All posts by nrsubba

Dr. Nawa Raj Subba is a Public Health Specialist, Researcher, and a Poet. He is an author of articles, books, and albums.

Assessment of Morang Innovative Neonatal Intervention 2006

To cite the article: Nawa Raj Subba. (2006). Assessment of Morang Innovative Neonatal Intervention. District Public Health Office, Morang, Nepal.

This is an update of the baseline report of an assessment conducted along with a pilot program of neonatal health intervention in Morang district of Nepal. District Public Health Office Morang with the support of JSI (R & T) launched a program called Morang Innovative Neonatal Intervention (MINI) aiming with lowering neonatal deaths by controlling neonatal infections. Objectives: The objective of this operational research and pilot program aimed to reduce neonatal death rates by controlling neonatal infections. To fulfill the objective of the program first needed the baseline information regarding neonatal health of the district was completed by pieces of training, supervision, and monitoring during project implementation. Tools are service registers used by Health Workers and FCHVs, reporting formats, service cards, supervision check-lists and reports, forms, regular review meetings’ reports, and HMIS data. Primary data collected by questionnaires, in-depth interviews with health workers and beneficiaries. Data had been regularly entered into the computer and reviewed on monthly basis from July 2004 to September 2006. Results: FCHVs have captured 58 percent of expected pregnant women in their wards of VDCs. FCHVs have taken birth weights of 99% babies of registered babies. Of the 12% of babies was found underweight. FCHVs followed up 83% of these underweight babies. FCHVs assessed as 23% of local bacterial infection and 15% of possible severe bacterial infection. FCHVs first managed 70%, VHWs and MCHWs first managed 16% and health institutions first managed 14% of Possible Severe Bacterial Infection (PSBI). Of total 895 PSBI 39 percent neonates were treated by home visits and 44% by health facilities. In the intervention area, 68% population has been occupied by Dalits, Indigenous people, and Muslims which are considered as Disadvantaged Groups (DAG) in Morang district. NMR is estimated as 21 per 1000 live births in the district.  Conclusion: Findings showed the progress report of the project. One of the interesting findings is the estimation of the neonatal death rate observed during program intervention which was 21 per 1000 live births in the intervention VDCs of the district. Applying nothing after cutting umbilical cord caused confusion and complication among mothers, volunteers, and health workers. The neonatal program was coordinated with child health and maternal health program by which other program results also noted improved in the villages. Recommendation:  Applying of local antibiotic over the umbilical cutting area is recommended to prevent applying other things although health workers asked a mother not to apply anything over there according to the WHO guidelines. Therefore we recommend to technical authority to review the WHO guideline and MINI guideline to apply local antibiotic over umbilical cutting area. The program also felt some incentives for FCHV and CHWs are needed for their overload.

Neonatal Mortality, FCHV, VHW, MCHW, Morang. Continue reading Assessment of Morang Innovative Neonatal Intervention 2006

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यो देशमा
जब बहुदल आयो

नेता भकाभक बहुलाए
एकदिन गणतन्त्र पनि आयो
कोही आत्तिए जनता एकाएक मात्तिए
खै के
सबैले मलाई पागल देख्छन्
हा…हा…हा… Continue reading बौलाहाको बकबक

The Morang Innovative Neonatal Intervention (MINI) Program

Nawa Raj Subba, Penny Dawson. (2006). A Report On The Morang Innovative Neonatal Morang Innovative Neonatal Intervention (MINI) ProgramIntervention (MINI) Program Increased Access Through Community Based Management In Morang Nepal. Ministry of Health District Public Health Morang/ JSI (R & T). 

Background: Ministry of Health District Public Health Morang and JSI (R & T) jointly launched a neonatal health intervention program in Morang (MINI) aiming to lower the neonatal death rate in the district. MINI followed the model established by the community–based management of ARI/pneumonia program management of ARI/pneumonia program. MINI has demonstrated that FCHVs can follow an algorithm for MINI has demonstrated that FCHVs can follow an algorithm for classification of sick neonates, initiate treatment, and facility classification of sick neonates, initiate treatment, and facilitate referral system. MINI has shown that VHW/MINI has shown that VHW/MCHWsMCHWscan provide Gentamicin, with can provide Gentamicin, with high treatment completion high treatment completion rates. This has resulted in increased has resulted in increased rates of appropriate treatment, and likely contributed to reducing rates of appropriate treatment, and likely contributed to reduction ion in neonatal deaths in neonatal deaths

Objectives: To determine whether Community based FCHVs FCHVs (Female Community Health Volunteers)(Female Community Health Volunteers)and the most peripheral Government Health and the most peripheral Government Health Workers can perform a set of activities that Workers can perform a set of activities that result in improvement in the early result in improvement in the early identification and correct management of identification and correct management of neonatal infections.

Findings: Neonatal health intervention reached to all 100% target population od disadvantaged tribes, most socially deprived, disadvantaged flat-land groups and 60 percent of relatively advantaged tribes and 84 percent of the upper caste target population. Breastfeeding practice within an hour improved from 30% (baseline) to 70% of the mothers. Among 5105 infants 680 (10%) infants had low birth weight (LBW) and percentage of LBW with PSBI was found in 150 (22%) infants. Among 9546 recorded infants the community health workers recorded 2953 (31%) infants were sick, 2040 (21%) were with the local bacterial infection and 1286 (13%) infants were found with possible severe bacterial infection (PSBI).
Management of possible severe bacterial infection (PSBI) covered 1360 episodes in neonates (93%) and among them, 1233 (91%) episodes completed Gentamicin injection. Total births recorded in the program was 9546 that is 60% of the projected population. Among them, female community volunteers (FCHV) followed within 2 months 8810 (92%) newborns. Total 157 neonatal deaths (within 28 days)recorded and it was 16 per 1000 live births. It was 21 per 1000 live births recorded in 2005.

This presentation was presented in an International seminar in Bangkok by Nawa Raj Subba (District Public Health Office Morang) and Penny Dawson (MINI/JSI). Preview/Download