state of newborn care services 1 4 . Paul V.K et al. (2000)
given for the state of newborn care services 1 4 . Paul V.K et al. (2000)
given for the state of newborn care services 1 4 . Paul V.K et al. (2000)
given for the state of newborn care services 1 4 . Paul V.K et al. (2000)

Paul V.K et al. (2000) 21

care services 1 4 . Paul V.K et al. (2000) 2 1 A survey was conducted

A survey was conducted in three states of India namely, Orissa, Himachal Pradesh and Haryana. The study was carried out at district, sub-district and primary health centres to assess status of neonatal care at these facilities. In Orissa, the district and sub-district hospitals had median 100 and 30 deliveries per month respectively. The study also found that most of these deliveries were carried out by nurses and not by doctors. Neonates were generally kept for a day in these facilities for supervision. Whereas; primary health centres seldom admitted a sick neonate and rarely conducted any deliveries. Most of Caesarean section deliveries were conducted at district hospital only.

section deliveries were conducted at district hospital only. D. K. Guha (1989) 2 2 A study
section deliveries were conducted at district hospital only. D. K. Guha (1989) 2 2 A study
section deliveries were conducted at district hospital only. D. K. Guha (1989) 2 2 A study

D. K. Guha (1989) 22

A study was conducted on the existing facilities and concept of newborn care. A questionnaire was sent to 135 hospitals. Most of the nurseries were found with inadequate infrastructure for space. The nurse: baby and doctor: baby ratios

were improper as per recommended. Most of the NSCUs were found to have gaps in maintenance of asepsis environment. Equipment, like incubators and phototherapy units were inadequate. The higher morbidity and mortality was among the LBW babies, those belonging to 1000-1500grms group.

P. R. Sodani (2011) 23

Another study was conducted in 13 community health centres of Bharathpur District of Rajasthan, India. The main objective of study was to find out the availability of infrastructure facility, human resources, laboratory service and facility based newborn care service according to Indian public health standards (IPHS). The process of data collection methods was through well- structured questionnaire filled by service providers. Availability of infrastructure was found to be adequate in most of CHC’s but there was shortage of human resource especially specialists. It was also observed that none of community health centres were fully equipped to carry out facility based newborn care service including newborn care corner (NBCC) and newborn stabilization unit (NBSU).

care corner (NBCC) and newborn stabilization unit (NBSU). Forhad Akhtar Zaman et al. (2008) 2 4
care corner (NBCC) and newborn stabilization unit (NBSU). Forhad Akhtar Zaman et al. (2008) 2 4
care corner (NBCC) and newborn stabilization unit (NBSU). Forhad Akhtar Zaman et al. (2008) 2 4
care corner (NBCC) and newborn stabilization unit (NBSU). Forhad Akhtar Zaman et al. (2008) 2 4
care corner (NBCC) and newborn stabilization unit (NBSU). Forhad Akhtar Zaman et al. (2008) 2 4
care corner (NBCC) and newborn stabilization unit (NBSU). Forhad Akhtar Zaman et al. (2008) 2 4

Forhad Akhtar Zaman et al. (2008) 24

unit (NBSU). Forhad Akhtar Zaman et al. (2008) 2 4 A cross-sectional study was carried out

A cross-sectional study was carried out to find out and compare to what extent the Indian Public Health Standards (IPHS) were followed by the PHCs of selected EAG and non EAG states (Assam and Karnataka respectively). It was found that all PHCs were rendering assured services of OPD, 24 hour general emergency services and referral services but 24 hour delivery services were provided by 80% of PHCs. Functional labor rooms were available in 90% of PHCs and basic lab. services in 80% of them. So, the study revealed few important deficiencies as per IPHS norms in the PHCs visited.

lab. services in 80% of them. So, the study revealed few important deficiencies as per IPHS
lab. services in 80% of them. So, the study revealed few important deficiencies as per IPHS

Karnataka scenario:

Rao Arathi P (2011) 2

A study conducted on causes of infant mortality in Udupi District showed Neonatal mortality of 56% of total Infant deaths, explaining that out of all places of deliveries, 97.2% were institutional based, 30.8% of them were delivered in private nursing homes, 20.6% were delivered in taluk hospitals, government tertiary hospitals and private tertiary hospitals and 4.7% were delivered in health centre’s (PHCs/CHCs). Out of the personnel who conducted the delivery, 97.2% were doctors. So, after focusing on the study results, it can be assumed that there may be lack of facility towards newborn care and trained health personnel as well as some constraint towards availability of infrastructure and utilization to carry out new born essential care specially immediately after birth(0-7 days) 2 .

C M Lakshmanaet al. (2010) 25

birth(0-7 days) 2 . C M Lakshmanaet al. (2010) 2 5 A District wise analysis was
birth(0-7 days) 2 . C M Lakshmanaet al. (2010) 2 5 A District wise analysis was
birth(0-7 days) 2 . C M Lakshmanaet al. (2010) 2 5 A District wise analysis was
birth(0-7 days) 2 . C M Lakshmanaet al. (2010) 2 5 A District wise analysis was

A District wise analysis was done to take stock of overall healthcare infrastructure for children in all 29 districts of Karnataka. It was found that there were no permanent doctors at child outpatient departments in four districts. Sixteen out of 53 posts of paediatrics were vacant. Only 5 districts had adequate beds for children. NICU was found to be non-existent in eight districts including Udupi. Medical equipment like fibre optics, ultrasound and microscope were found non-existent in few of the districts. 25 .

Medical equipment like fibre optics, ultrasound and microscope were found non-existent in few of the districts.
Medical equipment like fibre optics, ultrasound and microscope were found non-existent in few of the districts.
Medical equipment like fibre optics, ultrasound and microscope were found non-existent in few of the districts.
Medical equipment like fibre optics, ultrasound and microscope were found non-existent in few of the districts.
Medical equipment like fibre optics, ultrasound and microscope were found non-existent in few of the districts.
MATERIALS AND METHODS
MATERIALS AND METHODS
MATERIALS AND METHODS
MATERIALS AND METHODS
MATERIALS AND METHODS
MATERIALS AND METHODS
MATERIALS AND METHODS

MATERIALS AND

MATERIALS AND METHODS

METHODS

MATERIALS AND METHODS
MATERIALS AND METHODS Study area : Public and Private Hospitals in Udupi taluk. District Hospital

MATERIALS AND METHODS

MATERIALS AND METHODS Study area : Public and Private Hospitals in Udupi taluk. District Hospital Community

Study area:

Public and Private Hospitals in Udupi taluk.

Study area : Public and Private Hospitals in Udupi taluk. District Hospital Community Health centres Primary
Study area : Public and Private Hospitals in Udupi taluk. District Hospital Community Health centres Primary

District Hospital

Community Health centresMATERIALS AND METHODS Study area : Public and Private Hospitals in Udupi taluk. District Hospital Primary

Primary Health centresMATERIALS AND METHODS Study area : Public and Private Hospitals in Udupi taluk. District Hospital Community

: Public and Private Hospitals in Udupi taluk. District Hospital Community Health centres Primary Health centres
Private Hospitals Health Care Facilities, Udupi Taluk, Karnataka, India. Neel kamal. [internet]. [Cited 2012.August 14].

Private Hospitals

Health Care Facilities, Udupi Taluk, Karnataka, India. Neel kamal. [internet]. [Cited 2012.August 14]. Available from:

kamal. [internet]. [Cited 2012.August 14]. Available from: https://maps.google.co.in/maps/ms?
0915,74.793549&spn=0.538431,1.347198 Study design: Cross-sectional study. Study population:

Study design:

Cross-sectional study.

Study population:

Study design: Cross-sectional study. Study population: Public and Private Health care facilities providing delivery
Study design: Cross-sectional study. Study population: Public and Private Health care facilities providing delivery
Study design: Cross-sectional study. Study population: Public and Private Health care facilities providing delivery

Public and Private Health care facilities providing delivery services in Udupi taluk.

care facilities providing delivery services in Udupi taluk. Sampling technique: Complete enumeration of government &

Sampling technique:

delivery services in Udupi taluk. Sampling technique: Complete enumeration of government & private hospitals

Complete enumeration of government & private hospitals in Udupi taluk.

Total hospitals in Udupi Taluk= 48 [(Government=26) & (Private=22)]

in Udupi Taluk= 48 [(Government=26) & (Private=22)] Total hospitals in Udupi taluk providing delivery services =

Total hospitals in Udupi taluk providing delivery services = 44 [(Government=26) & (Private= 18)]

Total hospitals (44 from Udupi taluk)

--------------------------------------------------------------------

-------------------------------------------------------------------- Government hospitals (26) Private hospitals (18)

Government hospitals

(26)

-------------------------------------------------------------------- Government hospitals (26) Private hospitals (18)

Private hospitals

(18)

PHCs

District hospital

CHCs

(22)

(1)

(3)

Inclusion criteria:

All the PHCs, CHCs, District Hospital and Private Hospitals providing delivery services in Udupi Taluk.

Study period:

providing delivery services in Udupi Taluk. Study period: The study was conducted from March 2012 to
providing delivery services in Udupi Taluk. Study period: The study was conducted from March 2012 to
providing delivery services in Udupi Taluk. Study period: The study was conducted from March 2012 to
providing delivery services in Udupi Taluk. Study period: The study was conducted from March 2012 to

The study was conducted from March 2012 to August 2012.

Study tools:

was conducted from March 2012 to August 2012. Study tools: Standard checklist for Newborn care facility
was conducted from March 2012 to August 2012. Study tools: Standard checklist for Newborn care facility
was conducted from March 2012 to August 2012. Study tools: Standard checklist for Newborn care facility

Standard checklist for Newborn care facility assessment. (Facility based Newborn care operational guide 2011, MoHFW, GOI)

Data collection methods:

operational guide 2011, MoHFW, GOI) Data collection methods: (1) Site assessment. (2) Interview with head of

(1) Site assessment. (2) Interview with head of the institution or the in charge of heath care facility. (3) Reviewing the records/registers.

of heath care facility. (3) Reviewing the records/registers. Site assessment: The process based on observation of:

Site assessment:

The process based on observation of:

Infrastructure, Equipment & supply.

Interview:

To collect information on available facilities for Newborn care.

Human resources with their training status for providing Newborn care

services.

Reviewing the records/registers

To collect information on newborn care indicators.

Data analysis:

information on newborn care indicators. Data analysis: Analysis has been done using SPSS 15 version. Data

Analysis has been done using SPSS 15 version. Data has been expressed in frequency and percentage.

Ethical consideration:

in frequency and percentage. Ethical consideration: The proposal was approved by Institutional Ethics Committee,
in frequency and percentage. Ethical consideration: The proposal was approved by Institutional Ethics Committee,
in frequency and percentage. Ethical consideration: The proposal was approved by Institutional Ethics Committee,

The proposal was approved by Institutional Ethics Committee, Kasturba

Medical Hospital, Manipal.

Ethics Committee, Kasturba Medical Hospital, Manipal.  Written permission from District Health officer (DHO),

Written permission from District Health officer (DHO), Udupi for

permission from District Health officer (DHO), Udupi for Primary Health centres and Community Health centres. 

Primary Health centres and Community Health centres.

for Primary Health centres and Community Health centres.  Written permission from District surgeon, Udupi for

Written permission from District surgeon, Udupi for District (MCH)

Hospital.

from District surgeon, Udupi for District (MCH) Hospital.  Request letter from Indian Medical Association (IMA)


Request letter from Indian Medical Association (IMA) President, Udupi

District for Private Hospitals.

RESULTS AND DISCUSSION RESULTS AND DISCUSSION
RESULTS AND DISCUSSION RESULTS AND DISCUSSION
RESULTS AND DISCUSSION RESULTS AND DISCUSSION

RESULTS AND

RESULTS AND DISCUSSION RESULTS AND DISCUSSION

DISCUSSION

RESULTS AND DISCUSSION RESULTS AND DISCUSSION
RESULTS AND DISCUSSION RESULTS AND DISCUSSION
RESULTS AND DISCUSSION RESULTS AND DISCUSSION
RESULTS AND DISCUSSION RESULTS AND DISCUSSION
RESULTS AND DISCUSSION RESULTS AND DISCUSSION

RESULTS AND DISCUSSION

In the overall planning of facility based care, it is important to understand the level
In the overall planning of facility based care, it is important to understand the
level of care that can be provided at the various facility levels. The present study
aimed to assess the availability of infrastructure, equipment, supply and Human
resource in all Health care facilities providing delivery services in Udupi Taluk.
Table 1: Types of Health care Facilities in Udupi Taluk
Types of Health Facilities
Frequency (N)
Percentage (%)
Primary Health Centres (PHCs)
22
51.1
Community Health Centres (CHCs)
3
6.9
District Hospital (DH)
1
2.3
Private Hospitals (PHs)
17
39.5
100
Total
43
The table above shows the distribution of Health care facilities in Udupi taluk.
Among the facilities visited, there were twenty two Primary Health Centres,
three Community Health Centres, one District Hospital and seventeen Private
Hospitals.
Figure: 1
Tables 2: Table -Newborn Care Services: CATEGORIES Primary Community District S.NO VARIABLES Health Centre Health
Tables 2: Table -Newborn Care Services:
CATEGORIES
Primary
Community
District
S.NO
VARIABLES
Health Centre
Health Centre
Hospital
(22)
(3)
(1)
N (%)
N (%)
N (%)
Is there 24hrs duty roster
observed and
Staff present on-site?
Yes
1
(4.5)
3
(100.0)
1 (100.0)
1.
No delivery
3
(13.6)
0
(.0)
0
(.0)
service
Which type of delivery
Only Normal
19
(86.3)
3
(100.0)
0
(.0)
2.
services does the hospital
provide?
Normal, Manual,
Assisted and
0
(.0)
0
(.0)
1 (100.0)
C-section
Does the hospital provide
essential newborn care
services?
14
(63.6)
3
(100.0)
1 (100.0)
3.
Yes
Does the hospital provide
referral services?
22
(100.0)
3
(100.0)
1 (100.0)
4.
Yes
Does the hospital have
functional ambulance or
Yes
3
(13.6)
2
(66.7)
1 (100.0)
5.
other vehicle on site of
Referral?
No 24 hr coverage
5
(22.7)
0
(.0)
0
(.0)
Does the hospital provide
24hr coverage for delivery
and newborn care?
Only deliveries
16
(72.7)
0
(.0)
0
(.0)
6.
both deliveries
and newborn care
1
(4.5)
3
(100.0)
1 (100.0)
Is the person skilled in
conducting deliveries
present at hospital or on call
No skilled persons
observed
5
(22.7)
0
(.0)
0
(.0)
Yes present,
1
(4.5)
0
(.0)
1 (100.0)
7.
24-hrs a day including
weekend, to provide
delivery care?
schedule observed
Yes, on call,
schedule observed
16
(72.7)
3
(100.0)
0
(.0)
Obstetrician
0
(.0)
1
(33.3)
1 (100.0)
Who attends the
Obstetrician and
complicated delivery at
hospital?
0
(.0)
0
(.0)
0
(.0)
Paediatrician
8.
Referred to higher
services
22
(100.0)
2
(66.7)
0
(.0)
Is there any post-partum
20
(90.9)
3
(100.0)
1 (100.0)
9.
care offered at the hospital?
Yes
Does hospital immunizes
Yes
22
(100.0)
3
(100.0)
1 (100.0)
10.
newborns?
Does hospital have essential
Yes
22
(100.0)
3
(100.0)
1 (100.0)
11.
laboratory services?
Does hospital have blood
Yes
Not applicable
Not applicable
1 (100.0)
12.
transfusion service?

TYPES OF HEALTH FACILITIES

1

1

1

1

1

1

Primary Health Centres (PHCs)

24*7 coverage is available in 77% PHCs, with one PHCs having staff present with observed duty roster, as this is the only PHC with maximum no. of deliveries and 73% PHCs have on call 24 hour coverage whereas; 27% PHCs are without any kind of 24 hour coverage.

whereas; 27% PHCs are without any kind of 24 hour coverage. ∑ Fourteen percent PHCs have

Fourteen percent PHCs have no delivery service which is an essential requirement for Primary Health Care.

which is an essential requirement for Primary Health Care. ∑ Essential Newborn Care is unavailable in

Essential Newborn Care is unavailable in 32% PHCs and 9% PHCs do not provide post- partum care whereas; essential lab. services and immunization is provided by all of the Primary Health Centres.

is provided by all of the Primary Health Centres. ∑ Referral services are available in all
is provided by all of the Primary Health Centres. ∑ Referral services are available in all

Referral services are available in all PHCs but 86% of these do not have onsite vehicle for transport.

but 86% of these do not have onsite vehicle for transport. Community Health Centres (CHCs) ∑

Community Health Centres (CHCs)

Staff present with observed duty roster for twenty four hours in all CHCs.

with observed duty roster for twenty four hours in all CHCs. ∑ Delivery services are available
with observed duty roster for twenty four hours in all CHCs. ∑ Delivery services are available

Delivery services are available in all but two CHCs refer complicated deliveries to higher services because as they don’t have any specialists (OB/GYN).

because as they don’t have any specialists (OB/GYN). ∑ All CHCs provide referral, essential laboratory,

All CHCs provide referral, essential laboratory, post-partum care and immunization services but onsite vehicle for transport is present only in two CHCs.

onsite vehicle for transport is present only in two CHCs. District Hospital (DH) ∑ All staff

District Hospital (DH)

All staff are present with observed duty roster for twenty four hours and complicated deliveries are handled in the hospital itself.

Essential laboratory services, post-partum care, immunization, blood transfusion and referral service with onsite ambulance is available for transport in the District Hospital.

Private Hospital (PHs)

Private Hospital (PHs) ∑ All Private Hospitals have 24*7coverage with staff present with observed duty roster.

All Private Hospitals have 24*7coverage with staff present with observed duty roster.

24*7coverage with staff present with observed duty roster. ∑ But only 53% of Hospitals have skilled

But only 53% of Hospitals have skilled staff present for conducting deliveries 24hours including weekend whereas; 47% of hospitals have on call facilities for same.

whereas; 47% of hospitals have on call facilities for same. ∑ All Private Hospitals have facilities
whereas; 47% of hospitals have on call facilities for same. ∑ All Private Hospitals have facilities

All Private Hospitals have facilities to conduct deliveries in term of normal as well as complicated.

conduct deliveries in term of normal as well as complicated. ∑ All Private Hospitals provide referral,

All Private Hospitals provide referral, essential newborn care and post- partum services but immunization services are unavailable in 23% PHs and onsite vehicle not present in 29% PHs.

in 23% PHs and onsite vehicle not present in 29% PHs. ∑ Two Private Hospitals do
in 23% PHs and onsite vehicle not present in 29% PHs. ∑ Two Private Hospitals do

Two Private Hospitals do not have essential lab. services and one is without blood transfusion facility.

lab. services and one is without blood transfusion facility. Koyejo Oyerinde et al. 1 6 found

Koyejo Oyerinde et al. 16 found that no hospital could be traced with basic EmOC and only few facilities were able to provide assisted vaginal deliveries (AVD) among public, private, mission and non-governmental organizations (NGOs) hospitals providing maternal and child health services.

hospitals providing maternal and child health services. Youn-g Mi Kim et al. 1 7 also reported

Youn-g Mi Kim et al. 17 also reported that 42% of the peripheral health facilities did not have sufficient facility to provide or deliver comprehensive emergency obstetric and Neonatal care (EMoNC) facilities and services like C-sections were provided in 33% of CHCs, 76% of District Hospitals and all regional hospitals of Afghanistan.

Srivastava V. K et al. 20 found that Essential Newborn care infrastructure and laboratory services were far from adequate at CHCs and DHs. PHCs were grossly deficient for newborn care in 10 states covering 11 districts of India. No District Hospital reported offering referral services since all facilities reported providing complete essential Newborn care services. The transport for referral of patients to a higher-level health facility was available in a large number of the CHCs and approximately half of the PHCs.

large number of the CHCs and approximately half of the PHCs. Paul V.K et al. 2
large number of the CHCs and approximately half of the PHCs. Paul V.K et al. 2
large number of the CHCs and approximately half of the PHCs. Paul V.K et al. 2

Paul V.K et al. 21 found that most of the deliveries were carried out by nurses and not by doctors. Neonates were generally kept for a day in these facilities for supervision. Whereas; Primary Health Centres seldom admitted a sick Neonate and rarely conducted any deliveries. Most of Caesarean section deliveries were conducted at district hospital only, in three states of India.

at district hospital only, in three states of India. Forhad Akhtar Zaman et al. (2008) 2
at district hospital only, in three states of India. Forhad Akhtar Zaman et al. (2008) 2
at district hospital only, in three states of India. Forhad Akhtar Zaman et al. (2008) 2

Forhad Akhtar Zaman et al. (2008) 24 found that all PHCs were rendering assured services of OPD, 24 hour general emergency services and referral services but 24 hour delivery services were provided by 80% of PHCs, through a cross-sectional study carried out to find out and compare to what extent the Indian Public Health Standards (IPHS) were followed by the PHCs of selected EAG and non EAG states (Assam and Karnataka respectively).

Health Standards (IPHS) were followed by the PHCs of selected EAG and non EAG states (Assam
Health Standards (IPHS) were followed by the PHCs of selected EAG and non EAG states (Assam
Health Standards (IPHS) were followed by the PHCs of selected EAG and non EAG states (Assam
Tables 3A: Table – Infrastructure for Newborn Care TYPES OF HEALTH FACILITIES Primary Health District
Tables 3A: Table – Infrastructure for Newborn Care
TYPES OF HEALTH FACILITIES
Primary Health
District
Private
Centre
Community Health
Centre
Hospital
Hospita
S.NO
VARIABLES
(22)
(3)
(1)
(16)
Quantity
N (%)
Quantity
N (%)
N
Quantity
0
1
(4.5)
15-50
Total no. of beds
30
3
(100.0)
79
1.
1-3
10
(45.5)
51-100
4-6
11
(50.0)
>100
0
15
(68.2)
5
1(33.3)
0
No. of
maternity/postnatal
1-3
6 (27.3)
6
1(33.3)
50
1-20
2.
Beds
4
1
(4.5)
12
1(33.3)
21-40
0
0
20
(90.9)
0
1(33.3)
No of newborn
1-4
29
3.
beds
5-8
1
2
(9.1)
1-6
2
(66.7)
12
1
1
No. of labor room
(100.0)
4.
1
22 (100.0)
1 3
1
2
1
5.
No. of OT
(100.0)
NA
1 3
1
2
3
No. of postnatal
ward
0
6.
(100.0)
NA
1 3
2
1
1
0
NBCC
1
1(4.5)
1 3
(100.0)
1
7.
1
1
0
1
SNCU / NICU
NA
1
8.
NA
1
In the table above, one Private Hospital has been excluded as it is a Medical
In the table above, one Private Hospital has been excluded as it is a Medical College & Teaching
Hospital with maximum no. of beds.
Tables 3B: Table- Infrastructure for Newborn Care
TYPES OF HEALTH FACILITIES
Primary Health
Community
District
Centre
Health Centre
Hospital
S.NO
VARIABLES
CATEGORIES
(22)
(3)
(1)
N (%)
N (%)
N (%)
Where is the delivery
and neonatal
equipment located?
Labor Room
16
(72.7)
3
(100.0)
1 (100.0)
1.
Others
6
(27.3)
0
(.0)
0
(.0)
Does the hospital
2.
Yes
18
(88.1)
3
(100.0)
1 (100.0)
have adequate light?
No power
5
(22.7)
1
(33.3)
0
(.0)
Which type of power
backup
3.
backup does the
hospital have?
Generator
1 (4.5)
1
(33.3)
1 (100.0)
Inverter
16
(72.7)
1
(33.3)
0
(.0)
Open-well
5
(22.7)
1
(33.3)
0
(.0)
Which type of water
source does the
hospital have?
Bore-well
3
(13.6)
2
(66.7)
0
(.0)
4.
Panchayat
9
(40.9)
0
(.0)
0
(.0)
Mix
5
(22.7)
0
(.0)
1 (100.0)

Pr

Ho

N

8

9

17

0

17

3

1

0

1

12

Tables 3C: Table - Infrastructure for Newborn Care

S.NO VARIABLES CATEGORIES District Hospital (1) N (%) Area for Hand 1. washing Yes 1
S.NO
VARIABLES
CATEGORIES
District Hospital
(1)
N (%)
Area for Hand
1.
washing
Yes
1 (100.0)
Area for mixing IV
2.
Yes
1 (100.0)
fluid
Area for boiling &
3.
Yes
1
(100.0)
autoclaving
4.
Area for laundry
Yes
1
(100.0)
5.
Clean utility area
Yes
1
(100.0)
6.
Soiled utility area
Yes
1
(100.0)
7.
Store room
Yes
1
(100.0)
8.
Side lab
Yes
0 (.0)
7. Store room Yes 1 (100.0) 8. Side lab Yes 0 (.0) Primary Health Centres (PHCs)
7. Store room Yes 1 (100.0) 8. Side lab Yes 0 (.0) Primary Health Centres (PHCs)

Primary Health Centres (PHCs)

Fifty percent of the PHCs are 4-6 bedded and one PHC has no beds.

percent of the PHCs are 4-6 bedded and one PHC has no beds. ∑ Twenty seven

Twenty seven percent of PHCs have 1-3 maternity beds and 68% PHCs have not allotted any maternity beds whereas; only two PHCs are with one Newborn bed. This can be explained as due to poor demand of the services because most of the people prefer District and Private Hospitals for birth of their children.

District and Private Hospitals for birth of their children. TYPES OF HEALTH FACILITIES (17) N (%)

TYPES OF HEALTH FACILITIES

(17)

N (%)

17(100.0)

17(100.0)

15 (80.2)

17(100.0)

17(100.0)

16 (94.1)

17 (100.0)

2 (11.1)

All PHCs have one labor room each but NBCC is available only in one PHC.

Seventy three per cent of PHCs have placed the delivery and Neonatal equipment in labor room whereas other 27% have kept in other than labor room.

Private Hospital

Adequate light for examination is available in 88% PHCs.

Seventy three per cent PHCs use invertor whereas 28% are without any

power backup.

Primary Health Centres utilize water from different sources with 41% using water from Panchayat source.

sources with 41% using water from Panchayat source. Community Health Centres (CHCs) ∑ All Community Health

Community Health Centres (CHCs)

All Community Health Centres are thirty bedded with two CHCs having 5-6 maternity beds each and only one CHC with no bed for the Newborns.

beds each and only one CHC with no bed for the Newborns. ∑ Designated area for
beds each and only one CHC with no bed for the Newborns. ∑ Designated area for

Designated area for one labor room, OT and one NBCC each available in all CHCs.

one labor room, OT and one NBCC each available in all CHCs. ∑ All CHCs have

All CHCs have placed delivery & neonatal equipment in labor room with adequate light for examination.

equipment in labor room with adequate light for examination. ∑ One Community Health Centre has no
equipment in labor room with adequate light for examination. ∑ One Community Health Centre has no

One Community Health Centre has no power back up and water source for two CHCs is from bore-well.

back up and water source for two CHCs is from bore-well. District Hospital (DH) ∑ District

District Hospital (DH)

for two CHCs is from bore-well. District Hospital (DH) ∑ District Hospital has 50 maternity beds

District Hospital has 50 maternity beds and 29 newborn beds.

Designated area for labor room, OT, NBCC in labor room, postnatal ward and a separate SNCU available in District Hospitals.

Delivery and neonatal equipment are placed in labor room with adequate light for examination.

∑

District Hospital uses Generator as power backup and has multiple sources for water supply.

District Hospital has a separate ancillary area each for hand washing, IV fluid mixing, autoclaving, utility and store room but no side lab.

Private Hospitals (PHs)

and store room but no side lab. Private Hospitals (PHs) ∑ ∑ ∑ Nineteen per cent

Nineteen per cent PHs are without maternity beds and 31.3% are without newborn beds.

All

maternity beds and 31.3% are without newborn beds. All Private Hospitals have designated area for labor

Private Hospitals have designated area for labor room and OT.

Hospitals have designated area for labor room and OT. NBCC in labor room but NICU is
Hospitals have designated area for labor room and OT. NBCC in labor room but NICU is

NBCC in labor room but NICU is unavailable in 69% of PHs.

Eighty seven per cent of PHs has one post natal ward each and 69% have

one

Delivery and Neonatal equipment are placed in labor room with adequate light for examination in all PHs.

labor room with adequate light for examination in all PHs. All Private Hospitals use Generator as

All Private Hospitals use Generator as power backup and 71% use multiple sources for water supply.

backup and 71% use multiple sources for water supply. ∑ All IV present only in two
backup and 71% use multiple sources for water supply. ∑ All IV present only in two

All

IV

present only in two Private Hospitals.

Private Hospitals have separate ancillary area each for hand washing,

fluid mixing, autoclaving, utility and store room but side lab was

mixing, autoclaving, utility and store room but side lab was According to the guidelines on Facility
mixing, autoclaving, utility and store room but side lab was According to the guidelines on Facility

According to the guidelines on Facility Based Newborn Care (2011) formulated by Ministry of Health and Family Welfare, Government of India, Newborn Care Corner is mandatory for all health care facilities where deliveries are conducted and SNCU is deemed compulsory at District level and above. The study revealed that all health facilities visited provided delivery services except four

PHCs but NBCC and SNCU/NICU services were available only at District Hospital and few Private Hospitals (35%).

Casey et al. (2009) 13 found that the facilities had poor infrastructure, infection prevention and poor monitoring of reproductive health services related to EmOC in a study conducted by International Rescue Committee (IRC) and CARE as baseline assessments of public hospitals to determine the availability, utilization and quality of reproductive services in nine general referral hospitals of democratic republic of Congo.

utilization and quality of reproductive services in nine general referral hospitals of democratic republic of Congo.
general referral hospitals of democratic republic of Congo. Sutapa Neogi et al. 5 findings concluded that
general referral hospitals of democratic republic of Congo. Sutapa Neogi et al. 5 findings concluded that

Sutapa Neogi et al. 5 findings concluded that the SNCUs visited in eight rural districts of India had availability but inadequate repair and maintenance of equipment and lack of Human resources. So, more research is still required to evaluate the quality and monitoring of the health care facilities for a satisfactory conclusion and planning of the programs and policies for newborn care in the taluk.

care facilities for a satisfactory conclusion and planning of the programs and policies for newborn care
care facilities for a satisfactory conclusion and planning of the programs and policies for newborn care
care facilities for a satisfactory conclusion and planning of the programs and policies for newborn care
care facilities for a satisfactory conclusion and planning of the programs and policies for newborn care
care facilities for a satisfactory conclusion and planning of the programs and policies for newborn care
care facilities for a satisfactory conclusion and planning of the programs and policies for newborn care
Tables 4A: Table – Equipment for Management: TYPES OF HEALTH FACILITIES District Primary Health centres
Tables 4A: Table – Equipment for Management:
TYPES OF HEALTH FACILITIES
District
Primary Health centres
VARIABLES
Community Health
centres
Private
S.NO
Hospital
Hospitals
(22)
(3)
(1)
(16)
Quantity
N (%)
Quantity
N (%)
N
Quantity
N (%)
0
21 (95.5)
1
2
(66.7)
0
6
(37.5)
1.
Radiant warmer
9
1-3
9
(56.2)
1
1 (4.5)
2
1
(33.3)
5
1 (6.3)
0
2 (66.7)
0
1
(6.3)
Phototherapy unit
single head high
Intensity
NA
6
1-2
11 (68.7)
2.
2
1 (33.3)
4
4
(25.0)
0
9
(56.2)
3.
Incubator
NA
NA
0
1
6
(37.5)
2
1
(6.3)
In the table above one Private Hospital has been excluded as it was Medical College &
Teaching Hospital had maximum number of Equipment.
Primary Health Centres (PHCs)
Though 19 PHCs conduct deliveries (on call) but radiant warmer is
available in only one PHC.
Community Health Centres (CHCs)
∑ Three radiant warmers are required in each CHC but two CHCs have one radiant
∑ Three radiant warmers are required in each CHC but two CHCs have one
radiant warmer each and one CHC with two radiant warmers only.
∑ One phototherapy unit is required in each CHC but two CHCs did not
have the same.
District Hospital (DH)
District Hospital has nine radiant warmers, six phototherapy units and no
incubator.
Private Hospitals (PHs)
Sixty nine percent Private Hospitals have radiant warmers, 94% have
phototherapy unit and 47% have incubator.
Tables 4B: Table - Equipment for Monitoring:
TYPES OF HEALTH FACILITIES
District
Private
Primary Health centres
S.NO
VARIABLES
Community Health
centres
Hospital
Hospitals
(22)
(3)
(1)
(16)
Quantity
N (%)
Quantity
N (%)
N
Quantity
N (%)
1
10
(62.5)
1.
Baby weighing scale
1 (100.0)
22
1 3 (100.0)
1
2
6
(37.5)
1-3
12
(75.0)
2.
Thermometer
1 (100.0)
22
1 3(100.0)
8
4-6
4
(25.0)
0
1
(6.3)
3.
Pulse oximeter
NA
NA
6
1-2
12
(75.0)
3
3
(18.7)
0
1
(6.3)
4.
Stethoscope Neonates
NA
NA
13
1-3
12
(75.0)
4-5
3
(18.7)
0
2
(12.5)
5.
Sphygmomanometer
NA
NA
1
1
5
(31.3)
2
9
(56.2)
0
2
(12.5)
6.
Vital sign monitor
NA
1
1
9
(56.2)
NA
2
5
(31.3)

In the table above one Private Hospital has been excluded as it was Medical College & Teaching Hospital with maximum number of Equipment.

Primary Health Centres (PHCs)

All

PHCs

have

one

mechanical

baby

weighing

scale

and one
and
one

thermometer each.

mechanical baby weighing scale and one thermometer each. Community Health Centres (CHCs) ∑ All Community Health

Community Health Centres (CHCs)

one thermometer each. Community Health Centres (CHCs) ∑ All Community Health Centres have one electronic baby

All Community Health Centres have one electronic baby weighing scale

and one thermometer each but four thermometers are required in each

CHC.

each but four thermometers are required in each CHC. District Hospital (DH) ∑ District Hospital has
each but four thermometers are required in each CHC. District Hospital (DH) ∑ District Hospital has
each but four thermometers are required in each CHC. District Hospital (DH) ∑ District Hospital has
each but four thermometers are required in each CHC. District Hospital (DH) ∑ District Hospital has

District Hospital (DH)

are required in each CHC. District Hospital (DH) ∑ District Hospital has one electronic baby weighing

District Hospital has one electronic baby weighing scale in SNCU, eight

thermometers, six pulse oximeters, thirteen neonate stethoscopes, one

six pulse oximeters, thirteen neonate stethoscopes, one sphygmomanometer and one vital sign monitor but four

sphygmomanometer and one vital sign monitor but four electronic baby

weighing scales, twelve thermometers and six sphygmomanometers are

required.

Private Hospitals (PHs)

Fifty nine percent Private Hospitals have one baby weighing scale each

and 41% have two each.

Seventy percent of Private Hospitals have atleast one thermometer each and 30% have atleast 4 thermometers each.

Seventy percent of Private Hospitals have atleast one pulse oximeter and one thermometer each and 30% have three of both each.

Twenty nine percent Private Hospitals have one sphygmomanometer each and 59% have atleast two each.

one sphygmomanometer each and 59% have atleast two each. ∑ Fifty three percent of Private Hospitals

Fifty three percent of Private Hospitals have one vital sign monitor each and 35% have atleast five each.

one vital sign monitor each and 35% have atleast five each. Tables 4C: Table- Equipment for
one vital sign monitor each and 35% have atleast five each. Tables 4C: Table- Equipment for
Tables 4C: Table- Equipment for Investigation: TYPES OF HEALTH FACILITIES Primary Health centres VARIABLES Community
Tables 4C: Table- Equipment for Investigation:
TYPES OF HEALTH FACILITIES
Primary Health centres
VARIABLES
Community Health
centres
District
S.NO
Hospital
(22)
(3)
(1)
Quantity
N (%)
Quantity
N (%)
N
Quantity
Centrifuge,
hematocrit
0
1 (4.5)
1 2 (66.7)
1.
benchtop, up to
12000 rpm,
including rotator
2
1
21 (95.5)
2 1(33.3)

Private

Hospitals

(16)

0 2

1 5

2 9

N (%)

(12.5)

(31.3)

(56.2)

1 21 (95.5) 1 2 (66.7) 0 2 (12.5) 2. Microscope 2 1-2 8 (50.0)
1
21
(95.5)
1
2 (66.7)
0
2
(12.5)
2.
Microscope
2
1-2
8
(50.0)
2
1
(4.5)
2
1 (33.3)
2-3
6
(37.5)
Bilirubinometer,
0
20
(90.9)
0
2 (66.7)
0
7
(43.8)
3.
total bilirubin,
1
capillary based
1
2
(9.1)
1
1 (33.3)
1
9
(56.2)
0
3 (13.6)
1
2 (66.7)
0
2
(12.5)
4.
Glucometer
2
1-2
13 (81.2)
1
19
(86.4)
2
1 (33.3)
6
1
(6.3)
5.
ECG unit portable
NA
NA
0
0
3
(18.7)
1
9
(56.2)
2
5
(31.3)
0
5
(31.3)
6.
X-ray mobile
NA
NA
0
1
11
(68.7)
In the table above one Private Hospital has been excluded as it was Medical College
& Teaching Hospital had maximum number of Equipment.
Primary Health Centres (PHCs)
∑ Ninety five percent PHCs have one centrifuge and one microscope each.
∑ Eighty six percent have one glucometer each but 91% of PHCs do not
have bilirubinometer.
Community Health Centres (CHCs)
All CHCs have atleast one centrifuge, one microscope and one
glucometer each but bilirubinometer is not available in two CHCs.
District Hospital (DH)
District Hospital has two centrifuges, two microscopes; two glucometer
(three required) and one bilirubinometer but no portable ECG (desired)
and mobile X-ray (desired) could be traced.

Private Hospitals (PHs)

Fifty nine percent of Private Hospitals have atleast two centrifuges and two PHs do not have it.

have atleast two centrifuges and two PHs do not have it. ∑ Forty seven percent of

Forty seven percent of PHs have atleast one microscope each and 41% have atleast two microscopes each.

microscope each and 41% have atleast two microscopes each. ∑ Fifty-nine per cent have atleast one

Fifty-nine per cent have atleast one bilirubinometer and 81% have atleast one glucometer.

one bilirubinometer and 81% have atleast one glucometer. ∑ Eighty eight percent have portable ECG unit
one bilirubinometer and 81% have atleast one glucometer. ∑ Eighty eight percent have portable ECG unit

Eighty eight percent have portable ECG unit and 69% have mobile X-ray facility.

and 81% have atleast one glucometer. ∑ Eighty eight percent have portable ECG unit and 69%
and 81% have atleast one glucometer. ∑ Eighty eight percent have portable ECG unit and 69%
and 81% have atleast one glucometer. ∑ Eighty eight percent have portable ECG unit and 69%
and 81% have atleast one glucometer. ∑ Eighty eight percent have portable ECG unit and 69%
and 81% have atleast one glucometer. ∑ Eighty eight percent have portable ECG unit and 69%
Tables 4D: Table- Equipment for Resuscitation: TYPES OF HEALTH FACILITIES Primary Health centres Community Health
Tables 4D: Table- Equipment for Resuscitation:
TYPES OF HEALTH FACILITIES
Primary Health centres
Community Health
centres
District
Privat
S.NO
VARIABLES
Hospital
Hospit
(22)
(3)
(1)
(16)
Quantity
N (%)
Quantity
N (%)
N
Quantity
0
18
(81.8)
Resuscitator, hand
1
1
1.
1
3
(13.6)
0
3
(100.0)
1
operated 500ml
2
1
(4.5)
2
0
11
(50.0)
1
1
Resuscitator, hand
2.
1
3
(100.0)
4
operated 250ml
1
11
(50.0)
2
0 8
(36.4)
1
2
(66.7)
0
1
3.
Pump suction, foot
operated
1 13
(59.1)
1
2
1
(33.3)
1
2 1
(4.5)
Suction pump
1
1
portable,
NA
0
3
(100.0)
2
4.
220v.w/access
2-4
1
2
(66.7)
1-2
1
Laryngoscope sets,
NA
5
5.
Neonates
2
1
(33.3)
3-4
In the table above one Private Hospital has been excluded as it was Medical College &
Teaching Hospital had maximum number of Equipment.
Primary Health Centres (PHCs)
Fifty per cent of the PHCs have at least one 250ml resuscitator each and
one foot operated pump suction was available in 60% of PHCs each
whereas; resuscitator 500ml is available (1 required in each PHC) only in 18% of PHCs.
whereas; resuscitator 500ml is available (1 required in each PHC) only in
18% of PHCs.
Community Health Centres (CHCs)
All CHCs have atleast one 250ml resuscitator each and one pump-
suction foot operated each. Whereas; resuscitator 500ml is not available
(2 required in each CHC) in any of CHCs.
District Hospital (DH)
District Hospitals has four resuscitator 250ml, one foot operated suction,
two portable suction pumps and five laryngoscope sets.
Private Hospitals (PHs)
All PHs have at least one resuscitator 250ml, one portable suction pump
and one laryngoscope set each but foot operated suction is available only
in 31% PHs.
Tables 4E: Table- Equipment for Disinfection:
TYPES OF HEALTH FACILITIES
District
Private
Primary Health centres
S.NO
VARIABLES
Community Health
centres
Hospital
Hospitals
(22)
(3)
(1)
(16)
Quantity
N (%)
Quantity
N (%)
N
Quantity
N (%)
1
17
(77.3)
2
1
(33.3)
0
9
(56.3)
1.
1
Syringe hub cutter
2-5
5
(22.7)
3
2
(66.7)
1
7
(43.7)
Sterilizing drum
1
21
(95.5)
1-3
4
(25.0)
2.
1
3
(100.0)
5
165mm diameter
2
1
(4.5)
4-6
12
(75.0)
0
2
(9.1)
0
3
(18.7)
3.
Electric sterilizer
1
3
(100.0)
0
1
11
(68.8)
1
20
(90.9)
2
2
(12.5)
0
3
(13.6)
6
2
(66.7)
1-10
7
(43.7)
4.
Gowns
25
11-20
7
(43.7)
3
19
(86.4)
9
3
(33.3)
21-30
2
(12.5)
5.
Washable slippers
0
6
(27.3)
2
1
(33.3)
12
1-6
7
(43.7)
1-3
13(59.1)
3
1
(33.3)
7-12
7
(43.7)
   

4

3 (13.6)

4

1 (33.3)

 

>=20

6.

Washing machine

0

22 (100.0)

0

3 (100.0)

1

 
 

2

0 8

1 8

In the table above one Private Hospital has been excluded as it was Medical College & Teaching Hospital had maximum number of Equipment.

& Teaching Hospital had maximum number of Equipment. Primary Health Centres (PHCs) ∑ All PHCs have

Primary Health Centres (PHCs)

maximum number of Equipment. Primary Health Centres (PHCs) ∑ All PHCs have at least one syringe

All PHCs have at least one syringe hub cutter, one sterilizing drum and one electric sterilizer each.

Gowns and washable slippers were not available in three and six PHCs respectively.

were not available in three and six PHCs respectively. Community Health Centres (CHCs) ∑ All Community
were not available in three and six PHCs respectively. Community Health Centres (CHCs) ∑ All Community
were not available in three and six PHCs respectively. Community Health Centres (CHCs) ∑ All Community

Community Health Centres (CHCs)

and six PHCs respectively. Community Health Centres (CHCs) ∑ All Community Health Centres have one sterilizing

All Community Health Centres have one sterilizing drum, one electric sterilizer and atleast six gowns each.

drum, one electric sterilizer and atleast six gowns each. District Hospital (DH) ∑ District Hospital has
drum, one electric sterilizer and atleast six gowns each. District Hospital (DH) ∑ District Hospital has

District Hospital (DH)

∑

District Hospital has one syringe hub cutter, five sterilizing drums, 25

gowns and 12 washable slippers but no electric sterilizer because it has

separate autoclave facility.

Private Hospitals (PHs)

(12.5)

(50.0)

(50.0)

Twenty four percent Private Hospitals have atleast one sterilizing drum each and 76% have atleast four each.

Syringe hub cutter is unavailable in 53% of PHs because waste disposal is handled by a local based company.

All Private Hospitals have electric sterilizer, gowns and washable slippers except no electric sterilizer in three private hospitals as these hospitals have separate autoclaving facilities.

as these hospitals have separate autoclaving facilities. General Equipment: ∑ Four syringe pumps were available in
as these hospitals have separate autoclaving facilities. General Equipment: ∑ Four syringe pumps were available in
as these hospitals have separate autoclaving facilities. General Equipment: ∑ Four syringe pumps were available in
as these hospitals have separate autoclaving facilities. General Equipment: ∑ Four syringe pumps were available in
as these hospitals have separate autoclaving facilities. General Equipment: ∑ Four syringe pumps were available in
as these hospitals have separate autoclaving facilities. General Equipment: ∑ Four syringe pumps were available in
as these hospitals have separate autoclaving facilities. General Equipment: ∑ Four syringe pumps were available in
as these hospitals have separate autoclaving facilities. General Equipment: ∑ Four syringe pumps were available in
as these hospitals have separate autoclaving facilities. General Equipment: ∑ Four syringe pumps were available in

General Equipment:

Four syringe pumps were available in District Hospital whereas 62.5% of Private Hospitals did not have any syringe pump. In addition, surgical instruments were found in all Private Hospitals as well as District Hospital.

All health care facilities had one computer with printer each except 20% Private Hospitals.

All health care facilities were equipped with atleast one refrigerator, stabilizer and wall clock each. In addition, air conditioner was not present in any CHC and 12.5% of PHs.

air conditioner was not present in any CHC and 12.5% of PHs. ∑ Sixty nine percent
air conditioner was not present in any CHC and 12.5% of PHs. ∑ Sixty nine percent
air conditioner was not present in any CHC and 12.5% of PHs. ∑ Sixty nine percent

Sixty nine percent of Private Hospitals were lacking with infanotometer plexi and no room heater was available in any of health facilities except one Private Hospital.

in any of health facilities except one Private Hospital. ∑ Measuring tape, kidney basin, dressing tray
in any of health facilities except one Private Hospital. ∑ Measuring tape, kidney basin, dressing tray

Measuring tape, kidney basin, dressing tray and infusion stand were available in District Hospital and all Private Hospitals.

available in District Hospital and all Private Hospitals. ∑ Spot lamp was available in two CHCs,
available in District Hospital and all Private Hospitals. ∑ Spot lamp was available in two CHCs,

Spot lamp was available in two CHCs, District Hospital and all Private Hospitals.

in two CHCs, District Hospital and all Private Hospitals. Charles Opondo et al 1 2 also
in two CHCs, District Hospital and all Private Hospitals. Charles Opondo et al 1 2 also

Charles Opondo et al 12 also found lack of hygienic environment and some key equipment in first referral units of Kenya, which is also a developing country.

Sara E Casey et al 13 also reported shortage of equipment, essential drugs and poor infection prevention in public hospitals of Congo.

A B Biswas et al 19 showed that there was inadequate infrastructure facilities (e.g. no sanctioned post of specialist, no blood bank at rural hospital) and poor utilization of equipment like neonatal resuscitation sets, radiant warmer, lack of training of service providers were evident. It was also reported that most of the deliveries and immediate Neonatal resuscitation was done by nurses (94.9%) 19 in first referral level hospitals in six Districts of West Bengal.

referral level hospitals in six Districts of West Bengal. Neogi Sutapa et al. (2011) 5 also
referral level hospitals in six Districts of West Bengal. Neogi Sutapa et al. (2011) 5 also

Neogi Sutapa et al. (2011) 5 also reported inadequate repair and maintenance of the equipment in eight rural districts of India. Most of the NSCUs were found to have gaps in maintenance of asepsis environment.

found to have gaps in maintenance of asepsis environment. D. K. Guha (1989) 2 2 reported
found to have gaps in maintenance of asepsis environment. D. K. Guha (1989) 2 2 reported
found to have gaps in maintenance of asepsis environment. D. K. Guha (1989) 2 2 reported

D. K. Guha (1989) 22 reported that equipment, like incubators and phototherapy units were inadequate in most of the health facilities.

units were inadequate in most of the health facilities. Srivastava V. K et al. (2009) 2
units were inadequate in most of the health facilities. Srivastava V. K et al. (2009) 2

Srivastava V. K et al. (2009) 20 found that Essential newborn care equipment was available in the majority of DHs but CHCs and PHCs were not adequately equipped. Essential drugs and supplies were available in most of the DHs. Poor implementation of the program were cited as the main reason for poor performance of the program by most of the policy planners and state level program managers in eleven Districts of India.

performance of the program by most of the policy planners and state level program managers in
performance of the program by most of the policy planners and state level program managers in

Tables 5A: Table - Human Resource for Newborn Care

Tables 5A: Table - Human Resource for Newborn Care
Tables 5A: Table - Human Resource for Newborn Care
Tables 5A: Table - Human Resource for Newborn Care
Tables 5A: Table - Human Resource for Newborn Care
Tables 5A: Table - Human Resource for Newborn Care
Tables 5A: Table - Human Resource for Newborn Care
Tables 5A: Table - Human Resource for Newborn Care
Tables 5A: Table - Human Resource for Newborn Care
Tables 5A: Table - Human Resource for Newborn Care
TYPES OF HEALTH FACILITIES Primary Health Community Health District Private Centre Centre Hospital Hospital S.NO
TYPES OF HEALTH FACILITIES
Primary Health
Community Health
District
Private
Centre
Centre
Hospital
Hospital
S.NO
VARIABLES
(22)
(3)
(1)
(16)
Quantity
N (%)
Quantity
N (%)
N (%)
Quantity
N (%)
Permanent
NA
1
1
(33.3)
2
(100.0)
10
7
(43.7)
1
Paediatrician
Contractual
NA
0
(0)
0
(.0)
25
9
(56.3)
0
4
(25.0)
Permanent
NA
1
1
(33.3)
1
(100.0)
1
10
(62.5)
2-5
2
(12.5)
2.
OB/GYN
0
7
(43.7)
Contractual
NA
0
(.0)
0
(.0)
1
4
(25.0)
2-4
5
(31.3)
0
3
(18.7)
Permanent
21
21(95.5)
3
3
(100.0)
0
(0)
1-5
13
(81.3)
1.
Medical
0
15
(93.7)
officers
Contractual
1
1
(4.5)
0
(0)
3
(100.0)
4
1
(6.3)
4-8
10
(62.5)
Permanent
10
10(45.5)
0
(0)
9-16
5
(31.2)
14
3
(100.0)
24
1
(6.2)
2.
Staff nurse
Contractual
4
2
(9.1)
4
2
(66.7)
12 (100.0)
0 (0)
0 (0)
Permanent
20
20(90.9)
3
3
(100.0)
1
(100.0)
36
14
(87.5)
Lab.
4.
Technician
Contractual
2
2
(9.1)
0
(.0)
0
(.0)
0
2
(12.5)
Permanent
0
(.0)
3
3
(100.0)
1
(100.0)
24
13
(81.2)
5.
Data manager
Contractual
0
(.0)
0
(.0)
0
(.0)
0
3
(18.7)
Permanent
23
17(77.3)
10
3
(100.0)
4
(100.0)
73
15
(93.7)
Supporting
6.
staff
Contractual
6
5 (22.7)
0
(.0)
0
(.0)
15
1
(6.2)
In the table above one Private Hospital has been as it was Medical College & Teaching Hospital
with maximum number of Human Recourses.
Primary Health Centres (PHCs)

All Primary Health Centres have one permanent Medical officer each except one PHC.

Forty five percent PHCs have permanent staff nurses whereas; 9% have contractual staff nurses.

Twenty permanent Lab. Technicians are working in 91% PHCs and twenty permanent supporting staff are available in 77% of PHCs.

permanent supporting staff are available in 77% of PHCs. Community Health Centres (CHCs) ∑ One permanent

Community Health Centres (CHCs)

available in 77% of PHCs. Community Health Centres (CHCs) ∑ One permanent specialist (Paediatrician & OB/GYN)

One permanent specialist (Paediatrician & OB/GYN) is available in two CHCs each whereas one CHC has no specialist.

in two CHCs each whereas one CHC has no specialist. ∑ Each CHC has one permanent
in two CHCs each whereas one CHC has no specialist. ∑ Each CHC has one permanent

Each CHC has one permanent Medical officer, lab technician and data manager.

permanent Medical officer, lab technician and data manager. ∑ Fourteen permanent staff nurses are available in

Fourteen permanent staff nurses are available in three CHCs and four contractual in two CHCs.

available in three CHCs and four contractual in two CHCs. ∑ All together CHCs have 10

All together CHCs have 10 permanent supporting staff available.

together CHCs have 10 permanent supporting staff available. District Hospital (DH) ∑ All Paediatricians,

District Hospital (DH)

All Paediatricians, Obstetricians, Lab. technicians, Data manager and supporting working in District Hospital are permanent but the Medical officers and staff nurses working in DH are on contractual basis.

and staff nurses working in DH are on contractual basis. Private Hospitals (PHs) ∑ Forty four
and staff nurses working in DH are on contractual basis. Private Hospitals (PHs) ∑ Forty four

Private Hospitals (PHs)

Forty four percent of PHs have permanent and 56% have contractual paediatricians.

Seventy seven percent of PHs have permanent obstetricians and 53% have contractual but 25% PHs have no obstetrician at all.

∑ Three Private Hospitals do not have Medical officers and all PHs have permanent staff
∑ Three Private Hospitals do not have Medical officers and all PHs have
permanent staff nurses working in the hospitals.
∑ All PHs have permanent Lab. technicians, Data manager and supporting
staff.
Tables 5B: Table - Human Recourses with Training status
CODES FOR TRAINING STATUS
DAYS OF TRAINING ATTENDED
A. IMNCI: for medical officer/ staff nurse
8
Days
B. F-IMNCI: for medical officer/ staff nurse
11
Days
C. NSSK: for medical officer/ staff nurse/ANM
2
Days
D. Facility based newborn care: for medical
officer/staff nurse posted in SNCU
3
Days
E. SBA for ANMs/LHVs & Staff nurse
2-3 Days
F. SBA/BEmOC for Medical officer
9
Days
G. Observership
2
Weeks
H. Neonatology
3
months
TRAINING STATUS
N
B
C
F
B
B
C
E
B
B
B
B
C
C
S.NO
VARIABLES
o
&
&
&
&
,
,
,
,
,
,
G
C
E
C
E
E
T
C
F
F
&
C
&
&
&
&
r
a
G
&
G
D
G
F
i
n
F
i
n
g
Permanent
PHC
2
3
0
2
9
3
0
0
0
1
0
1
0
0
(21)
Medical
(22)
officers
Contractual
1
0
0
0
0
0
0
0
0
0
0
0
0
0
(1)
Permanent
1
1
0
0
1
0
0
0
1
0
2
0
0
0
Staff
(10)
nurse
Contractual
1
0
0
0
0
0
0
2
0
0
0
0
0
0
(4)
Medical
Permanent
CHC
0
0
0
1
0
0
1
0
0
1
0
0
0
0
officers
(3)
Staff
Permanent
0
0
1
0
2
0
0
2
0
0
3
0
3
0
(3)
nurse
(14)

Contractual

(4)

0

0

0

0

0

0

0

0

0

0

1

0

2

In the District hospital, out of 3 only 1 Medical Officer and all 12 staff nurses were trained in Neonatology.

In all Private Hospitals, neither Medical officers nor Staff nurses were trained, except two Paediatricians trained with one year fellowship in Neonatology.

trained with one year fellowship in Neonatology. Primary Health Centres (PHCs) ∑ Most of the Medical
trained with one year fellowship in Neonatology. Primary Health Centres (PHCs) ∑ Most of the Medical
trained with one year fellowship in Neonatology. Primary Health Centres (PHCs) ∑ Most of the Medical

Primary Health Centres (PHCs)

Most of the Medical officers in PHCs were trained with F-IMNCI and

NSSK.

Medical officers in PHCs were trained with F-IMNCI and NSSK. ∑ Staff nurses in most of

Staff nurses in most of the PHCs were trained with F-IMNCI, NSSK,

SBA and observer-ship.

PHCs were trained with F-IMNCI, NSSK, SBA and observer-ship. Community Health Centres (CHCs) ∑ In all
PHCs were trained with F-IMNCI, NSSK, SBA and observer-ship. Community Health Centres (CHCs) ∑ In all

Community Health Centres (CHCs)

SBA and observer-ship. Community Health Centres (CHCs) ∑ In all CHCs, Medical officers were trained with

In all CHCs, Medical officers were trained with BEmOC and NSSK.

District Hospital (DH)

were trained with BEmOC and NSSK. District Hospital (DH) ∑ In the District Hospital, out of

In the District Hospital, out of 3 only one Medical Officer and all 12

staff nurses were trained in Neonatology for 3 months.

∑

Private Hospitals (PHs)

In all Private Hospitals, neither Medical officers nor Staff nurses were

trained, except two paediatricians trained with one year fellowship in

Neonatology.

0

Sara E Casey et al. 13 also reported shortage of staff in public hospitals of Congo. Charles Opondo reported that there was often lack of poorly organized and insufficient staffing to support the provision of care at eight first referral level hospitals in Kenya.

of care at eight first referral level hospitals in Kenya. Charles Ahmeh et al. 1 8

Charles Ahmeh et al. 18 evaluated the baseline and after training, performance and confidence of the Human resource for emergency obstetric and Newborn care (life- saving skills). They concluded that though there was improvement in confidence, knowledge and skills of the trained staff but the training of the staff alone can’t contribute sufficiently to obstetric and newborn care if there is inadequacy of the equipment, supply and drugs. Moreover, sufficiently available infrastructures, equipment, supply and Human resource can be left unused if the staffs are not trained with the knowledge and skills required for obstetric and Newborn care.

and skills required for obstetric and Newborn care. In addition, Koyejo Oyerinde et al. 1 6
and skills required for obstetric and Newborn care. In addition, Koyejo Oyerinde et al. 1 6
and skills required for obstetric and Newborn care. In addition, Koyejo Oyerinde et al. 1 6
and skills required for obstetric and Newborn care. In addition, Koyejo Oyerinde et al. 1 6

In addition, Koyejo Oyerinde et al. 16 reported that there was severe shortage of staff, equipment and supplies in his study.

shortage of staff, equipment and supplies in his study. Youn-g Mi Kim et al. 1 7

Youn-g Mi Kim et al. 17 found that 77% of the facilities cited lack of Human resources in first referral level Hospitals in Afghanistan.

1 7 found that 77% of the facilities cited lack of Human resources in first referral
resources in first referral level Hospitals in Afghanistan. Biswas A B et al. 1 9 reported

Biswas A B et al. 19 reported that most of the deliveries and immediate Neonatal resuscitation was done by nurses (94.9%) in six Districts of West Bengal.

was done by nurses (94.9%) in six Districts of West Bengal. Neogi Sutapa et al. 5

Neogi Sutapa et al. 5 cited lack of Human resources in 8 rural Districts of India.

Srivastava V. K et al. 20 found that DHs had a paediatrician compared to one-third of the CHCs. Staff nurses for essential newborn care functions were available in

almost all DHs and CHCs and one-half of the PHCs. The doctors posted at DHs
almost all DHs and CHCs and one-half of the PHCs. The doctors posted at DHs
were more skilled compared to those posted at CHCs and PHCs in 11 Districts
of India whereas; C M Lakshmanaet al. 25 cited sixteen out of 53 vacant posts of
paediatrics in 29 districts of Karnataka.
Tables 6: Table – Records of deliveries from last 3-months
TYPES OF HEALTH FACILITIES
S.NO
VARIABLES
District Hospital
Private Hospital
(1)
(15)
N (%)
N (%)
COUNT
N (%)
0
1
(6.6)
Normal/ Assisted
1-50
12
(80.0)
414
(65.0)
1.
deliveries
51-100
1
(6.6)
391
(60.6)
>100
1
(6.6)
1-25
10
(66.7)
2.
C-section deliveries
219
(35.0)
255
(39.4)
26-50
5
(33.3)
1-50
10
(66.7)
3.
Total deliveries
646
51-100
4
(26.7)
633
>100
1
(6.6)
1 3
(20.0)
Total newborn deaths
6
5
4.
2 1
(6.6)
1-50
10
(66.6)
Total live births
51-100
4
(26.7)
5.
627
641
>100
1
(6.6)
In the table above two Private Hospitals have been excluded as they were Medical College
& Teaching Hospitals with maximum number of deliveries.
Primary Health Centres (PHCs) ∑ No PHC has conducted any deliveries in last three months
Primary Health Centres (PHCs)
No PHC has conducted any deliveries in last three months except one
PHC with 12 normal deliveries and one PHC with one normal delivery.
Community Health Centres (CHCs)
Out of three CHCs, one conducted four normal deliveries and one CHC
conducted one normal delivery.
District Hospital (DH)
District Hospital has conducted 65% normal & 35% C-section deliveries
with neonatal mortality of 9.57 per 1000 live births in last three months.
Private Hospitals (PHs)
Private hospitals have conducted 61% normal & 39% C-section
deliveries with neonatal mortality of 7.8% per 1000 live births in last
three months.
Tables 7: Table - Registers maintained for Newborns
TYPES OF HEALTH FACILITIES
Primary Health
Community
District
S.NO
VARIABLES
CATEGORIES
Centre
Health Centre
Hospital
(22)
(3)
(1)
N (%)
N (%)
N (%)
Does the hospital
1.
maintain
delivery and type
of birth
registers?
10
(45.5)
2 (66.7)
1 (100.0)
Yes
Does the hospital
2.
maintain OT
register?
Yes
0 (0)
0
(0)
1 (100.0)
Does the hospital
3.
maintain
newborn
register?
Yes
6 (27.3)
0
(0)
1 (100.0)
Does the hospital
4.
maintain ward
register?
Yes
12
(54.5)
3 (100.0)
1 (100.0)

Priv

Hosp

(17

N (

17 (10

16 (9

5 (29

14 (8

Does the hospital 5. maintain monthly reports/HMIS? Yes 20 (90.9%) 3 (100.0) 1 (100.0) 16
Does the hospital
5.
maintain
monthly
reports/HMIS?
Yes
20 (90.9%)
3
(100.0)
1 (100.0)
16
(9
Does the hospital
6.
maintain labor
room register?
Yes
11
(50.0)
3
(100.0)
1 (100.0)
17
(10
Does the hospital
7.
maintain birth
register?
Yes
7 (31.8)
1
(33.3)
1 (100.0)
10
(5
Does the hospital
8.
maintain
neonatal death
register?
Yes
12
(54.5)
1
(33.3)
1
(100.0)
6
(35
Does the hospital
9.
maintain circular
issue?
Yes
20
(90.9)
3
(100.0)
1
(100.0)
17
(10
Does the hospital
10.
maintain
partogram?
Yes
10
(45.5)
3
(100.0)
1
(100.0)
4
(23
Does the hospital
11.
maintain birth
charts?
Yes
17
(77.3)
3
(100.0)
1
(100.0%)
4
(23
The table above shows that:
All registers enlisted in the checklist were available and maintained by
District Hospital and two Private Hospitals only.
Delivery and type of birth register, ward register, Neonatal death register
and partogram were maintained by only 50% of PHCs, all CHCs and
most of the Private Hospitals except neonatal death register and
partogram maintained only by few Private Hospitals (35.3% and 23.5%
respectively)
None of the PHCs and CHCs maintained OT register and 94% of Private
Hospitals maintained the same.

Newborn register was not maintained by most of PHCs (78%), no CHC

and 71% of Private Hospitals whereas; monthly reports/ HMIS were

maintained by 91% PHCs, all CHCs, DH and 94% Private Hospitals.

Birth register was maintained by only 32% of PHCs, one CHC and 60%

of Private Hospitals maintained the same.

one CHC and 60% of Private Hospitals maintained the same. Biswas A B et al. (2011)

Biswas A B et al. (2011) 19 reported that records/ registers were available but incomplete & referral services were found to be almost non-existent in first referral units of six districts in West Bengal.

& referral services were found to be almost non-existent in first referral units of six districts
& referral services were found to be almost non-existent in first referral units of six districts
& referral services were found to be almost non-existent in first referral units of six districts
& referral services were found to be almost non-existent in first referral units of six districts
& referral services were found to be almost non-existent in first referral units of six districts
& referral services were found to be almost non-existent in first referral units of six districts
& referral services were found to be almost non-existent in first referral units of six districts
& referral services were found to be almost non-existent in first referral units of six districts

SUMMARY

SUMMARY SUMMARY Health services depend, to a large extent, on the availability of both Human resources
SUMMARY SUMMARY Health services depend, to a large extent, on the availability of both Human resources
SUMMARY SUMMARY Health services depend, to a large extent, on the availability of both Human resources
SUMMARY SUMMARY Health services depend, to a large extent, on the availability of both Human resources
SUMMARY SUMMARY Health services depend, to a large extent, on the availability of both Human resources
SUMMARY SUMMARY Health services depend, to a large extent, on the availability of both Human resources
SUMMARY SUMMARY Health services depend, to a large extent, on the availability of both Human resources
SUMMARY SUMMARY Health services depend, to a large extent, on the availability of both Human resources
SUMMARY SUMMARY Health services depend, to a large extent, on the availability of both Human resources

SUMMARY

Health services depend, to a large extent, on the availability of both Human resources and properly equipped health facilities. Maternal and Newborn care services particularly depend on health facilities with the equipment and skilled staff to provide the essential lifesaving services required for mothers with complicated deliveries and ill Newborns. Hence, this cross-sectional study was conducted to assess the availability of Neonatal care services in terms of infrastructure, equipment and Human resource in all 43 Health care facilities

providing delivery services in Udupi taluk of Karnataka. The data was collected through site assessment using a standard checklist, interviews and review of records and registers by the single investigator. Collected data was entered and analysed separately according to the objectives, to produce the results in form of categorised variables and respective percentages. It was found that only one Primary Health Centre was working 24 hours and conducted maximum deliveries in last three months. Though two CHCs had specialists but the complicated deliveries were handled only by the District hospital and Private Hospitals. However, satisfactory referral services, postpartum care, immunization services and essential laboratory services were available in all the health care facilities visited.

were available in all the health care facilities visited. Infrastructure was observed to be available in
were available in all the health care facilities visited. Infrastructure was observed to be available in

Infrastructure was observed to be available in most of the PHCs, CHCs, District Hospital and Private Hospitals. Equipment for management and investigation equipment were unavailable in most of the facilities. However, monitoring equipment was found to be available in most of the health facilities visited. Government health facilities had more availability of resuscitation equipment as compared to the private hospitals. Equipment for disinfection were available in most of the health care facilities except the syringe hub cutter being unavailable in 50% of Private Hospitals. Syringe pump and infanotometer plexi were unavailable in high percentage of Private Hospitals.

were unavailable in high percentage of Private Hospitals. The permanent and trained staffs were available more
were unavailable in high percentage of Private Hospitals. The permanent and trained staffs were available more
were unavailable in high percentage of Private Hospitals. The permanent and trained staffs were available more
were unavailable in high percentage of Private Hospitals. The permanent and trained staffs were available more

The permanent and trained staffs were available more in the government health facilities than Private Hospitals. Through the records, it can be concluded that most of the deliveries were normal and conducted in District Hospital and Private Hospitals in last three months. Complete records and registers enlisted in the checklist were available and maintained by only District Hospital and two Private Hospitals.

and registers enlisted in the checklist were available and maintained by only District Hospital and two
and registers enlisted in the checklist were available and maintained by only District Hospital and two
and registers enlisted in the checklist were available and maintained by only District Hospital and two
CONCLUSION CONCLUSION
CONCLUSION CONCLUSION
CONCLUSION CONCLUSION

CONCLUSION

CONCLUSION CONCLUSION
CONCLUSION CONCLUSION
CONCLUSION CONCLUSION
CONCLUSION CONCLUSION
CONCLUSION CONCLUSION
CONCLUSION CONCLUSION

CONCLUSION

The present study assessed all the forty three health care facilities providing delivery services in Udupi taluk of Karnataka. Through the results of the survey it was revealed that out of all 22 PHCs, only one was working 24x7 as it handled the maximum deliveries among all Primary Health Centres in the Taluk. Though out of three, two CHCs had specialists but complicated deliveries were handled only by the District Hospital and Private Hospitals in the area. However, satisfactory referral services, postpartum care, immunization services and essential lab. Services were available in all the health care facilities visited. Only six Primary Health Centres had allotted beds for mothers and Newborns as compared to requirement in all of the centres.

Newborns as compared to requirement in all of the centres. Infrastructure in terms of no. of
Newborns as compared to requirement in all of the centres. Infrastructure in terms of no. of
Newborns as compared to requirement in all of the centres. Infrastructure in terms of no. of

Infrastructure in terms of no. of beds, equipment location, power back up and water source, was observed to be available in most of the PHCs, CHCs, District Hospital and Private Hospitals. Equipment for management of Newborns like radiant warmers and phototherapy units and investigation equipment like Bilirubinometer were unavailable in most of the facilities. However, monitoring equipment was found to be available in most of the health facilities visited. Government facilities had more availability of resuscitation equipment as compared to the Private Hospitals. Oxygenation facility deemed as very important for Newborn care, was found in all health care facilities. Equipment for disinfection were available in most of the health care facilities except the syringe hub cutter being unavailable in 50% of Private Hospitals.

hub cutter being unavailable in 50% of Private Hospitals. The permanent and trained staffs were available
hub cutter being unavailable in 50% of Private Hospitals. The permanent and trained staffs were available
hub cutter being unavailable in 50% of Private Hospitals. The permanent and trained staffs were available
hub cutter being unavailable in 50% of Private Hospitals. The permanent and trained staffs were available
hub cutter being unavailable in 50% of Private Hospitals. The permanent and trained staffs were available

The permanent and trained staffs were available more in the government sector than Private sector. Most of the deliveries were normal and conducted in District hospital and Private Hospitals in last three months. Estimated Neonatal mortality rate was found to be 9.57 per 1000 and 7.8 per 1000 in District Hospital and Private Hospital respectively in last three months. Complete records and registers enlisted in the checklist were available and maintained by only District hospital and two private hospitals.

by only District hospital and two private hospitals. Hence, it can be concluded that the health

Hence, it can be concluded that the health care facilities providing delivery services in Udupi taluk need to be strengthened and further research on the quality of the available services is required for successful planning and implementation of the measures planned.

LIMITATIONS
LIMITATIONS
LIMITATIONS
LIMITATIONS
LIMITATIONS
LIMITATIONS

LIMITATIONS

LIMITATIONS
LIMITATIONS
LIMITATIONS

LIMITATIONS

All the private hospitals could not be covered as one private hospital’s authorities were not willing to participate in the study.

authorities were not willing to participate in the study.  During data collection, some of the
authorities were not willing to participate in the study.  During data collection, some of the

During data collection, some of the private hospitals did not allow to observe the NICU area, therefore the collected information is based on the interviews only.

the collected information is based on the interviews only.  The present study is cross-sectional therefore
the collected information is based on the interviews only.  The present study is cross-sectional therefore

The present study is cross-sectional therefore more of analytical studies can provide with detailed information and associations.

can provide with detailed information and associations.  Lastly, the present study focussed on the availability
can provide with detailed information and associations.  Lastly, the present study focussed on the availability

Lastly, the present study focussed on the availability of neonatal care services in the taluk. The quality of the available services can be further assessed by continued research and thus, reliable conclusion can be achieved.

of the available services can be further assessed by continued research and thus, reliable conclusion can
of the available services can be further assessed by continued research and thus, reliable conclusion can
of the available services can be further assessed by continued research and thus, reliable conclusion can
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