Archive

Posts Tagged ‘MMR’

Pyramid-structure health service planned to check infant, maternal mortality

April 20, 2011 Leave a comment

Adam Halliday,ADAMHALLIDAY Posted: Apr 20, 2011 at 0355 hrs IST

Ahmedabad: The Commissionerate of Health, Medical Services and Medical Education is putting together a pyramid-structured
organisation in an attempt to arrest the infant and maternal mortality rates, senior health officials have said. The move comes in the wake of a report by the Comptroller and Auditor General of India (CAG) which states that Gujarat
has been unable to bring down IMR from 57:1000 in 2005-06 to 30:1000 by March 2010 despite launching of the Chiranjeevi Yojana. Dr N B Dholakia, Deputy Director, RCH at the Commissionerate, said the structure will seek to look at the grassroots level and strengthen penetration through training of workers at the primary level . He said 36,000 ground-level workers have been trained under the Integrated Management of Neo-Natal and Childhood Illnesses scheme. The target, expected to be complete by the year-end, is 45,000 workers. These workers will be responsible for identifying unhealthy children and reporting such cases to paediatricians. Above this level will be 333 Newborn Care Corners in PHCs across the state, to be manned by Auxiliary Nurse Midwives (ANMs). Above these care corners will be 148 Newborn Stabilisation Units in as many Community Healthcare Centres. The top-level will have 41 Neo-
Natal ICUs at various locations in the state. Dr Dholakia further said the effort to arrest the deaths of newborns and mothers will be coupled by setting-up of “family-friendly ” hospitals. Dr Prakash Vaghela, assistant director, said the postpartum care is sometimes missing in the care of pregnant mothers. Postpartum care is the care given to mothers who have just delivered, at least for the 48 hours following delivery. They said the hospitals in the state will be equipped with space for attendants, and services like food will be also taken care of. The concept is a result of observations that many people shun institutional deliveries because attendants sometimes find it difficult to be in the hospital.

Source: Pyramid-structure health service planned to check infant, maternal mortality

Advertisements

Medical errors in top 10 killers: WHO

April 20, 2011 Leave a comment

Malathy Iyer, TNN | Apr 20, 2011, 12.59am IST

MUMBAI: Medicine heals, but this fact doesn`t hold true for every 300th patient admitted to hospital. Call it the law of averages or blame human error for it, but the World Health Organization believes that one in 10 hospital admissions leads to an adverse event and one in 300 admissions in death.

An adverse event could range from the patient having to spend an extra day in hospital or missing a dose of medicine, said Dr Nikhil Datar, a gynaecologist and health activist. Unintended medical errors are a big threat to patient safety.

Although there is no Indian data available on this topic, WHO lists it among the top 10 killers in the world. While a British National Health System survey in 2009 reported that 15% of its patients were misdiagnosed, an American study published in the Journal of the American Medical Association in 2000 quantified this problem most effectively.

It said that there are 2,000 deaths every year from unnecessary surgery; 7,000 deaths from medication errors in hospitals; 20,000 from other errors in hospitals; 80,000 from infections in hospitals; and 106,000 deaths every year from non-error, adverse effects of medications. In all, 225,000 deaths occur per year in the US due to unintentional medical errors.

It is to create awareness both among doctors and patients about errors dubbed as unintended medical errors that Datar organized a seminar to discuss patient safety at the Indian Medical Associations office on Sunday. “In the western nations, it is believed that the incidence of unintentional medical errors is between 10% and 17% of all cases,” said Datar.

The Indian government has woken up to the concept. It set up the National Initiative on Patient Safety in the All-India Institute of Medical Sciences a couple of years back.

But the idea, as Dr Akhil Sangal of the Indian Confederation for Healthcare Accreditation, points out is not to apportion blame. “When medical negligence occurs, the first question to be asked is who is to blame. We instead have to evolve to a system in which we ask questions about how, when and where the negligence occurred,” said Delhi-based Dr Sangal.

Datar illustrates with an example of a 10-year-old leukemia patient in Britain who had to be given a chemotherapy injection. “This is a published report of how due to a series of unintended changes the boy died due to a wrong injection being given to him,” said Datar. The boy ate food that was prohibited before the procedure; he was hence taken hours later by a different department than the cancer doctors. “The injections were given in a particular order but that day due to the mix-up he got the wrong injection and died five days later.” The committee exonerated the doctor because it found the other factors — the when, where and how — had all played a role in the boy`s death.

“By talking about patient safety, we can reduce the overall mortality and morbidity associated with hospitalization. Even hospitalization time and costs could come down as a result,” said Dr Mathew Joseph who is attached to PGI Chandigarh and is involved in a nationwide study on clinical practices. “One of our earlier studies had shown unsafe practices associated with 70% of the injections administered in our country,” Joseph said.

BOX

* One in 10 patients is harmed while receiving hospital care

* The risk of health care-associated infection in some developing countries is as much as 20 times higher than in developed countries

* At any given time, 1.4 million people worldwide suffer from infections acquired in hospitals

* At least 50% of medical equipment in developing countries is unusable or only partly usable. Often the equipment is not used due to lack of skills or commodities. As a result, diagnostic procedures or treatments cannot be performed. This leads to substandard or hazardous diagnosis or treatment that can pose a threat to the safety of patients and may result in serious injury or death

* In some countries, the proportion of injections given with syringes or needles reused without sterilization is as high as 70%. This exposes millions of people to infections. Each year, unsafe injections cause 1.3 million deaths, primarily due to transmission of blood-borne pathogens such as hepatitis B virus, hepatitis C virus and HIV

* Over 100 million people require surgical treatment every year. Problems associated with surgical safety in developed countries account for half of the avoidable adverse events that result in death or disability

* There is a one in 1,000,000 chance of a traveller being harmed while in an aircraft. In comparison, there is a one in 300 chance of a patient being harmed while being given health care

Source: Medical errors in top 10 killers: WHO

Health outcomes across major States

April 19, 2011 Leave a comment

C. P. CHANDRASEKHAR, JAYATI GHOSH

An examination of the most recent health outcome indicators revealed by the Sample Registration Surveys of the Registrar General of India reveals some surprising results across the major States on infant mortality and maternal mortality rates.

Despite the nod given to “human development” indicators, policy makers and even the general public persist in viewing GDP growth as the primary indicator of progress, whether in India as a whole or in different States.

This is arguably not just inadequate but possibly even misleading, as it is possible for relatively high rates of GDP growth to be combined with stagnant or even worsening conditions of life for a substantial segment of the population, even the majority.

Obviously, therefore, employment conditions (such as access to productive employment, wage rates and conditions of work) should have equal if not greater importance in any assessment of economic progress.

But one obvious set of indicators that is only casually examined by even serious and well-meaning observers relates to health.

There is no doubt that it is hard to assess morbidity, especially when the database for such analysis is poor and much depends upon self-perception.

However, we do have relatively good data on the most basic health outcome indicators of all – infant mortality and maternal mortality – that allow us to assess the differential performance of States across time.

The Sample Registration Surveys (SRS) of the Registrar-General of India provide the most reliable source of such data.

The most recent results of the SRS relate to 2009, and they allow us to look at both the current conditions as well as changes over the previous decade. While in general the infant mortality and maternal mortality indicators track the general level of economic development, the matches are not exact by any means. In fact, these data provide a somewhat different picture of the conditions of life in different States and the progress in the past decade, than is generally perceived.

Infant mortality

Consider infant mortality rates, which are globally considered to be the primary indicator of basic health conditions in a population. Chart 1 shows that these vary widely across States, and that some States with relatively high per capita incomes do not perform well in this regard.

Chart 2 shows that even performance over time is not necessarily related to increases in per capita GDP over the decade.

Thus Maharashtra, which has one of the highest per capita incomes of all major States, is only a moderate performer with respect to IMR, although it has decreased relatively more than the Indian average (Chart 2).

The poor performance Uttar Pradesh, Orissa and Madhya Pradesh is expected, but the relatively rapid decline of IMR in Jharkhand is less expected (though it must be noted that the IMR in Jharkhand is still well above the Indian average).

Two positive examples are Tamil Nadu and West Bengal, both of which have shown relatively rapid declines in IMR over the decade and had IMR very significantly below the Indian averge in 2009.

In the case of West Bengal, a middle income State, this is even more notable. Kerala has long been held as an example in terms of health conditions, and its IMR is many times less than the Indian average, so it is all the more creditable that it managed to reduce the low IMR even further over the period.

Negative example

The negative example comes from Gujarat, a State which for some reason is otherwise being presented as a model of development in various corporate and other quarters.

Not only was the IMR in 2009 close to the Indian average despite the much higher per capita income in that State, but progress over the previous decade was meagre. In 2009, the IMR in Gujarat was only slightly lower than in much poorer and less developed Bihar, and actually higher than in Jharkhand.

Delhi is the richest State in the country, but its performance in terms of IMR has been disappointing, with no improvement and even a slight decline in the decade under consideration. Similarly poor health performance is evident from another rich Northern state, Haryana, which shows higher than average IMR and low rate of reduction. Haryana’s IMR in 2009 was higher than in West Bengal, Andhra Pradesh and Jharkhand.

Urban-rural gap

Chart 3 describes rural and urban IMRs, and here too the results are interesting. Some States show very large gaps, and clearly rural IMRs remain very high even in some relatively rich States such as Gujarat and Haryana. But urban IMRs also do not run along completely expected lines. For example, it is surprising to note that the urban infant mortality rate in Delhi is clearly higher than in Tamil Nadu and West Bengal!

Chart 4 gives an idea of the extent of the location-specific gap in IMRs, by showing the rural IMR as a percentage of the urban IMR.

Predictably, the gap is lowest in Kerala, but Tamil Nadu, West Bengal and Chhattisgarh also perform well in this regard. The largest gaps are in Rajasthan (with a 40 per cent difference!) and Assam. Once again Gujarat is among the States with a very large rural-urban gap in IMRs, along with Maharashtra – both indicating gaps even larger than in poor States such as Madhya Pradesh and Jharkhand.

Maternal mortality

The other critical indicator of health conditions – and of the overall condition of women in society – is the maternal mortality rate.

Data for this also come from the Registrar-General’s office, for periods of three year averages. They are described in Charts 5 and 6.

Once again the north-central belt performs poorly, with Uttar Pradesh, Rajasthan, Madhya Pradesh and Bihar showing the highest rates of maternal mortality as well as relatively low rates of reduction.

The biggest improvement in maternal mortality among the major States appears to be in West Bengal. As a result, by 2009, West Bengal appears more like a southern State with respect to this indicator, as MMRs are relatively low in all the southern States.

Among the richer northern States, Punjab and Haryana show little or no improvement, and Gujarat also underperforms with respect to this indicator.

Such evidence clearly needs to be much more widely publicised and taken seriously by our policy makers, who need to move away from their current obsession with GDP alone.

If sheer survival is seen as at least one valid indication of the overall human condition, then the various States in the country should be ranked quite differently, both in terms of policy direction and public perception.

Source: Health outcomes across major States

66% of worldwide stillbirths occurs in India

April 14, 2011 Leave a comment
Kounteya Sinha, TNN | Apr 14, 2011, 07.04am IST

NEW DELHI: Four lakh fewer children died while still in their mother’s womb in 2009 — in India, Bangladesh and China — as compared to 1995.

However, India is among 10 countries, which, though, contributes 54% of total worldwide births, 66%, or 1.8 million of all stillbirths.

India’s stillbirth — death after 28 weeks’ of gestation — figures have reduced over the past decade. Be that as it may, it’s still shameful — 22 stillbirths per 1,000 births. In some states, it varies from 20 to 66 per 1,000 births.

According to a series on stillbirth, published in “The Lancet” on Wednesday, more than 7, 200 babies are stillborn every day. Around 2.6 million stillbirths occur worldwide each year during the last trimester of pregnancy, and 98% of them occur in low and middle-income countries. High-income countries, too, report stillbirths with one in 320 babies stillborn.

Sadly, the number of stillbirths worldwide has declined by only 1.1% per year — from 3 million (1995) to 2.6 million (2009). The global stillbirth rate, in turn, has reduced from 22 stillbirths per 1,000 to 19.

Dr Monir Islam, World Health Organization’s (WHO) South-East Asia director on family health, said, “Though India has made some progress, what worries me most are the intra-partum deaths (a child being alive all through the nine months inside a mother’s womb but dying during labour). Around 50% of stillbirths are such cases, which is unacceptable.”

WHO says, one in every two stillbirths in developing countries occurs during birth (intra-partum). Worldwide, 1.2 million babies die during labour and most of these are term babies who should survive if born alive and whose deaths are often associated with lack of obstetric care.

“If every woman had access to a skilled birth attendant – a mid-wife and if necessary a physician – for both essential care and for procedures such as emergency caesarean sections, we would see a dramatic decrease in the number of stillbirths,” Dr Carole Presern, director of The Partnership for Maternal, Newborn & Child Health (PMNCH) said.

In India, 60% women have access to skilled care during child birth.

The main causes of stillbirth are childbirth complications, infections during pregnancy, disorders — especially hypertension and diabetes — fetal growth restriction and congenital abnormalities.

Globally, the rate of stillbirths ranges from 2 per 1,000 total births in Finland to more than 47 per 1,000 in Pakistan. The stillbirth rate varies sharply across the world — such as Nigeria (42), Bangladesh (36) and Djibouti and Senegal (34).

In developed nations, risks are clear. Up to 58% of women of childbearing age are overweight or obese, which is a major risk factor for stillbirth. Around half of all pregnant women consume alcohol during pregnancy, raising the risk of stillbirth by 40%. Any smoking during pregnancy increases the risk of stillbirth by 40%.

Can India prevent 200 children dying every hour? Op-Ed

April 14, 2011 Leave a comment

Can India prevent 200 children dying every hour?

Poonam Khetrapal-Singh

It is estimated that India lost 1.8 million children under five in 2008. That is more than 200 child deaths every hour, each day, or more than three deaths every minute. Out of about 25 million babies born every year in India, one million die. Most who survive do not get to grow up and develop well. About 48 per cent are stunted (sub-normal height) and 43 per cent are under-weight. Additionally, about one-third of babies are born with a low birth weight of less than 2,500 grams.

MDG target

In South-East Asia, the Maldives, Sri Lanka and Thailand have reduced newborn and childhood mortality significantly. India has also demonstrated steady progress. Under-five mortality decreased from about 150 per 1,000 live births in 1990 to 74 per 1,000 live births in 2005-06. But at this rate of decline, India will not be able to achieve the Millennium Development Goal 4 (MDG) target of 50 under-five deaths per 1,000 live births by 2015. Moreover, progress has been uneven in various States in the country.

Causes

The causes of death among children are well understood in India. Newborn mortality (death within the first 28 days of life) contributes to more than half of under-five mortality. In newborns they are asphyxia (inability to breathe at the time of delivery), infections and prematurity. After 28 days of life, they are the result of acute respiratory infections (pneumonia) and diarrhoea. Undernutrition contributes to 35 per cent of deaths. In addition to these, immediate causes of childhood deaths, there are several socio-cultural factors including poverty, poor water and sanitation facilities, illiteracy (especially among women), the inferior status of women in society, and pregnancy during adolescence (that can be attributed to early marriage). Child mortality rates are also higher among rural populations when compared to their urban counterparts.

We know what needs to be done to save these precious lives. Newborn deaths can be prevented by ensuring nutrition of adolescent girls; delaying pregnancy beyond 20 years of age and ensuring a gap of three-five years between pregnancies; skilled care during pregnancy, childbirth and post-natal care; and improved newborn care practices that include early (within first hour of birth) and exclusive breastfeeding; preventing low body temperature and infections; and early detection of sickness and prompt treatment. Childhood deaths can be prevented by exclusive breastfeeding for six months and complementary feeding from six months of age with continued breastfeeding for two years; immunisation; and early treatment of pneumonia, diarrhoea and malaria. In addition, it is important for the mother and other caretakers at home to invest in appropriate child caring practices, right from birth to support early childhood development and lay a foundation to maximise human potential.

India needs to provide these life-saving interventions to most, if not all, newborn and children who need them. However, their (interventions) coverage has been quite low. For example, in 2005-06 (the National Family Health Survey – NFHS 3 report), the rate of initiation of breastfeeding within an hour of birth was only 26 per cent and exclusive breastfeeding at six months was just 46 per cent. Yet these two interventions have the potential to prevent 19 per cent of deaths. The use of oral rehydration salts in cases of diarrhoea, the most recommended treatment, was just 43 per cent and only 13 per cent cases of suspected pneumonia received antibiotics. Immunisation coverage has been relatively better, suggesting that high coverage is achievable.

Intervention

The main causes of poor coverage of interventions include ineffective planning and implementation, mainly due to weaknesses in the health system. To address the systemic challenges, India launched a flagship programme, the National Rural Health Mission in 2005-06, to strengthen the health system in rural areas. Commendable initiatives have been put in place such as training about 8,00,000 village level health volunteers (Accredited Social Health Activist, or ASHA), hiring additional staff, strengthening the infrastructure of health facilities, augmenting programme management capacity at State and district levels, and enhancing community participation. However, much more needs to be done to minimise health inequities that exist among different subpopulations in the country.

Public health expenditure in India has remained at a low — about one per cent of GDP — for quite some time. This needs to be scaled up. Considering that about 70 per cent of health care is accessed from the private sector in the country, better regulation and participation of private health service providers must be ensured. Synergy between the health and nutrition sectors must be fostered through better coordination between the Ministry of Health and the Ministry of Women and Child Development, which are responsible for the ICDS (Integrated Child Development Services) programme.

To reach unreached newborns and children, there is a strong case for providing home-based newborn care as well as community-based management of non-severe pneumonia and diarrhoea in children by trained ASHAs and other community health workers. This initiative needs to be supported by provision of incentives, necessary drug supplies, close supervision and appropriate referral linkages. At the same time, the quality of health services at first-level health facilities and referral hospitals must continue to be strengthened.

Fortunately, there is renewed commitment at the global and national levels towards achievement of MDG 4. To save newborns and children, national governments, development agencies, civil society and other stakeholders must work in close collaboration.

( Dr. Poonam Khetrapal-Singh is WHO Deputy Regional Director for South-East Asia Region.)