Newborn care at peripheral health care facilities

Primary health centres, sub-district hospitals (first referral units) and district hospitals constitute the backbone of the health services in the country. These facilities are expected to cater to the care of the newborn infants who are delivered there, as well as those brought from the community with sickness. This paper, based on a survey in Orissa, and studies in a district hospital in Himachal Pradesh and a sub-district hospital in Haryana, is an attempt to piece together the present status of neonatal care at these facilities. In Orissa, the district and sub-district hospitals cater to a median of 100 and 30 deliveries per month, respectively. Most of the deliveries at these facilities are conducted by the nurses and not the physicians. Neonates are generally kept in the facility only for a day. Hardly any deliveries take place at primary health centres. Cesarean deliveries are mostly confined to the district hospitals. The commonest diagnosis of neonates admitted in the district and sub-district facilities is sepsis (septicemia pneumonia, skin infections, diarrhea and meningitis). Primary health centres seldom admit a sick neonate. It is reassuring to note that the outcome of sick neonates admitted at a functional district or sub-district hospital manned by a pediatrician is highly rewarding with low mortality rates.