Malhotra Sumit, Zodpey Sanjay P, Vidyasagaran Aishwarya L, Sharma Kavya, Raj Sunil S, Neogi Sutapa B, Pathak Garima, Saraf Abhay
J Health Popul Nutr. 2014 Mar;32(1):130-41.
India faces a formidable burden of neonatal deaths, and quality newborn care is essential for reducing the high neonatal mortality rate. We examined newborn care services, with a focus on essential newborn care (ENC) in two districts, one each from two states in India. Nagaur district in Rajasthan and Chhatarpur district in Madhya Pradesh were included. Six secondary-level facilities from the districts-two district hospitals (DHs) and four community health centres (CHCs) were evaluated, where maximum institutional births within districts were taking place. The assessment included record review, facility observation, and competency assessment of service providers, using structured checklists and sets of questionnaire. The domains assessed for competency were: resuscitation, provision of warmth, breastfeeding, kangaroo mother care, and infection prevention. Our assessments showed that no inpatient care was being rendered at the CHCs while, at DHs, neonates with sepsis, asphyxia, and prematurity/low birthweight were managed. Newborn care corners existed within or adjacent to the labour room in all the facilities and were largely unutilized spaces in most of the facilities. Resuscitation bags and masks were available in four out of six facilities, with a predominant lack of masks of both sizes. Two CHCs in Chhatarpur did not have suction device. The average knowledge score amongst service providers in resuscitation was 76% and, in the remaining ENC domains, was 78%. The corresponding average skill scores were 24% and 34%, highlighting a huge contrast in knowledge and skill scores. This disparity was observed for all levels of providers assessed. While knowledge domain scores were largely satisfactory (> 75%) for the majority of providers in domains of kangaroo mother care and breastfeeding, the scores were only moderately satisfactory (50-75%) for all other knowledge domains. The skill scores for all domains were predominantly non-satisfactory (< 50%). The findings underpin the need for improving the existing ENC services by making newborn care comers functional and enhancing skills of service providers to reduce neonatal mortality rate in India.
印度面临着严峻的新生儿死亡负担，而高质量的新生儿护理对于降低高新生儿死亡率至关重要。我们对新生儿护理服务进行了调查，重点关注印度两个邦各一个地区的基本新生儿护理（ENC）。拉贾斯坦邦的纳戈尔区和中央邦的恰塔普尔区被纳入其中。对这两个地区的六个二级医疗机构进行了评估，其中包括两个区级医院（DHs）和四个社区卫生中心（CHCs），这些机构承担了所在地区大部分的机构内分娩。评估包括记录审查、机构观察以及使用结构化清单和问卷对服务提供者进行能力评估。评估的能力领域包括：复苏、保暖、母乳喂养、袋鼠式护理和感染预防。我们的评估显示，社区卫生中心未提供住院护理，而区级医院对患有败血症、窒息和早产/低出生体重的新生儿进行了管理。所有机构的产房内或附近都设有新生儿护理角，但在大多数机构中这些空间基本未被利用。六个机构中有四个配备了复苏袋和面罩，但两种尺寸的面罩大多短缺。恰塔普尔的两个社区卫生中心没有吸引装置。服务提供者在复苏方面的平均知识得分是76%，在其余的基本新生儿护理领域为78%。相应的平均技能得分分别为24%和34%，凸显了知识和技能得分的巨大差距。在所评估的所有级别服务提供者中均观察到这种差异。虽然在袋鼠式护理和母乳喂养领域，大多数服务提供者的知识领域得分基本令人满意（>75%），但在所有其他知识领域得分仅为中等满意（50 - 75%）。所有领域的技能得分大多不令人满意（<50%）。这些发现强调了通过使新生儿护理角发挥作用并提高服务提供者的技能来改善现有基本新生儿护理服务的必要性，以降低印度的新生儿死亡率。
