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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

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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

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.)