Just as Nashik civil authorities were dealing with the public outcry over 55 infant deaths in August, 80 km away in Jawhar, a tribal area three hours’ drive away, Hira Dambale lost the battle to save her 28-day-old baby. Blind in one eye due to a childhood measles infection, Hira battled anaemia during her pregnancy and gave birth prematurely, at just 24 weeks, to a child who weighed only 490 grams.
Doctors at the sub-district hospital in Jawhar tried in vain to save the baby that had been kept in the Special Newborn Care Unit (SNCU) for nearly a month. Hira has a seven-year-old boy who is moderately malnourished. She lost another baby two years ago and her third one could survive for less than a month. Hira required blood transfusion due to her low haemoglobin count. “During my pregnancy, the doctors gave me tablets to increase my blood count but I did not take them. There was too much acidity,” says this tribal woman whose staple meal is rice grown in a small patch near her hut at Talasri village.
For 22-year-old Anita Budhar, who is from Mokhada taluka in Palghar district, it was her second delivery on September 2. The baby weighed only 700g and has been admitted to the SNCU at Jawhar hospital. Like Hira, she too had required blood transfusion due to her low haemoglobin count. At the government-run 100-bed cottage hospital at Jawhar, admits medical superintendent Dr Ramdas Marad, at least 30 new mothers undergo blood transfusions after deliveries every month.
Low birth weight, one of the main reasons for a large number of infant deaths in Maharashtra and other states, is linked to factors like nutrition and anaemia. An anaemic pregnant woman is more likely to deliver a baby lighter than normal, and 49.3 per cent pregnant women across Maharashtra were anaemic according to the 2015-16 National Family Health Survey (NFHS 4). Among the non-pregnant women too, 48 per cent of them in the age group of 15-49 were anaemic.
Jawhar and Mokhada, along with adjoining Vada and Vikramgad talukas in Palghar district, have reported several cases of children with malnutrition. According to a National Human Rights Commission report, at least 600 children died due to malnutrition in Palghar district last year. The 100-bed cottage hospital at Jawhar caters to 1.5 lakh people and gets referrals from tribal pockets of Mokhada, Vikramgad and others. There are at least 180-200 admissions of sick babies every month at the 12-bed SNCU. “Most of the babies weigh between 800 grams and 1 kg. From April to August, a total of 748 sick babies were admitted at the Jawhar SNCU, of which 27 died. While malnutrition related deaths are high in these tribal pockets, the cottage hospital has set up a Nutrition Rehabilitation Centre where every month a minimum of 20 children are admitted,” says Marad.
At Nashik civil hospital, which was in the eye of a storm with 55 deaths in August this year, about 250 to 300 sick babies are admitted to the 28-bed SNCU every month. Nearly 25 per cent of the 700-odd women who give birth at the hospital every month suffer from anaemia.
“While majority of the women have mild or moderate anaemia that is treated with injections, those whose haemoglobin count less than 7 need blood transfusions and at least two out of ten such women require it every month,” says Dr Suresh Jagdale, Civil Surgeon, Nashik district.
At Thane’s 336-bed district hospital, Civil Surgeon Dr B C Kempi Patil admitted that out of 738 admissions at the 16-bed SNCU, there were 47 deaths of neonates between April and August this year. “These are extremely critical babies referred from other centres. However, the death rate is 6.37 per cent and we have been managing these babies. In fact, a team from Uttar Pradesh recently visited the hospital to take tips on how we were managing the babies,” says Patil.
Maharashtra registers about 20 lakh deliveries annually. Between April and August this year, a total of 22,692 babies were admitted and treated at the 36 SNCUs across the state. About 16.62 per cent of the babies that were admitted to these SNCUs weighed less than 1,000g, while 29.33 per cent weighed between 1,000 and 1,499g. In 2016-17, a total of 50,373 children were admitted and treated in the SNCUs. According to the state analysis, a total of 15.31 per cent babies at the time of admission had weighed less than 1,000g, while 29.45 per cent had weighed between 1,000 and 1,499g.
The state health department will now introduce National Iron Plus Initiative (NIPI) to address anaemia that includes providing supervised biweekly iron folic acid supplementation for all under-5 children and weekly tablets for adolescents in the age group of 10-19 years. The challenge, public health experts say, is huge. Fauzdar Ram, former director of Indian Institute of Population Sciences, Mumbai, who is a co-author of the Million Death Study published in September in The Lancet, told The Indian Express that the total number of childbirths in India had declined only slightly from 28 million every year to 26 million between 2000 and 2015.
“Our challenge is now to meet the 2030 sustainable development goals (SDGs) for child and neonatal mortality. The child mortality rates have halved from 2.5 million child deaths in 2000 to 1.2 million child deaths in 2015. Neonatal deaths that were 50 per cent of all child deaths in 2000, however rose to 58 per cent in 2015. We will now have to address several challenges and will require an average annual decline from 2015 onwards of 4.1 per in child mortality and 5.3 per cent in neonatal mortality. The biggest target is to reduce neonatal mortality due to prematurity or low birth-weight deaths, especially in poorer states. These are strongly linked to factors like antenatal care, anaemia, education and nutrition,” says Ram.