Newborn Thesis Neel Kamal 102802004

AVAILABILITY OF NEONATAL CARE SERVICES IN UDUPI TALUK
A Cross-Sectional Study
A Dissertation Submitted to Manipal University in Partial Fulfilment for the Award of Masters in Public Health (MPH) AUGUST 2012 By
Neel Kamal BPT, FAGE

Under the guidence of
Dr. Ramachandra Kamath

Professor and Head Department of Public Health Manipal University
Co-guides
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 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 candidates personal work. Guide

Professor and Head Department of Public Health Date: / / 2012 Place: Manipal
Co-guides
Dr. Leonard Machado, MD Associate professor Depart of Public Health
Dr. Lesley Lewis, DCH, DNB Professor Department of Paediatrics
Manipal University Date: / /2012
Manipal University Date: / /2012
Place: Manipal
Place: Manipal
Certificate Certificate
This is to certify that the dissertation entitled, Availability of Neonatal
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.
Guide

Professor and Head Department of Public Health Date: / / 2012 Place: Manipal
Co-guides
Dr. Leonard Machado, MD Associate professor Depart of Public Health Manipal University Date: / / 2012 Place: Manipal
Dr. Lesley Lewis, DCH, DNB Professor Department of Paediatrics Manipal University Date: / / 2012 Place: Manipal
DECLARATION
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.
Place: Manipal Date:
Neel Kamal (102802004)
ACKNOWLEDGEMENT
It gives me immense pleasure to acknowledge and thank all those who have given consistent guidance, advice and encouragement in my endeavour. I would like to thank our Professor and Head of the Department, Dr. Ramachandra Kamath, for giving me an opportunity to undertake this project. I am ever grateful to my co-guide, Dr. Leonard Machado, Associate professor, Department 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. I 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 spending his valuable time, required permissions and support while preparing this project. I am greatly indebted to Dr. Anand Naik, District Surgeon, District Hospital, Udupi, Karnataka. I 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:
Introduction
11-15
Aim and Objectives
16-17
Literature Review
18-24
Materials and Methods
25-28
Results and Discussion
29-57
Summary
58-59
Conclusions
60-61
Limitations
62-63
References
64-66
10
Appendix
67-94
TABLES AND FIGURE
TABLES & FIGURE Table: 1 Figure: 1 Tables: 2 Table: 3A Table: 3B Table: 3C Table: 4A Table: 4B Table: 4C Table: 4D
DESCRIPTIONS Types of Health Care Facilities Distribution of Health Care Facilities Newborn Care Services Infrastructure for Newborn Care Infrastructure for Newborn Care Infrastructure for Newborn Care Equipment for Management: Equipment for Monitoring Equipment for Investigation Equipment for Resuscitation Equipment for Disinfection Human Resource for Newborn Care Human Recourses with Training status
PAGE NO. 29 29 30 34 35 35 39 40 42 44 45 49 51
Table: 4E Table: 5A Table: 5B
Table: 6
Records of deliveries from last 3-months
54
Table: 7
Registers maintained for Newborns
55
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 NBSU: Newborn Stabilization Unit SNCU: Special Newborn Care Unit NICU: Neonatal Intensive Care Unit CSSM: Child Survival & Safe Motherhood RCH: Reproductive and Child Health IMNCI: Integrated Management of Neonatal & Childhood Illness F-IMNCI: Facility Based IMNCI SC: Sub-Centre 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 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 IPHS: Indian Public Health Standard OB/GYN: Obstetrician and Gynaecologist OT: Operation Theatre ECG: Electro Cardio Gram 24*7: 24 Hours Round The Clock 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
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 country2. 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 regions3. 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 1990s. Thereafter, its pace of decline has slackened considerably4. 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 period3. 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 2530% of Neonatal deaths yearly and among those 45% die within first two days of life5. 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 Karnatakas Infant mortality is 41 per 1000 live births4 and Neonatal mortality is 28.9(70.48%) per 1000 live births6. 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 life4. 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 attention8. 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
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 life5. 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 facilities9.
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 priority4. 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 couldnt 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 resources10.
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 outcomes11. Since independence, there has been a great expansion of health services through Primary Health Centres (PHCs), Community Health Centres (CHCs) and Sub
Centres (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. 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 district2 If above mentioned causes (direct) are looked carefully, it can be seen that most of these are preventable8 despite of having support to indirect causes at greater extent in Udupi district2. 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 managers20. 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.
AIM AND OBJECTIVES
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.
Secondary objective: To find out records and registers maintained for Neonatal care.
LITERATURE REVIEW
LITERATURE REVIEW
Global scenario:
Charles Opondo et al. (2009) 12 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. 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 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.
Mike English et al. (lancet 2004, 364: 1622-29) 15 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 staffs views regarding infrastructure and human consumable resources indicated their dissatisfaction with the physical environment around them.
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 cross-sectional study was conducted in seventy eight first line referral facilities of Afghanistan with the objective to assess the availability & utilization of emergency obstetric and neonatal care (EMoC) facilities as defined by UN 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.
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.
Indian scenario:
Biswas A B et al. (2011) 19 A study was conducted in twelve first referral units of 6 Districts in WestBengal 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
B. Neogi Sutapa et al. (2011) 5 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. 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 providers 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 services14.
Paul V.K et al. (2000) 21 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. 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 CHCs 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).
Forhad Akhtar Zaman et al. (2008) 24 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.
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 centres (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 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.
MATERIALS AND METHODS
MATERIALS AND METHODS
Study area: 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]. Available from: https://maps.google.co.in/maps/ms? msid=208588570602665024468.0004c72065bc4adb25dfb&msa=0&ll=13.37 0915,74.793549&spn=0.538431,1.347198
Study design: Cross-sectional study. Study population: Public and Private Health care facilities providing delivery services in Udupi taluk. Sampling technique: Complete enumeration of government & private hospitals in Udupi taluk. Total hospitals in Udupi Taluk= 48 [(Government=26) & (Private=22)] 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)
PHCs (22)
District hospital (1)
CHCs (3)
Inclusion criteria: All the PHCs, CHCs, District Hospital and Private Hospitals providing delivery services in Udupi Taluk.
Study period: The study was conducted from March 2012 to August 2012.
Study tools: Standard checklist for Newborn care facility assessment. (Facility based Newborn care operational guide 2011, MoHFW, GOI) Data collection methods: (1) Site assessment. (2) Interview with head of the institution or the in charge of heath care facility. (3) Reviewing the records/registers. 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:
Analysis has been done using SPSS 15 version. Data has been expressed in frequency and percentage.
Ethical consideration:
The proposal was approved by Institutional Ethics Committee, Kasturba Medical Hospital, Manipal.
Written permission from District Health officer (DHO), Udupi for
Primary Health centres and Community Health centres.
Written permission from District surgeon, Udupi for District (MCH)
Hospital.
Request letter from Indian Medical Association (IMA) President, Udupi
District for Private Hospitals.
RESULTS AND DISCUSSION
RESULTS AND DISCUSSION
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 Primary Health Centres (PHCs) Community Health Centres (CHCs) District Hospital (DH) Private Hospitals (PHs)
Frequency (N) 22 3 1 17
Percentage (%) 51.1 6.9 2.3 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:

TYPES OF HEALTH FACILITIES
S.NO VARIABLES CATEGORIES Primary Health Centre (22) N (%) 1 (4.5) 3 (13.6) 19 (86.3) 0 (.0) 14 (63.6) 22 (100.0) Community Health Centre (3) N (%) 3 (100.0) 0 (.0) 3 (100.0) 0 (.0) 3 (100.0) 3 (100.0) District Hospital (1) N (%) 1 (100.0) 0 (.0) 0 (.0) 1 (100.0) 1 (100.0) 1 (100.0)
1.
Is there 24hrs duty roster observed and Staff present on-site? Which type of delivery services does the hospital provide? Does the hospital provide essential newborn care services? Does the hospital provide referral services? Does the hospital have functional ambulance or other vehicle on site of Referral? Does the hospital provide 24hr coverage for delivery and newborn care? Is the person skilled in conducting deliveries present at hospital or on call 24-hrs a day including weekend, to provide delivery care? Who attends the complicated delivery at hospital? Is there any post-partum care offered at the hospital? Does hospital immunizes newborns? Does hospital have essential laboratory services? Does hospital have blood transfusion service?
Yes No delivery service Only Normal Normal, Manual, Assisted and C-section Yes Yes Yes No 24 hr coverage Only deliveries both deliveries and newborn care No skilled persons observed Yes present, schedule observed Yes, on call, schedule observed Obstetrician Obstetrician and Paediatrician Referred to higher services Yes Yes Yes Yes
2.
3. 4.
5.
3 (13.6) 5 (22.7) 16 (72.7) 1 (4.5) 5 (22.7) 1 (4.5) 16 (72.7) 0 (.0) 0 (.0) 22 (100.0) 20 (90.9) 22 (100.0) 22 (100.0) Not applicable
2 (66.7) 0 (.0) 0 (.0) 3 (100.0) 0 (.0) 0 (.0) 3 (100.0) 1 (33.3) 0 (.0) 2 (66.7) 3 (100.0) 3 (100.0) 3 (100.0) Not applicable
1 (100.0) 0 (.0) 0 (.0) 1 (100.0) 0 (.0) 1 (100.0) 0 (.0) 1 (100.0) 0 (.0) 0 (.0) 1 (100.0) 1 (100.0) 1 (100.0) 1 (100.0)
6.
7.
8.
9. 10. 11. 12.
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. Fourteen percent PHCs have no delivery service which is an essential requirement for Primary Health Care. Essential Newborn Care is unavailable in 32% PHCs and 9% PHCs do not provide postpartum care whereas; essential lab. services and immunization is provided by all of the Primary Health Centres. Referral services are available in all PHCs but 86% of these do not have onsite vehicle for transport. Community Health Centres (CHCs) Staff present with observed duty roster for twenty four hours in all CHCs. Delivery services are available in all but two CHCs refer complicated deliveries to higher services because as they dont have any specialists (OB/GYN). All CHCs provide referral, essential laboratory, post-partum care and immunization services but onsite vehicle for transport is present only in two CHCs. 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) All Private Hospitals have 24*7coverage with staff present with observed duty roster. 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. All Private Hospitals have facilities to conduct deliveries in term of normal as well as complicated. All Private Hospitals provide referral, essential newborn care and postpartum services but immunization services are unavailable in 23% PHs and onsite vehicle not present in 29% PHs. Two Private Hospitals do not have essential lab. services and one is without blood transfusion facility.
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.
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.
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.
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).
Tables 3A: Table Infrastructure for Newborn Care

TYPES OF HEALTH FACILITIES Primary Health Centre (22) Quantity 0 1. Total no. of beds 1-3 4-6 2. No. of maternity/postnatal Beds No of newborn beds No. of labor room 0 1-3 4 0 1 1 N (%) 1 (4.5) 10 (45.5) 11 (50.0) 15 (68.2) 6 (27.3) 1 (4.5) 20 (90.9) 2 (9.1) 22 (100.0) 5 6 12 0 1-6 1 1(33.3) 1(33.3) 1(33.3) 1(33.3) 29 2 (66.7) 3 (100.0) 1 50 30 3 (100.0) 79 Community Health Centre (3) Quantity N (%) District Hospital (1) N
S.NO
VARIABLES
Private Hospita (16) Quantity 15-50 51-100 >100 0 1-20 21-40 0 1-4 5-8 12 1 2 1 2 3 0 1 0 1 0 1
3.
4 5 6 4
4.
5.
No. of OT No. of postnatal ward NBCC SNCU / NICU 1
NA
3 (100.0)
6.
NA 1(4.5) NA
1 1 NA
3 (100.0) 3 (100.0)
2 1 1
7. 8.
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 Centre (22) N (%) 16 (72.7) 6 (27.3) 18 (88.1) 5 (22.7) 1 (4.5) 16 (72.7) 5 (22.7) 3 (13.6) 9 (40.9) 5 (22.7) Community Health Centre (3) N (%) 3 (100.0) 0 (.0) 3 (100.0) 1 (33.3) 1 (33.3) 1 (33.3) 1 (33.3) 2 (66.7) 0 (.0) 0 (.0) District Hospital (1) N (%) 1 (100.0) 0 (.0) 1 (100.0) 0 (.0) 1 (100.0) 0 (.0) 0 (.0) 0 (.0) 0 (.0) 1 (100.0)
S.NO
VARIABLES
CATEGORIES
Pr Ho ( N
1. 2.
Where is the delivery and neonatal equipment located? Does the hospital have adequate light? Which type of power backup does the hospital have?
Labor Room Others Yes No power backup Generator Inverter Open-well Bore-well Panchayat Mix
8(
9(
17 (
3.
17 (
4.
Which type of water source does the hospital have?
3( 1 12
1(
Tables 3C: Table - Infrastructure for Newborn Care

TYPES OF HEALTH FACILITIES S.NO VARIABLES CATEGORIES
District Hospital (1) N (%)
Private Hospital (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)
1. 2. 3. 4. 5. 6. 7. 8.
Area for Hand washing
Yes Yes Yes Yes Yes Yes Yes Yes
1 (100.0) 1 (100.0) 1 (100.0) 1 (100.0) 1 (100.0) 1 (100.0) 1 (100.0) 0 (.0)
Area for mixing IV fluid Area for boiling & autoclaving Area for laundry Clean utility area Soiled utility area Store room Side lab
Primary Health Centres (PHCs) Fifty percent of the PHCs are 4-6 bedded and one PHC has no beds. 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. 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.
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. 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. Designated area for one labor room, OT and one NBCC each available in all CHCs. All CHCs have placed delivery & neonatal equipment in labor room with adequate light for examination. One Community Health Centre has no power back up and water source for two CHCs is from bore-well.
District Hospital (DH)
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)
Nineteen per cent PHs are without maternity beds and 31.3% are without newborn beds.
All Private Hospitals have designated area for labor room and OT. Eighty seven per cent of PHs has one post natal ward each and 69% have one NBCC in labor room but NICU is unavailable in 69% of PHs.
Delivery and Neonatal equipment are placed in labor room with adequate light for examination in all PHs.
All Private Hospitals use Generator as power backup and 71% use multiple sources for water supply.
All Private Hospitals have separate ancillary area each for hand washing, IV fluid mixing, autoclaving, utility and store room but side lab was present only in two Private Hospitals.
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.
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.
Tables 4A: Table Equipment for Management:

TYPES OF HEALTH FACILITIES Primary Health centres (22) Quantity 0 1. Radiant warmer 1 1 (4.5) 2 0 2. Phototherapy unit single head high Intensity NA 2 1 (33.3) 4 0 3. Incubator NA NA 0 1 2 4 (25.0) 9 (56.2) 6 (37.5) 1 (6.3) 1 (33.3) 5 2 (66.7) 6 0 1-2 1 (6.3) 1 (6.3) 11 (68.7) N (%) 21 (95.5) Community Health centres (3) Quantity 1 N (%) 2 (66.7) 9 District Hospital (1) N Private Hospitals (16) Quantity 0 1-3 N (%) 6 (37.5) 9 (56.2)
S.NO
VARIABLES
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 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 has nine radiant warmers, six phototherapy units and no incubator.
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 Primary Health centres (22) Quantity 1. 2. 3. Baby weighing scale Thermometer Pulse oximeter 1 1 N (%) 22 (100.0) 22 (100.0) NA Community Health centres (3) Quantity 1 1 NA N (%) 3 (100.0) 3(100.0) District Hospital (1) N 1 8 6 Private Hospitals (16) Quantity 1 2 1-3 4-6 0 1-2 3 0 1-3 4-5 0 1 2 0 1 2 N (%) 10 (62.5) 6 (37.5) 12 (75.0) 4 (25.0) 1 (6.3) 12 (75.0) 3 (18.7) 1 (6.3) 12 (75.0) 3 (18.7) 2 (12.5) 5 (31.3) 9 (56.2) 2 (12.5) 9 (56.2) 5 (31.3)
S.NO
VARIABLES
4.
Stethoscope Neonates
NA
NA
13
5.
Sphygmomanometer
NA
NA
6.
Vital sign monitor
NA
NA
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 thermometer each.
Community Health Centres (CHCs) All Community Health Centres have one electronic baby weighing scale and one thermometer each but four thermometers are required in each CHC.
District Hospital has one electronic baby weighing scale in SNCU, eight thermometers, six pulse oximeters, thirteen neonate stethoscopes, one sphygmomanometer and one vital sign monitor but four electronic baby weighing scales, twelve thermometers and six sphygmomanometers are required.
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.
Fifty three percent of Private Hospitals have one vital sign monitor each and 35% have atleast five each.
Tables 4C: Table- Equipment for Investigation:

TYPES OF HEALTH FACILITIES Primary Health centres (22) Quantity Centrifuge, hematocrit benchtop, up to 12000 rpm, including rotator 0 1 N (%) 1 (4.5) 21 (95.5) Community Health centres (3) Quantity 1 2 N (%) 2 (66.7) 2 1(33.3) District Hospital (1) N Private Hospitals (16) Quantity 0 1 2 N (%) 2 (12.5) 5 (31.3) 9 (56.2)
S.NO
VARIABLES
1.
1 2. Microscope Bilirubinometer, total bilirubin, capillary based Glucometer ECG unit portable 2 0 1 0 4. 5. 1
21 (95.5) 1 (4.5) 20 (90.9) 2 (9.1) 3 (13.6) 19 (86.4) NA
1 2 0 1 1 2 NA
2 (66.7) 1 (33.3) 2 (66.7) 1 (33.3) 2 (66.7) 1 (33.3) 2 0 2
0 1-2 2-3 0 1 0 1-2 6 0 1 2 0 1
2 (12.5) 8 (50.0) 6 (37.5) 7 (43.8) 9 (56.2) 2 (12.5) 13 (81.2) 1 (6.3) 3 (18.7) 9 (56.2) 5 (31.3) 5 (31.3) 11 (68.7)
3.
6.
X-ray mobile
NA
NA
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 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.
Fifty nine percent of Private Hospitals have atleast two centrifuges and two PHs do not have it.
Forty seven percent of PHs have atleast one microscope each and 41% have atleast two microscopes each.
Fifty-nine per cent have atleast one bilirubinometer and 81% have atleast one glucometer.
Eighty eight percent have portable ECG unit and 69% have mobile X-ray facility.
Tables 4D: Table- Equipment for Resuscitation:
TYPES OF HEALTH FACILITIES Primary Health centres (22) Quantity 1. Resuscitator, hand operated 500ml Resuscitator, hand operated 250ml Pump suction, foot operated Suction pump portable, 220v.w/access Laryngoscope sets, Neonates 0 1 2 0 1 0 1 2 NA NA N (%) 18 (81.8) 3 (13.6) 1 (4.5) 11 (50.0) 11 (50.0) 8 (36.4) 13 (59.1) 1 (4.5) Community Health centres (3) Quantity 0 N (%) 3 (100.0) District Hospital (1) N 1
S.NO
VARIABLES
Privat Hospita (16) Quantity 1 2 1 2 0 1 1 2-4 1-2 3-4
2.
1 1 2 0 1 2
3 (100.0) 2 (66.7) 1 (33.3) 3 (100.0) 2 (66.7) 1 (33.3)
3.
1 2 5
4. 5.
5 1 2
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. Community Health Centres (CHCs)
All CHCs have atleast one 250ml resuscitator each and one pumpsuction foot operated each. Whereas; resuscitator 500ml is not available (2 required in each CHC) in any of CHCs.
District Hospitals has four resuscitator 250ml, one foot operated suction, two portable suction pumps and five laryngoscope sets.
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 Community Health centres (3) Quantity 2 3 1 1 6 9 2 3 N (%) 1 (33.3) 2 (66.7) 3 (100.0) 3 (100.0) 2 (66.7) 3 (33.3) 1 (33.3) 1 (33.3) 25 12 District Hospital (1) N 1 5 0 Private Hospitals (16) Quantity 0 1 1-3 4-6 0 1 2 1-10 11-20 21-30 1-6 7-12 N (%) 9 (56.3) 7 (43.7) 4 (25.0) 12 (75.0) 3 (18.7) 11 (68.8) 2 (12.5) 7 (43.7) 7 (43.7) 2 (12.5) 7 (43.7) 7 (43.7)
S.NO
VARIABLES
Primary Health centres (22)
Quantity 1. 2. 3. 1 Syringe hub cutter Sterilizing drum 165mm diameter Electric sterilizer 2-5 1 2 0 1 0 4. 5. Gowns Washable slippers 3 0 1-3
N (%) 17 (77.3) 5 (22.7) 21 (95.5) 1 (4.5) 2 (9.1) 20 (90.9) 3 (13.6) 19 (86.4) 6 (27.3) 13(59.1)
4 6. Washing machine 0
3 (13.6) 22 (100.0)
4 0
1 (33.3) 3 (100.0) 1
>=20 0 1
2 (12.5) 8 (50.0) 8 (50.0)
Primary Health Centres (PHCs)
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.
Community Health Centres (CHCs)
All Community Health Centres have one sterilizing drum, one electric sterilizer and atleast six gowns each.
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.
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.
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.
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.
Measuring tape, kidney basin, dressing tray and infusion stand were available in District Hospital and all Private Hospitals.
Spot lamp was available in two CHCs, District Hospital and all Private Hospitals.
Charles Opondo et al12 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 al13 also reported shortage of equipment, essential drugs and poor infection prevention in public hospitals of Congo.
A B Biswas et al19 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.
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.
D. K. Guha (1989) 22 reported that equipment, like incubators and phototherapy units were inadequate in most of the health facilities.
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.
Tables 5A: Table - Human Resource for Newborn Care
TYPES OF HEALTH FACILITIES Primary Health S.NO VARIABLES Centre (22) Quantity Permanent 1 Paediatrician Contractual Permanent 2. OB/GYN Contractual Permanent 1. Medical officers Contractual Permanent 2. Staff nurse Contractual Permanent 4. Lab. Technician Contractual Permanent 5. Data manager Contractual Permanent 6. Supporting staff Contractual 6 5 (22.7) 0 (.0) 0 (.0) 15 1 (6.2) 23 0 (.0) 17(77.3) 10 0 (.0) 3 (100.0) 0 (.0) 4 (100.0) 0 73 3 (18.7) 15 (93.7) 2 2 (9.1) 0 (.0) 3 0 (.0) 3 (100.0) 0 (.0) 1 (100.0) 0 24 2 (12.5) 13 (81.2) 4 20 2 (9.1) 20(90.9) 4 3 2 (66.7) 3 (100.0) 12 (100.0) 1 (100.0) 21 1 10 NA 21(95.5) 1 (4.5) 10(45.5) 3 0 (.0) 3 (100.0) 0 (0) 0 (.0) 0 (0) 3 (100.0) 0 (0) NA NA 1 0 (0) 1 (33.3) 0 (.0) 1 (100.0) 25 0 1 2-5 0 1 2-4 0 1-5 0 4 4-8 9-16 24 0 (0) 36 9 (56.3) 4 (25.0) 10 (62.5) 2 (12.5) 7 (43.7) 4 (25.0) 5 (31.3) 3 (18.7) 13 (81.3) 15 (93.7) 1 (6.3) 10 (62.5) 5 (31.2) 1 (6.2) 0 (0) 14 (87.5) NA N (%) Community Health Centre (3) Quantity 1 N (%) 1 (33.3) District Hospital (1) N (%) 2 (100.0) Quantity 10 Private Hospital (16) N (%) 7 (43.7)
14
3 (100.0)
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.
One permanent specialist (Paediatrician & OB/GYN) is available in two CHCs each whereas one CHC has no specialist.
Each CHC has one permanent Medical officer, lab technician and data manager.
Fourteen permanent staff nurses are available in three CHCs and four contractual in two CHCs.
All together CHCs have 10 permanent supporting staff available.
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.
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 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 A. IMNCI: for medical officer/ staff nurse B. F-IMNCI: for medical officer/ staff nurse C. NSSK: for medical officer/ staff nurse/ANM D. Facility based newborn care: for medical officer/staff nurse posted in SNCU E. SBA for ANMs/LHVs & Staff nurse F. SBA/BEmOC for Medical officer G. Observership H. Neonatology DAYS OF TRAINING ATTENDED 8 2 3 Days Days Days
11 Days
2-3 Days 9 Days 2 Weeks 3 months
S.NO
VARIABLES
N o T r a i n i n g
B & C
TRAINING STATUS B C E B B & & & , , G C F F & C G & F
B , E & G
B , C & D
C , E & G
C , E & F
PHC (22) Medical officers
Permanent (21) Contractual (1) Permanent (10) Contractual (4) Permanent (3) Permanent (14)
2 1 1 1 0 0
3 0 1 0 0 0
0 0 0 0 0 1
2 0 0 0 1 0
9 0 1 0 0 2
3 0 0 0 0 0
0 0 0 0 1 0
0 0 0 2 0 2
0 0 1 0 0 0
1 0 0 0 1 0
0 0 2 0 0 3
1 0 0 0 0 0
0 0 0 0 0 3
0 0 0 0 0 0
Staff nurse Medical officers Staff nurse
CHC (3)
Contractual (4)
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.
Primary Health Centres (PHCs) Most of the Medical officers in PHCs were trained with F-IMNCI and NSSK. Staff nurses in most of the PHCs were trained with F-IMNCI, NSSK, SBA and observer-ship. Community Health Centres (CHCs) In all CHCs, Medical officers were trained with BEmOC and NSSK.
District Hospital (DH) 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.
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.
Charles Ahmeh et al.18 evaluated the baseline and after training, performance and confidence of the Human resource for emergency obstetric and Newborn care (lifesaving skills). They concluded that though there was improvement in confidence, knowledge and skills of the trained staff but the training of the staff alone cant 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.
In addition, Koyejo Oyerinde et al.16 reported that there was severe shortage of staff, equipment and supplies in his study.
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.
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.
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 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

S.NO VARIABLES District Hospital (1) N (%) Normal/ Assisted deliveries C-section deliveries Total deliveries Total newborn deaths Total live births 414 (65.0) N (%) TYPES OF HEALTH FACILITIES Private Hospital (15) COUNT 0 1-50 51-100 >100 1-25 26-50 1-50 51-100 >100 1 2 1-50 51-100 >100 N (%) 1 (6.6) 12 (80.0) 1 (6.6) 1 (6.6) 10 (66.7) 5 (33.3) 10 (66.7) 4 (26.7) 1 (6.6) 3 (20.0) 1 (6.6) 10 (66.6) 4 (26.7) 1 (6.6)
1. 2. 3. 4. 5.
391 (60.6) 255 (39.4) 646 5
219 (35.0) 633 6 627
641
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 except one PHC with 12 normal deliveries and one PHC with one normal delivery.
Out of three CHCs, one conducted four normal deliveries and one CHC conducted one normal delivery.
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 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 Centre (22) N (%) Community Health Centre (3) N (%) District Hospital (1) N (%)
S.NO
VARIABLES
CATEGORIES
Priva Hospi (17 N (%
1.
2.
Does the hospital maintain delivery and type of birth registers? Does the hospital maintain OT register? Does the hospital maintain newborn register? Does the hospital maintain ward register?
Yes
10 (45.5)
2 (66.7)
1 (100.0)
17 (10
Yes
0 (0)
0 (0)
1 (100.0)
16 (94
3.
Yes
6 (27.3)
0 (0)
1 (100.0)
5 (29
4.
Yes
12 (54.5)
3 (100.0)
1 (100.0)
14 (82
5.
6.
Does the hospital maintain monthly reports/HMIS? Does the hospital maintain labor room register? Does the hospital maintain birth register? Does the hospital maintain neonatal death register? Does the hospital maintain circular issue? Does the hospital maintain partogram? Does the hospital maintain birth charts?
Yes
20 (90.9%)
3 (100.0)
1 (100.0)
16 (94
Yes
11 (50.0)
3 (100.0)
1 (100.0)
17 (10
7.
Yes
7 (31.8)
1 (33.3)
1 (100.0)
10 (58
8.
Yes
12 (54.5)
1 (33.3)
1 (100.0)
6 (35
9.
Yes
20 (90.9)
3 (100.0)
1 (100.0)
17 (10
10.
Yes
10 (45.5)
3 (100.0)
1 (100.0)
4 (23
11.
Yes
17 (77.3)
3 (100.0)
(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.
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.
SUMMARY
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. 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. 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.
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. 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. 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. 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 All the private hospitals could not be covered as one private hospitals authorities were not willing to participate in the study.
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 present study is cross-sectional therefore more of analytical studies can provide with detailed information and associations.
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.
REFERENCES
REFERENCES 1. Karnataka India. Child health. PIP. Karnataka: NRHM; 2011-12. 2. Rao A.P. Cause of Infant mortality in Udupi district a descriptive study [Maters dissertation]. Dept. of public Health: Manipal University; 2011. 3. Darmstadt G L, Lawn J Z, Costello A, Advancing the state of the Worlds Newborns. Bulletin of the World Health Organization 2003; 81 (4). 4. Siddarth R. Newborn and Child health in India: problems and interventions. NCMH Background PapersBurden of Disease in India. Available From http://whoindia.org/LinkFiles/Commision_on_Macroeconomic_and_Health_ Bg_P2
5. Sutapa B.N, Malhotra S, Zodpey S and Mohan P. Assessment of Special Care Newborn
Units in India, JHPN 2011 October 29; 5:500-509.
6. India. SRS/UNICEF: 2009 7. Karnataka India. RCH office Udupi; March 2010-April 11 8. India. NRHM. Facility Based New Born Care: Operational guideline. Ministry of health and Family welfare, GOI; 2011
9. UNICEF: tool kit for setting up Special Care New Born Unit, Stabilization Unit & Newborn Care Corner.
10. India. WHO. Students Handbook for IMNCI Integrated Management of Neonatal and Childhood Illness. Ministry of health and Family welfare, GOI; 2003
11. Knippenberg R, Lawn J E, Darmstadt G L, Begkoyian G, Fogstad H, Walelign N et al. Neonatal Survival 3: Systematic scaling up of neonatal care in countries.Lancet2005, March 03; 365:108798 12. Opondo C, Ntoburi S, Wagai J, Wafula J, Wasunna A, Were F et al. Are hospitals prepared to support newborn survival: an evaluation of eight first-referral level hospitals in Kenya. Tropical Medicine and International Health 2009 October; 14:11651172. 13. Casey S E, Kathleen T M, Immacule M A, Martin M H, Blandine A and Prince K. Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo. Conflict and Health 2009 December 21; 3: 12 14. Eugene J. K, Jan H, Grace M, Chisale M and Nynke van den B. Availability, Utilisation and Quality of Basic and Comprehensive Emergency Obstetric Care Services in Malawi. MCHJ. 2009; 13: 687694.
15. Mike E, Fabian E, Aggrey W, Fred W, Bernhards O and Annah W. Delivery of paediatric care at the first-referral level in Kenya Lancet 2004; 364: 1622 29. 16. Koyejo O, Yvonne H, Philip A, Rugiatu K, Rumishael S and Kizito D. The status of maternal and newborn care services in Sierra Leone 8 years after ceasefire. IJGO. 2011 May 6; 114:168173.
17. Young M K, Partamin Z, Jaime M, Hannah T, Linda B and Nabila Z. Availability and quality of emergency obstetric and neonatal care services in Afghanistan. IJGO. 2011 October 17; 116: 192196. 18. Charles A, Adetoro A, Jan H, Fouzia M I, Fatuma M A, and Nynke van den B. The impact of emergency obstetric care training in Somaliland, Somalia. IJGO. 2012 January 15; 117: 283287. 19. Biswas A.B, Nandy .S, Sinha R.N, Das D.K, Roy R.N and Data.S. Status of maternal and new born care at first referral units in the state of West Bengal. IJPH. 2004 Jan-Mar; 48(1): 21-6. 20. Coffey P S, Chirmulay D, Paintal K, Srivastava V, Ahuja R, Malik G et al. Rapid Assessment of Essential Newborn Care Services and Needs in NRHM Priority States of India. Project proposal available from: http://www.ipen.org.in/images/stories/Proposal-ENC.pdff
21. Paul VK and Ramani AV. Newborn care at peripheral health care facilities. IJP. 2000 May; 67(5): 378-82.
22. Guha D.K and Mahajan J. Status of newborn care in India. IJP. 1989 Feb 26; (2):144-9. 23. Sodahi P.R and Sharma.K. Assessing Indian Public Health Standard for Community Health Centres: a case study with special reference to Essential Newborn Care Services. IJPH. 2011 Oct-Dec; 55 (4): 260-66.
24. Zaman A F and Lascar B N. An application of Indian Public Standard for
evaluation of Primary Health Centres of an EAG and non-EAG states. IJPH. 2010 JanMarch; 54 (1): 36-39.
25. Lakshamana C M. A Study on Healthcare Infrastructure for Children in Karnataka: District-wise Analysis. JHM. 2010 December 4; 423-443.
APPENDIX
APPENDIX Annexure 1 Dissertation Time Frame:
Steps Problem selection Review of literature Preparation of research proposal Ethical committee clearance Protocol presentation Data collection Data Analysis Submission of first Draft Submission of final draft Submission of manuscript Final presentation Final submission
March 2012
April 2012
May 2012
June 2012
July 2012
August 2012
Annexure 2 Ethical Committee Approval Certificate
Annexure 3 Request letter from IMA President Udupi District
Annexure 4 Permission Letter from District Health Officer (DHO) Udupi
Annexure 5
QUESTIONNAIRE FOR PRIMARY HEALTH CENTRES
Availability of Neonatal care facilities in Udupi Taluk, Karnataka
Checklist for Newborn facilities Survey:

SECTION 1
01. Types of health facility: Health centre
Primary
02. Date of the Assessment:
03. Name of facility Institution:
04. Location of the facility Institution:
...
Signature of In-charge
SECTION: 2
AVAILABILITY OF NEWBORN CARE SERVICES
Yes 05. Is there 24- hours delivery and newborn care coverage? If yes, specify; A. Yes 24-hours duty roster observed or staff present onsite B. Yes 24-hours coverage but no duty roster observed & no staff present onsite 06. Does hospital provide following delivery service? If yes, specify;
A. Normal deliveries
No
B. Manual removal of Placenta D. Caesarean section (C- section) delivery
C. Assisted deliveries (E.g. forceps/vacuum)
E. Administration of parental oxytocics/antibiotics/inj. Magnesium sulphate/Management of PPH/others complications 07. Does hospital have essential newborn care services? If yes; specify
A.
Resuscitation
B. Thermal care
C. Breast feeding support services 08. Does the hospital provide referral services? 09. Does the hospital provide 24-coverage for delivery &newborn care Services? If yes; specify A. Only deliveries services B. Only newborn care services
C .Both deliveries & newborn care services 10. Is the person skilled in conducting deliveries present at the hospital or on call 24-hours a day, including weekends, to provide delivery care? A. Yes present, schedule observed B. Yes present, schedule reported, not seen C. Yes, on call schedule observed D. Yes, on call, schedule reported, not seen 11. Who attends the complicated delivery at hospital? Obstetrician Paediatrician
Both
Others services
12. Is there any postpartum care offered at the hospital? 13. Does hospital Immunizing Newborn? 14. Does hospital have essential laboratory services? 15. Does hospital have blood transfusion service?
SECTION-3
AVAILABILITY OF INFRASTRUCTURE, EQUIPMENTS & SUPPLY Yes 16. How many beds does the hospital have? 17. Are there any beds are allotted for maternity/postnatal ward? If yes; specify in number: 18. Are there any beds allotted for newborn care? If yes; specify in number: 19. Where is the delivery and neonatal equipments located?
A. B.
No
General consultation room
B. Labor room
Operation theatre D. Others (specify) 20. Does the hospitals have functional ambulance or other vehicle onsite for referral? 21. Does hospital have adequate light? A. Labor room B. Newborn care corner 22. Does hospital have power back up? A. Generator B. Inverter 23. What is the source of water for the hospital?
24. EQUIPMENTS AT NEWBORN CARE CORNER
S. No
Equipments Open care system: radiant warmer, fixed height, with trolley, drawers, O2 bottles Resuscitator, handoperated neonates, 500ml Weighing scale, spring Pump suction, foot operated Thermometer, clinical, digital, 32-34C Light for examination, mobile, 220-12V Syringe hub cutter
Essential (E)/ Desirable (D)
Availability
Functioning
Required
Y/N
Y/N 1 1 1 1 1 1 1
Quantity Available
1 2 3 4 5 6 7
E E E E E E E
25. EQUIPMENTS FOR DISINFECTION

S. No
Equipments Sterilizing drum, 165mm diameter Electric sterilizer Washing machine with dryer Gowns for staff & mothers Washable slippers
Essential(E) /Desire(D)
Functioning Y/N
Availability Y/N
Required
Quantity Available
1 2 3 4 5
D D E E E
1 1 1 1 4
26. LABORATRY EQUIPMENTS
S. No
Equipments Centrifuge, hematocrit, benchtop, up to 12000rpm, including rotor Microscope, binocular, with illuminator Bilirubinometer, total bilirubin, capillary-based Glucometer with dextrostir
Availability
Functioning
Required
Y/N
Y/N 1 1 1 1
Quantity Available
1 2 3 4
D E E E
SECTION-4 AVAILABILITY OF HUMAN RESOURCE 27. Please specify number for first three categories &their training status from coding below Designation Medical Officers Staff Nurses Lab technician Data manager Supporting staff Required/ Sanctioned 1 1 1 1 1 Available Permanent Contractual Training status
CODES FOR TRAINING STATUS A. IMNCI: for medical officer/ staff nurse B. F-IMNCI: for medical officer/ staff nurse C. NSSK: for medical officer/ staff nurse/ANM D. Facility based newborn care: for medical officer/staff nurse posted in SNCU E. SBA for ANMs/LHVs & Staff nurse F. SBA/BEmOC for Medical officer G. Observership H. Neonatology
DAYS OF TRAINING ATTENDED 8 Days 11 Days 2 Days 3 Days 2-3 Days 9 Days 2 Weeks 3- Months
SECTION: 5 AVAILABILITY OF RECORDS/REGISTERS 28. A RECORDS: FROM LAST 3-MONTHS 01. Total number of deliveries including C-section 02. Total number of assisted deliveries 03. Total number of C-section deliveries 04. Total number of live birth 05. Total number of newborn deaths 06. Total number of still birth Within 24 hours: 0 to 7 days: 0 to 28 days:
28. B REGISTERS MAINTAINED BY HOSPITAL: S.No A. B. C. D. Registers Delivery & types of birth register OT register Newborn register Ward register Available Y/N Maintained Y/N
E. OTHERS F. G. H. I. J. K.
Monthly reports/ HMIS Labor room register Birth weight register Neonatal death register Circular issue Partogram Birth charts (bed side)
Annexure 6
QUESTIONNAIRE FOR COMMUNITY HEALTH CENTRES
SECTION 1
01. Types of health facility: Referral unit
Community Health centre/First
SECTION: 2
AVAILABILITY OF NEWBORN CARE SERVICES
Yes 05. Is there 24- hours delivery and newborn care coverage? If yes, specify; C. Yes 24-hours duty roster observed or staff present onsite D. Yes 24-hours coverage but no duty roster observed & no staff present onsite 06. Does hospital provide following delivery service? If yes, specify; B. Normal deliveries B. Manual removal of Placenta C. Assisted deliveries (E.g. forceps/vacuum) D .Caesarean section (C- section) delivery
No
B.
Resuscitation
B. Thermal care
C. Breast feeding support services 08. Does the hospital provide referral services? 09. Does the hospital provide 24-coverage for delivery &newborn care services? If yes; specify A. Only deliveries services B. Only newborn care services
C .Both deliveries & newborn care services 10. Is the person skilled in conducting deliveries present at the hospital or on call 24-hours a day, including weekends, to provide delivery care? A. Yes present, schedule observed B. Yes present, schedule reported, not seen C. Yes, on call schedule observed D. Yes, on call, schedule reported, not seen 11. Who attends the complicated delivery at hospital? Obstetrician Paediatrician Both Others services
12. Is there any postpartum care offered at the hospital?
13. Does hospital Immunizing Newborn? 14. Does hospital have essential laboratory services? 15. Does hospital have blood transfusion service?
SECTION-3
AVAILABILITY OF INFRASTRUCTURE, EQUIPMENTS & SUPPLY Yes 16. How many beds does the hospital have? 17. Are there any beds are allotted for maternity/postnatal ward? If yes; specify in number: No
18. Are there any beds allotted for newborn care? If yes; specify in number: 19. Where is the delivery and neonatal equipments located?
. General consultation room
B. Labor room
C. Operation theatre D. Others (specify) 20. Does the hospitals have functional ambulance or other vehicle onsite for referral? 21. Does hospital have adequate light? A. Labor room B. Newborn care corner 22. Does hospital have power back up? A. Generator B. Inverter 23. What is the source of water for the hospital?
24. EQUIPMENTS AVAILABLE ATNEWBORN STABILIZATION UNIT
S. No
Equipments Open care system: radiant warmer, fixed height, with trolley, drawers, O2 bottles Phototherapy unit, single head, high intensity Resuscitator, hand-operated neonates, 500ml Laryngoscope set, neonates Electronic baby- weighing scale 10 kg< 5kg> Suction pump foot operated Thermometer, clinical, digital, 32-34C Light for examination, mobile, 220-12V Syringe hub cutter
Availability Y/N
Functioning Y/N
Required
Quantity Available
1 2 3 4 5 6 7 8 9
E E E E E E E E E
3 1 2 2 1 2 1 2 4
25. GENERAL EQUIPMENTS

S. No
Equipments AC (1.5 tonne) Generator set 25-50 KVA Refrigerator, hot zone,1101 Voltage servo-stabilizer (three phase): 25-50 KVA Room heater (oil) Computer with printer Spot lamps Wall clock with second hand
Essential(E)/ Desire(D)
Availability Y/N
Functioning Y/N
Required
Quantity Availabl e
1 2 3 4 5 6 7 8
E E E E D D E E
1 1 1 1 4 1 2 2
S. No
Availability Y/N
Functioning Y/N
Required
Quantity Available
1 2 3 4 5
D D E E E
1 1 1 1 4

S. No
Availability Y/N
Functioning Y/N
Required
Quantity Available
1 2 3 4
D D E E
1 1 1 1
SECTION-4 AVAILABILITY OF HUMAN RESOURCE 28. Please specify number for first three categories &their training status from coding below Designation Medical Officers Staff Nurses Lab technician Data manager Supporting staff Required/ Sanctioned 1 4 1 1 2 Available Permanent Contractual Training status
DAYS OF TRAINING ATTENDED 8 Days 11 Days 2 Days 3 Days 2-3 Days 9 Days 2 Weeks 3- Months
SECTION: 5 AVAILABILITY OFRECORDS/REGISTERS 29. A RECORDS: FROM LAST 3-MONTHS 01. Total number of deliveries including C-section 02. Total number of assisted deliveries 03. Total number of C-section deliveries 04. Total number of live birth 05. Total number of newborn deaths 06. Total number of still birth Within 24 hours: 0 to 7 days: 0 to 28 days:
29. B. REGISTERS MAINTAINED BY HOSPITAL: S.No A. B. C. D. E. OTHERS F. G. H. I. J. L. Register Delivery & types of birth register OT register Newborn register Ward register Monthly reports/ HMIS Labor room register Birth weight register Neonatal death register Circular issue Partogram Birth charts (bed side) Available Y/N Maintained Y/N
Annexure 7
QUESTIONNAIRE FOR DISTRICT AND PRIVATE HOSPITALS
SECTION 1
01. Types of health facility: Private Hospitals
District Hospital/
SECTION: 2 AVAILABILITY OF NEWBORN CARE SERVICES Yes 05. Is there 24- hours delivery and newborn care coverage? If yes, specify; E. Yes 24-hours duty roster observed or staff present onsite F. Yes 24-hours coverage but no duty roster observed & no staff present onsite 06. Does hospital provide following delivery service? If yes, specify; C. Normal deliveries B. Manual removal of Placenta C. Assisted deliveries (E.g. forceps/vacuum) D. Caesarean section (C- section) delivery No
A. Resuscitation
B. Thermal care
C. Breast feeding support services 08. Does the hospital provide referral services? 09. Does the hospital provide 24-coverage for delivery &newborn care services? If yes; specify A. Only deliveries services B. Only newborn care services
C .Both deliveries & newborn care services 10. Is the person skilled in conducting deliveries present at the hospital or on call 24-hours a day, including weekends, to provide delivery care?
A. Yes present, schedule observed B. Yes present, schedule reported, not seen C. Yes, on call schedule observed D. Yes, on call, schedule reported, not seen 11. Who attends the complicated delivery at hospital? Obstetrician Both Paediatrician Others services
12. Is there any postpartum care offered at the hospital?
13. Does hospital Immunizing Newborn? 14. Does hospital have essential laboratory services? 15. Does hospital have blood transfusion service?
SECTION-3
AVAILABILITY OF INFRASTRUCTURE, EQUIPMENTS & SUPPLY Yes 16. How many beds does the hospital have? 17. Are there any beds are allotted for maternity/postnatal ward? If yes; specify in number: 18. Are there any beds allotted for newborn care? If yes; specify in number: 19. Where is the delivery and neonatal equipments located?
. General consultation room
No
B. Labor room
C. Operation theatre D. Others (specify) 20. Does the hospitals have functional ambulance or other vehicle onsite for referral? 21. Does hospital have adequate light?
A. Labor room B. Newborn care corner 22. Does hospital have power back up? A. Generator B. Inverter 23. What is the source of water for the hospital?
24. Does hospital have designated area for facilitating newborn care? Designated area Labor room Operation theatre Postnatal ward/ rooming in/ step-down area Newborn corner Special newborn care unit (for 3000 deliveries) Ancillary space at SNCU Hand washing Designated area for mixing IV fluid Designated area for boiling & autoclaving Designated area for laundry Clean utility area (for storing supplies for regular use) Soiled utility room (for storing use and contaminated material) Store Side lab Yes No No. of rooms/ area
25. EQUIPMENTS ATSPECIAL NEWBORN CARE UNIT
S. No
Equipments Open care system: radiant warmer, fixed height, with trolley, drawers, O2 bottles Resuscitator, hand-operated neonates, 500ml Resuscitator, hand-operated neonates, 250ml Electronic baby weighing scale, 10kg <5kg> Pump suction, foot operated Suction Pump, portable, 220v, w/access Thermometer, clinical, digital, 32-34C Light for examination, mobile, 220-12V Syringe hub cutter Surgical instrument, suture/SET Syringe pump, 10,20,50 ml, single phase Oxygen hood, S & M, set of 3 each, including connecting tubes Laryngoscope set, neonates Oxygen supply system Pulse Oximeter bed side, neonatal Stethoscope binaural, neonates Sphygmomanometer neonates electronic Measuring tape, vinyl-coated , 1.5 cm Kidney basin, stainless steel , 825ml Dressing tray, stainless steel, 330*200*30mm Infusion stand, double hook, on castors Infanotometer, plexi, 3.5 ft/105cm Phototherapy unit, single head, high intensity Irradiance meter for phototherapy unit Oxygen concentrator Monitor, vital sign, NIBP, HR, SpO2, ECG,RR ,temperature ECG unit, 3 channel, portable/SET Indicator TST ,control
Availability Y/N
Functioning Y/N
Required
Quantity Available
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
E E E E E E E E E E E E E E E E E E E E E E E D D D D D
12 4 2 4 2 2 12 6 2 2 3 6 6 1 6 12 6 2 4 4 1 1 6 2 4 1 2 1
26. GENERAL EQUIPMENTS

S. No
Equipments AC (1.5 tonne) Generator set 25-50 KVA Refrigerator, hot zone,1101 Voltage servo-stabilizer (three phase): 25-50 KVA Room heater (oil) Computer with printer Spot lamps Wall clock with second hand
Essential(E)/ Desire (D)
Functioning Y/N
Availability Y/N
Required
Quantity Available
1 2 3 4 5 6 7 8
E E E E D D E E
1 1 1 1 4 1 2 2

S. No
Functioning Y/N
Availability Y/N
Required
Quantity Available
1 2 3 4 5
D D E E E
1 1 1 1 4

S. No
Functioning Y/N
Availability Y/N
Required
Quantity Available
1 2 3 4
D D E E
1 1 1 1
SECTION-4 AVALIBILITY OF HUMAN RESOURCE
29. Please specify number for first three categories &their training status from coding below Designation Paediatrician OB/GYN Medical Officers 1 2 3 4 Staff Nurses 1 2 3 4 5 6 Lab technicians Data manager Other supporting staff Required/ Sanctioned 1 1 4 Available Permanent Contractual Training status
1 1 4 DAYS OF TRAINING ATTENDED 8 Days 11 Days 2 Days 3 Days 2-3 Days 9 Days 2 Weeks 3- Months
SECTION: 5 AVAILABILITY OF RECORDS/REGISTERS
30. A. RECORDS: FROM LAST 3-MONTHS 01. Total number of deliveries including C-section 02. Total number of assisted deliveries 03. Total number of C-section deliveries 04. Total number of live birth 05. Total number of newborn deaths 06. Total number of still birth Within 24 hours: 0 to 7 days: 0 to 28 days:
30. B. REGISTERS MAINTAINED BY HOSPITAL: S.No A. B. C. D. E. OTHERS F. G. H. I. J. K. Register Delivery & types of birth register OT register Newborn register Ward register Monthly reports/ HMIS Labor room register Birth weight register Neonatal death register Circular issue Partogram Birth charts (bed side) Available Y/N Maintained Y/N
Annexure 8.A
List of the Government Hospitals Visited S. no 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Names of the Health Facilities KODIBENGRE MANDARTHI KOLALAGIRI MANIPURA SALIGRAMA KEMMANNU AVERSE BARKUR HIRIADKKA HIREBETTU KUKKEHALLI KOKKARNE KAUP MOODABETTU MUDARANGADI MALPE PERNANKILA PADUBIDRI PETHRI SASTHANA KERJE SAIBRAKATTE BRAHMAVARA SHIRVA KOTA MCH DISTRICT HOSPITAL Types of health facilities PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE PRIMARY HEALTH CENTRE COMMUNITY HEALTH CENTRE COMMUNITY HEALTH CENTRE COMMUNITY HEALTH CENTRE DISTRICT HOSPITAL
Annexure 8.B List of Private Hospitals Visited S. No 1. 2. 3. 4. Names of the Health Facilities KAMATH NURSING HOME, HIRIADIKA UDUPI TALUK KAMATH NURSING HOME, UPENDRA TOWER, K.M. MARG, UDUPI TALUK ADARSH HOSPITALS, NEAR KSRTC BUS STAND, UDUPI TALUK LALITH HOSPITAL, RAG LALITH BULDING K.M. MARG, UDUPI TALUK Number of Beds <30 BEDS <30 BEDS <100 BEDS <30 BEDS
5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18.
NEW CITY HOSPITALS, KADABETTU, UDUPI TALUK Dr. A.V. BALIGA MEMORIAL HOSPITALS, DODDANAGUDDE, UDUPI TALUK SONIA CLINIC & NURSING HOME, ANANTH NAGAR, MANIPAL, UDUPI TALUK CITY HOSPITALS & DIAGNOSTIC CENTRE, ALANKAR, UDUPI TALUK PRASANTH HOSPITALS KOPPLANGADI, KAUP, UDUPI TALUK C.S.I LOMBARD MEMORIAL HOSPITAL, UDUPI TALUK GORRETTI HOSPITALS, SANTHEKATTE, UDUPI TALUK MAHESH HOSPITAL NH-17, BRAHMAVARA, UDUPI TALUK KASTURBA HOSPITALS, MANIPAL, UDUPI TALUK GANDHI HOSPITAL, NEAR CITY BUS STAND, UDUPI TALUK SIDDHI VINAYAK HOSPITAL, MAHADEVI COMPLEX, PADUBIDRI, UDUPI TALUK MITHARA HOSPITALS, MITHARA PRIYA, UDUPI TALUK DR. TMA. PAI HOSPITALS, OPPOSITE TO TALUK OFFICE, UDUPI TALUK HITECH MEDICAL HOSPITAL & RESERCH CENTRE, NH-17 AMBALPADY, UDUPI TALUK
<50 BEDS <100 BEDS <30 BEDS <100 BEDS <30 BEDS <100 BEDS <50 BEDS <100 BEDS 1000 BEDS <100 BEDS <30 BEDS <100 BEDS 100 BEDS 50 BEDS

Newborn Thesis Neel Kamal 102802004

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Newborn Thesis Neel Kamal 102802004

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AVAILABILITY OF NEONATAL CARE SERVICES IN UDUPI TALUK

Neel Kamal BPT, FAGE

Dr. Ramachandra Kamath

Dr. Ramachandra Kamath

Dr. Leonard Machado, MD Associate professor Depart of Public Health

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

Manipal University Date: / /2012

Manipal University Date: / /2012

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

Dr. Ramachandra Kamath

Place: Manipal Date:

Neel Kamal (102802004)

Aim and Objectives

Materials and Methods

Results and Discussion

TABLES AND FIGURE

Table: 4E Table: 5A Table: 5B

Records of deliveries from last 3-months

Registers maintained for Newborns

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

AIM AND OBJECTIVES

MATERIALS AND METHODS

MATERIALS AND METHODS

Study area: Public and Private Hospitals in Udupi taluk.

Community Health centres

Primary Health centres

Government hospitals (26)

Private hospitals (18)

District hospital (1)

Primary Health centres and Community Health centres.

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

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

District for Private Hospitals.

RESULTS AND DISCUSSION

RESULTS AND DISCUSSION

Percentage (%) 51.1 6.9 2.3 39.5 100

Tables 2: Table -Newborn Care Services:

9. 10. 11. 12.

Forhad Akhtar Zaman et al. (2008)

found that all PHCs were rendering

Tables 3A: Table Infrastructure for Newborn Care

No. of OT No. of postnatal ward NBCC SNCU / NICU 1

Tables 3B: Table- Infrastructure for Newborn Care

Which type of water source does the hospital have?

Tables 3C: Table - Infrastructure for Newborn Care

District Hospital (1) N (%)

Area for Hand washing

Yes Yes Yes Yes Yes Yes Yes Yes

1 (100.0) 1 (100.0) 1 (100.0) 1 (100.0) 1 (100.0) 1 (100.0) 1 (100.0) 0 (.0)

District Hospital (DH)

Private Hospitals (PHs)

Tables 4A: Table Equipment for Management:

District Hospital (DH)

Private Hospitals (PHs)

Tables 4B: Table - Equipment for Monitoring:

Vital sign monitor

District Hospital (DH)

Private Hospitals (PHs)

Tables 4C: Table- Equipment for Investigation:

21 (95.5) 1 (4.5) 20 (90.9) 2 (9.1) 3 (13.6) 19 (86.4) NA

2 (66.7) 1 (33.3) 2 (66.7) 1 (33.3) 2 (66.7) 1 (33.3) 2 0 2

0 1-2 2-3 0 1 0 1-2 6 0 1 2 0 1

District Hospital (DH)

Private Hospitals (PHs)