Effectiveness of Home Based Newborn Care HBNC on knowledge attitude and practices among ASHAs Accredited Social Health Activists working in rural areas of Uttarakhand

Abstract

Neonatal mortality stays high regardless of a decline in under-five deaths. About 40% of all under-five deaths are among infants.1 Almost all (99%) of these neonatal deaths were happened in developing nations with the most elevated rates in sub-Saharan Africa.2 More than 50% of child deaths occur below the age of five years. In 2008, the number of death of under-five children was 1,829,826 out of which 1,003,767 (54.8%) died in the neonatal period. Preterm birth, neonatal infections, asphyxia, sepsis, diarrhea, malnutrition, etc. are the main reasons for most neonatal deaths.3-5 India ranks second with the largest population, accounting for about 17% of the global population and 20% of worldwide births. India accounts for a fifth of the global under-five child death. Around 27 million live births and two million deaths of under-five children are reported each year. The annual mortality rate of under-five children in India represents a quarter of the global child mortality. Therefore control of child death is very crucial if the world is destined to achieve the targeted Sustainable Development Goal (SDG).6 Indian Academy of Pediatrics (IAP) has critically examined numerous health programs of children started by state and central government. Mission 20/20 by IAP has come up to further decrease IMR. With this mission, IAP conveys its zeal to commit its endeavors and assets to catalyze the decrease of IMR in India. This activity supports all necessary requirements to achieve the objective of the mission, IMR of 20 by 2020.7 2 The present neonatal mortality rate is still far from achieving the targeted goal of less than 20/1000 live births.8 Control of neonatal death is crucial to attain the targeted sustainable development goal of WHO. The government of Indian, through the Ministry of Health and Family Welfare (MoHFW) and the National Health Mission (NHM), has initiated various health programs to control newborn mortality in both villages and cities.9-10 Under the scheme “Janani Suraksha Yojana”, institutional deliveries have been intended to improve by health professionals through cash rewards to the mothers.9,11 This may further encourage providing children with good food and quality health care. However, the achievement concerning the control of neonatal mortality rate is still far from the targeted rate. Significant inequalities of NMR are found in rural and urban, and different socioeconomic classes. The neonatal mortality in villages is just double as compared to developed cities (31 vs 15 per 1000 live births).8 The failure may be due to the way of functioning of the health departments. At this point of time, it is imperative to execute sincere and collaborative services from all related departments i.e. government and private health sectors, and society organizations. Various factors influence the survival of children after birth that include proper breastfeeding, maintaining a warm body temperature, periodic medical check-ups and getting treatment, etc. The early few years of birth of children is a stage of life where possible maximum care must be provided as they are exposed all of a sudden to a polluted external environment from the sterile condition. The children need to be protected in all respects in the new environment. As a result, a huge number of neonates fall under prey in economically least developed and developing countries. Under-five 3 deaths are mainly due to premature birth, neonatal sepsis, birth asphyxia, pneumonia, diarrhea, etc in rural areas of India.12-13 Efforts have been made to reduce the death rate by incorporating new strategies with respect to premature birth, asphyxia, pneumonia, etc. in several child survival programs.14-17 Reports are available on the successful implementation of some effective measures related to child health care being taken up by rural health care workers. Management of pneumonia in under-five children using cotrimoxazole could result in a 20% reduction in neonatal mortality that hints the importance of possible home-based care in the management of child mortality