Prof. (Dr.) Muneer A Masoodi & Dr. Abdul Rouf
Every year about 140 million babies are born worldwide, of which nearly 5 million die before their first birthday and nearly additional 2 million before reaching age 5 years. It is noteworthy that 50% of all these deaths are concentrated in five countries; India, Nigeria, Democratic Republic of Congo, Pakistan, and China. India alone accounts for more than 17% of these deaths. Although India has been able to decrease the said mortality by improving the care during pregnancy which is important for survival of newborn and mother, but lot more needs to be done in this context. Mothers and children not only constitute a vulnerable or special group but also a large group (about 60% of the population) in India, women of child bearing age (15-44 years) about 25% and children under 15 years about 35%. Government of India has introduced various facilities and health programmes with the aim to provide medical and social services for mothers and children. These services rendered mainly through the infrastructure of primary health centre and sub-centre level are mostly mother centric as healthy child needs a healthy mother and as per our culture mother is foundation of family and children are future of the country.
Interventions of proven benefit for mother and child health (MCH) provided during antenatal care include tetanus immunization, supplementations, screening for high risk pregnancy, prevention and treatment of complications of pregnancy and other associated illnesses. Antenatal care provides the basis for continued care during and after childbirth by planning for birth with a skilled attendant and preparing for unforeseen complications, and by helping the family to prepare for maternal and newborn care practices, such as early initiation and exclusive breastfeeding. Skilled care at childbirth is obligatory for all women and babies without exception because the complications that may occur during and immediately following childbirth (for both mothers and babies) cannot be predicted and may very rapidly become fatal. This means that skilled childbirth care in primary level health facilities, with the backup of a hospital that can manage complications, should be available 24 hours a day in addition to continuum of care to counter the maternal, perinatal, early and late-neonatal mortality.
The maternal mortality, which refers to death of women due to complications of pregnancy or childbirth has been reduced by about 68% since 2000 (from 395 to less than 125 per lakh live births) and infant mortality rate i.e. infant death less than one year per 1000 live births, by about 50% (from 65 to less than 33) in India, because of preventive and case management interventions. In this context, the Government of India has introduced a series of programs over the past three decades to address maternal and newborn health. The major milestones so far are; Child Survival and Safe Motherhood Program (1992), Reproductive Child Health-1 (1997), National Rural Health Mission (2005), Reproductive Child Health-2 (2006), RMNCH+A Strategy and National Health Mission (2013) and India Newborn Action Plan (2014). The result of these initiatives are being reflected by Mother and child health indicators, which have been showing positive trend towards improvement, as reported in National Family Health Surveys conducted time to time (NFHS-1 in 1992-93, NFHS-2 in 1998-99, NFHS-3 in 2005-06 and NFHS-4 in 2015-16).
It is evident from the survey reports that status of Maternal Health is improving across the board nationally all over the India. Indubitably, the credit goes to MOHFW both at Central level and at State/UT level, which has been investing heavily in maternal health through various programmes since 1992, like CSSM, RCH, RMHCH+A and finally the flagship programme NHM where this group is placed at top most priority. The health care network of peripheral health institutions, first referral units and now Health and Wellness Centres strengthened over the years by allocating the resources for MCH activities and visibly the results are encouraging. The maternal and child health also improved once ASHA (Accredited Social Health Activist) was agreed upon, recruited and posted all over India. Moreover, a social/nutritional impetus to this vulnerable group was initiated in 1975 as Integrated Child Development services (ICDS), wherein the nutritional aspect was taken care of under nutrition and health check-ups, using ICDS centres at immunisation points.
As on date, all these MCH centric institutions are facing crises due to the unforeseen COVID-19 pandemic, which is encompassing the global health system all over the world. So, continuing to provide essential services, is important not only to maintain people’s trust in the health system to deliver essential health services, but also to minimize an increase in morbidity and mortality from other health conditions particularly in this vulnerable group. Although Government has restarted these essential services but there in apprehension and fear among common people to visit these institutions as they believe that these centres are sources of infection and may contract SARS-Cov-2 as a nosocomial (hospital acquired) infection, either from other patients or hospital staff. So, what we need to do is to take confidence building measures, so that these patients can visit our hospitals and avail these services, which government is providing in the form of various facilities and Health programs. If China can build the 1000-bedded hospital in ten days for COVID-19 patients, can’t we have one infectious disease hospital in each district over the period of time, and for the time being we can have make shift arrangement in other low priority infrastructures until the same is ready. We can designate infectious diseases centre (one CHC/PHC) in each block so that patient with respiratory symptoms and other communicable diseases may visit these designated centres, which are already there physically. This Infectious Disease Hospital needs to have an adequate supply of isolation and negative pressure rooms in wards, emergency departments (EDs) and Intensive Care Units (ICUs). While hospitals may not have complete control over host factors and agents, they are still responsible for the environment that surrounds the patients. By controlling and ensuring adequate sanitization of the environment of the host, hospital authorities can reduce the incidence of hospital-acquired infections. Just at entry point of hospital and in the ED, patients should be screened/triaged, using a rapid questionnaire on their travel exposure, fever history and other symptoms like temperature which is recorded and documented. Suspected patients should be channelized to further investigation and managed accordingly.
At the same time, we have to avoid overcrowding in all hospitals and prevent transmission of SARS-CoV-2 virus during travel or in health facilities. Wherever feasible, those beneficiaries due for any services may be asked to visit peripheral facilities (SHCs/ PHCs/UPHCs, including HWCs) on particular dates and times, decided at local levels and informed telephonically or through link workers. This can be done by allocating fixed day services for each area, ensuring adherence to social distancing and other necessary precautions. Reverse isolation (which means avoiding transmission of an infectious disease to a highly susceptible host, is to provide reverse, or protective isolation) for those who have received cancer chemotherapy, old debilitated and immunocompromised patients. Reverse isolation procedures range from provision of a private room with the use of masks, gloves and gowns by all people entering the room, to elaborate facilities with laminar airflow rooms and sterilization of all foods. These are some of the most effective ways of restoring faith of MCH group on health care delivery system. We may have to take early call to avoid falling down of above-mentioned MCH indicators of health. Moreover, there are special health needs of this most vulnerable and huge group of population, which is obligatory to be taken care of at all costs.
Authors are working in the Department of
Community Medicine, Government Medical
College Anantnag and can be reached at firstname.lastname@example.org