Reducing Perinatal Deaths: A Distant Dream But on the Right Path!
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Reducing Perinatal Deaths: A Distant Dream But on the Right Path! SRINIVAS MURKI1* AND SANJEEV UPADHYAYA2 1Chief Neonatologist, Paramitha Children Hospital, and 2Health Specialist
UNICEF Office for Andhra Pradesh, Telangana & Karnataka; Hyderabad, Telangana, India. *[email protected]
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“In God we trust, all others bring data!”
he phrase emphasizes the importance of ‘data’ to understand a problem, identify the causes, implement preventive and therapeutic activities and specially to plan health programs that concern public health issues. Data collection is an ongoing systematic process of gathering, analyzing and interpreting various types of information from relevant sources. Quality assurance and quality control are two important components of any data. Quality assurance starts before the data collection and quality control occurs during and after data collection. The study by Kumar, et al. [1] published in the current issue of Indian Pediatrics,the authors evaluated the quality assurance aspect of a perinatal mortality audit. They evaluated the available resources including manpower (public and private hospital staff), protocols (registries, case-sheets, certification), training and reporting (reports generated) required for audit of perinatal mortality. The study shows major gaps in the documentation and reporting of peri-natal deaths. The reasons for lack of quality assurance on perinatal mortality audit from the current study include recent introduction of facility based CDR (child death review) or community based CDR of neonatal deaths and absence of any policy on still birth review till recent times [2]. Inclusion of many private hospitals in the audit also seems to be a major reason for identifying wider systemic gaps. The present study as well as other Indian studies have highlighted the poor engagement of private sector in maternal and infant death reviews, although the private sector contributes to 43% of deliveries in urban areas and 22% deliveries (NHFS 4) in rural areas [3]. Perinatal mortality (PMR) includes still births and early neonatal deaths. As the cause of mortality for these components are closely related to maternal antenatal and intrapartum care, PMR is considered one of the important health indicators of quality of care around delivery. The current PMR of the country is 36 per 1000 pregnancies (NFHS -4). Although reduction of PMR is not addressed INDIAN PEDIATRICS
directly, the health programs in the country are largely directed to reduce still births and neonatal deaths. India newborn action plan (INAP) targets to reduce still birth rate (SBR) and neonatal mortality rate (NMR) to a single digit by 2030 [4]. Annually approximately 6 lac still births occur in the country and of these nearly 45% occur during delivery. As per the estimates published in Lancet in 2011, the SBR in India is 22 per 1000 total births [5]. The portal of the Health management information system (HMIS) published by the Ministry of health and family welfare, Government of India (GOI), reported 3,03,857 s
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