Utilization of postnatal care for newborns and its association with neonatal mortality in India: An analytical appraisal

Abhishek Singh,Awadhesh Yadav,Ashish Singh

doi:10.1186/1471-2393-12-33

Abstract

Background39% of neonatal deaths in India occur on the first day of life, and 57% during the first three days of births. However, the association between postnatal care (PNC) for newborns and neonatal mortality has not hitherto been examined. The paper aims to examine the association of PNC for newborns with neonatal mortality in India.MethodsData from District Level Household Survey, waive three (DLHS-3) conducted in 2007–08 is utilized in the study. We used conditional logit regression models to examine the association of PNC with neonatal mortality. The matching variables included birth order and the age of the mother at the birth of the newborn.ResultsThe findings suggest no association between check-up of newborns within 24 hours of birth and neonatal mortality. However, the place where the newborns were examined was significantly associated with neonatal mortality. Moreover, findings do reveal that children of mothers who were advised on ‘keeping baby warm (kangaroo care) after birth’ during their antenatal sessions were significantly less likely to die during the neonatal period compared to those children whose mothers were not advised about the same.ConclusionsThe findings are relevant because ‘keeping baby warm’ is one of the most cost-effective and easiest interventions to save babies from dying during the neonatal period. Though randomized controlled trials have already demonstrated the effectiveness of ‘keeping baby warm’, for the first time this has been found effective in a large-scale population-based study. The findings are of immense value for a country like India where the neonatal mortality rates are unacceptably high.

Highlights

There is no doubt that India has improved in terms of infant and child survival; from a infant mortality rate of 80 per 1000 live births in 1990 to 55 in 2007 [1,2] and under-five mortality rate of 109 per 1000 live births in 1991–92 to 74 in 2005–06 [3]; one cannot deny the fact that despite this progress, current infant mortality rates in India are alarmingly high compared to other countries of similar socio-economic conditions
Small-scale studies clearly highlight the contribution of postnatal care strategies, including ‘kangaroo care’ in reducing neonatal mortality in low income settings [9,10,11,12,13,14]
The choice of facility where the newborn was examined was associated with neonatal mortality – newborns examined in a government facility were significantly less likely to have died during the neonatal period than those who were not examined

Summary

Introduction

There is no doubt that India has improved in terms of infant and child survival; from a infant mortality rate of 80 per 1000 live births in 1990 to 55 in 2007 [1,2] and under-five mortality rate of 109 per 1000 live births in 1991–92 to 74 in 2005–06 [3]; one cannot deny the fact that despite this progress, current infant mortality rates in India are alarmingly high compared to other countries of similar socio-economic conditions. Promoting antenatal care (ANC) and skilled attendance at birth is clearly not enough for improving child health. Strategies that promote universal access to PNC have been recommended for some years [8] and have the potential to contribute to sustained reductions in neonatal and maternal mortality [5]. Small-scale studies clearly highlight the contribution of postnatal care strategies, including ‘kangaroo care’ in reducing neonatal mortality in low income settings [9,10,11,12,13,14]. The provision of PNC has been an important component of various governmental interventions in India [15], – given the focus on skilled attendance at birth and antenatal care – the PNC component has received little attention

Methods

Results

Conclusion