On September 30, Sarla Velurkar realised she was in labour around midnight. Her home, in Dhamangaon village, is just a few minutes away from the rural hospital at Warwat-Bakal in Buldhana district. Her family hired an autorickshaw, but Sarla, 19, delivered before they could reach the hospital.
Investigation showed that the placenta was stuck in her uterus. Since there was no anaesthetist at the 30-bed rural hospital, Sarla was referred to the sub-district hospital at Shegaon, about one-and-a-half hours away. The post of a gynaecologist at the 100-bed Shegaon hospital remains vacant, and the doctor on duty helped expel the placenta.
The baby, born at seven-and-a-half months, weighed only 1.5 kg. Sarla and the newborn were referred to the Special Newborn Care Unit (SNCU) at Akola district women’s hospital, another hour away. She reached the Akola hospital, Maharashtra’s largest women’s hospital, which takes care of critically ill babies, finally at 4.30 am.
“My baby has been admitted for days now… the baby is tiny,” said Sarla, as nurses encouraged her to provide skin-to-skin contact as part of the Kangaroo Mother Care initiative. The baby was later placed again in the SNCU’s warmer.
The SNCU at Nashik civil hospital had attracted national attention after it reported the death of 55 newborn babies in August. The deaths, according to officials, were largely due to the high number of sick infants being admitted. In August, 346 babies, most of them underweight, were admitted.
The 48-bed SNCU at Akola — it has the maximum number of beds among SNCUs in the state — receives many more sick babies every month, and the number is steadily rising since the SNCU was opened in 2013, according to officials. This hospital recorded 15984 births in 2016-17, 4152 of which had to be admitted to the SNCU. As many as 451 of these babies could not be saved.***
The need for more hands is felt acutely at the hospital. “Every month, we admit at least 250 babies in the SNCU,” medical superintendent Dr Kulwal said. This August, for instance, 199 babies were admitted to the SNCU from within the hospital, and there were 91 sick babies referred from other centres. “Twenty-one of these babies died, as they came in highly critical condition and suffered from respiratory distress. This year, in July, 367 sick babies were admitted to the SNCU, of which 192 were referred from other centres; 22 of them died,” Kulwal said.
While the state has approved setting up another 20 beds at the SNCU in Akola, there is no ventilator at this highly critical unit. Against the requirement of a minimum 40 staff nurses for a 48-bed SNCU, there are only 24 staff nurses, nine medical officers (of which four posts are vacant), and three paediatricians.
“We have been able to bring down the fatality rate from 18 per cent in 2013-14 to 10.86 per cent in 2016-17,” said Dr Arati Kulwal, medical superintendent at district women’s hospital, Akola.
Between April and August this year, 1,606 sick babies were admitted to the SNCU, the most across all 36 SNCUs in Maharashtra. According to the state health department, 22,692 critically ill newborn babies were admitted to these 36 SNCUs across the state during this period.
Dr Archana Patil, Additional Director of Health, Maharashtra, said mortality rate in these 36 SNCUs has come down from 11 per cent to 7.7 per cent over the last five years. The major causes of death at the SNCUs were respiratory distress syndrome, birth asphyxia and prematurity.
In 2015-16, 30.09 per cent of deaths of babies in SNCUs was attributed to respiratory distress syndrome (RDS), according to state government’s statistics. This figure came down to 29.81 per cent in 2016-17. Between April and August this year, 32.86 per cent deaths was reported due to RDS.
Asphyxia led to death in 18.22 per cent cases between April and August this year, and 11.34 per cent fatalities were caused by prematurity, according to records. These numbers show a trend similar to the results of the Million Death Study, published in The Lancet journal in September this year. The study, which captured 52,252 deaths in neonates and 42,057 deaths of children between one and 59 months across the country from 2001 to 2013, was coordinated by Prabhat Jha. It showed that neonatal deaths from prematurity, or low birth-weight, had risen in rural areas and poorer states.
Jha, head of the Centre for Global Health Research at St Michael’s Hospital in Toronto, told The Indian Express in an email interview that three causes — prematurity or low birth weight, neonatal infections, and birth asphyxia or trauma — accounted for more than three-quarters of neonatal deaths in India.
“Treatment efforts have reduced pneumonia and diarrhoea deaths, while special vaccine efforts have reduced deaths due to measles and tetanus. But births with low weight have risen, and are driven by several factors,” according to Jha. In Akola, Dr Narayan Sadhwani, a paediatrician who retired from the district women’s hospital in September, said pregnancy-induced hypertension is a huge problem, and all babies born with low birth have mothers with high risk factors.
*** “An earlier version of this story had said that 4170 children had to be admitted to the SNCU in Akola in the year 2016-17 and 1472 of them had died. Those figures were not correct. The correct figure is 4152 children being admitted in the SNCU out of which 451 died. The Indian Express regrets the error.”