Our reporter presents a case for saving newborn lives

Shweta Malla

Kathmandu

When we feel cold, we wrap ourselves in warm clothes. When we feel hungry, we ask for food. But there was a time when none of us could do this — the time when we were born. We should consider ourselves lucky to have survived the most vulnerable period of our lives — the neonatal period, the first 28 days of our life. Yes, we are indeed fortunate to be alive — for we have been born in a country with the third highest neonatal mortality in the world.

In Nepal nearly 90 per cent of the births take place at home where there is no skilled or trained care to provide the special care and attention required for a newborn baby. “Leading causes of neonatal death include birth asphyxia, septicaemia, hypothermia, prematurity and low birth weight,” said Dr Neena Khadka of Save The Children, US (SCF/US).

Nepal has made significant progress in health and survival of children. Yet, the decrease in neonatal mortality rate has not matched the decline in mortality rates for children of other ages and is now contributing to 60 per cent of all infant deaths. Further reduction of mortality rates of children is now dependent on saving more newborn lives.

The present high rate of neonatal mortality in the country is because newborns are not getting the simplest of essential neonatal care at their homes where most of them are born. Global health experts have identified proven interventions that can be practised at homes and communities to prevent sickness and death. They include practises to keep babies warm by immediately wiping and wrapping them and keeping them on their mothers’ chest or abdomen. This prevents them from dying of hypothermia.

Other practises include not bathing babies for at least 24 hours, initiating breast feeding within one hour of birth and keeping the cords clean and dry and not applying anything on it.

These are practices, which though so simple are yet, not practised in Nepali homes. This is due to age-old superstitions and traditions. “In rural areas of Kailali, the practice of applying vermilion, ash, mustard oil, turmeric and other herbs on the newborn’s cord is still rampant,” informs Dr Khadka.

Adding, “The people of Siraha provide goat milk as the first feed to their newborns, believing that if they did not do so the babies would remember their past lives. And, of course, there is also the ritual of not feeding the newborn until and unless it is given a bath.”

Nepal is a signatory to the Millennium Development Goals (MDG) and to the Convention of the Rights of Children. The MDG goals cannot be reached unless we start focusing on neonatal health and survival in the country. Similarly we will be in no way honouring the rights of children unless we respect the rights of the helpless newborn to breathe, be warm, and to be fed in the appropriate manner.

The Ministry of Health (MOH) having sensed the importance of neonatal lives in the country has been making great efforts to improve the health and survival of newborns in the country. A National Neonatal Health Strategy (NNHS) has been drafted and endorsed.

Dr Yashobardhan Pradhan, director of Family Health Division (FHD), in the MOH, has emphasised that hereafter the NNHS will be the guiding force for all programming efforts for neonatal health in the country. He reiterates the need for all government and non-governmental partners to join hands to implement the activities outlined in the strategy document.

Dr Prakash Sunder Shrestha, head of department of Paediatrics in the Institute of Medicine and a member of the Neonatal Working Group which drafted the NNHS, suggested that the NNHS has to be implemented in a phased manner. “To make the efforts adequate activities should be both at the community and service level. Since the last 15 years we doctors have been demanding that the there should be a strategic document for neonatal health. Even though the strategy has been approved, I wonder how long it will take to function smoothly.”

As stated by Dr Benu Bahadur Karki, former director of MOH, “The main reason for high neonatal mortality is because of poor antenatal care, the facilities provided and trainings are not up to the mark. The government has been responsive towards NNHS and has made provisions to solve the problem. Earlier health posts were established by locals but now government is training 500 health workers, providing emergency services and also has plans to build 250 health posts in different parts of the country.” He is of the opinion that the government can reach the MDG target by 2015.

Every effort must now be made to spread the messages on normal newborn care to caregivers and also improve the services provided for sick newborns from health institutes at all levels. The government must be supported by NGOs, INGOs and private sector to achieve the targets set for our country in reducing children mortality.