Bangladesh: Antenatal care, safe delivery can curb neonatal deaths

Article from The New Nation. The Oldest Independent English Daily of Bangladesh.

Neonatal death can reduce to a great extent by ensuring adequate antenatal care and institutional delivery as the death rate has become a grave concern among the medical personnel and related others.

"Antenatal care and safe delivery could be the effective way of preventing most of the neonate related complexities like birth asphyxia, preterm low birth weight, septicaemia, bronchopneumonia, neonatal jaundice, neonatal convulsion and congenital abnormality," said Prof Dr Iqbal Bari, Head of Pediatrics Department of Rajshahi Medical College and Hospital (RMCH).

All pregnant mothers, he said, should be brought under antenatal care, safe delivery and postnatal services for the sake of protected labor together and reduction of infant and maternal mortality and morbidity.

Many of the women are still seen opting for giving birth at home instead of hospitals due to various reasons like illiteracy, ignorance, poverty, superstition and religious belief.

He stated that a total of 789 neonates died within 28 days of birth out of 4,554 patients admitted in the neonatal ward, while 265 babies died out of 11,369 admitted in the RMCH pediatrics wards in 2010.

Besides, 451 intra uterine deaths were recorded and 172 mothers and six neonates died during labor against 13,636 births in the Gynecology and Obstetrics wards of the hospital in the same year.

The perinatal asphyxia, major cause to the neonatal mortality and morbidity, has become a common problem among the rural mothers due to lack of timely diagnosis relating to their uncontrolled hypertension, diabetes, malnutrition and other maternal illness, said the physician.

While mothers in rural areas, he said, work very hard during pregnancy together with being subjected to repression and domestic violence causing intra uterine growth retardation. On the other hand, optimum care is not given to overcome the maternal malnutrition during pregnancy.

Moreover, when these deliveries are done at home by untrained personnel, the birth asphyxia occurred in most of the cases as the pregnant mothers are not motivated to antenatal care and institutional labor, Dr Iqbal Bari said.

The asphyxia related deaths could be reduced if the facilities for neonatal care including well-equipped intensive care unit and trained pediatric nurses at all the existing hospitals in the semi urban and rural areas are enhanced substantially.

According to health experts, advanced life support machinery like nebulization can improve the outcome of the birth asphyxiated infants in the rural hospitals and importance should be given in this regard.

Preterm low birth weight has been detected as the second major neonatal health problem mainly caused by maternal malnutrition, overwork during pregnancy, uncontrolled hypertension, prolonged urinary tract infection and other maternal illness.

These babies die because of hypothermia, hypoglycemia and infections. Unsafe delivery, prolonged rupture of membrane and poor hygiene were identified as the main causes behind the problem which triggers the mortality rate if not cured through proper and timely treatment, they said.

"The existing facility for care of newborns is not adequate. It is merely available in RMCH and some of district hospitals in the region," said Assistant Prof Dr Belal Uddin of the same department.

The real breakthrough in neonatal care and reduction in neonatal mortality and morbidity rate is totally depends on providing neonatal and parietal care to the rural areas, reducing neonatal mortality and morbidity among high- risk pregnancies.

"There is no alternative to ensure need- based steps to control the rate of neonatal deaths side by side with children-friendly atmosphere for development of their physical and mental properly to build a healthy generation," said Prof Dr AB Siddiqui, Director of Rajshahi Shishu Hospital.