Factors leading to neonatal mortality due to neonatal purpura fulminans through the lens of a child death review

A case of neonatal death due to neonatal purpura fulminans (NPF) was brought to community physicians’ notice by the auxiliary nurse midwife in her catchment area as part of the routine demographic health surveillance. The community physician then conducted the child death review in the community. The neonate was born out of consanguineous marriage (mother married to her first-degree maternal cousin) with spontaneous conception. This neonate was fourth in the birth order. The second-order and third-order births had also suffered from NPF and died. The baby was delivered in a tertiary care setting, and the paediatric surgeon planned debridement of the affected part on the third day of the birth, as per the mother. However, due to inadequate counselling regarding the procedure, mother left the hospital without seeking care against medical advice, and the child died at home.

Community Health Officer Post – Potential Concerns

Under Ayushman Bharat Health and Wellness Centre (HWC) initiative, a middle-level health provider post, named Community Health Officer (CHO), is envisioned to bridge the gap between the health system and community. This cadre has multiple roles and responsibilities that mirror what used to be done by the Auxiliary Nurse Midwife (ANM) at sub-center before conversion to HWC. Owing to educational and experience requirements of CHO, and existing other cadres at the sub-center, there may be some concerns related to role ambiguity, interpersonal issues, inter- and intra-cadre conflicts, and non-cooperation challenges.

The development and testing of a co-designed distance learning programme to improve the knowledge of trained auxiliary nurse midwives in normal midwifery practice in central India

Background In the Indian State of Madhya Pradesh maternal health is poor, and women’s social status is low. For some women, autonomy and decision-making within the family is limited as they seek medical treatment through their husband or father-in-law. The then state government identified a need to strengthen midwifery care given by auxiliary nurse midwives to improve maternal and neonatal health.>* Methods This cross-cultural, two phase study was designed in partnership with an Indian non-governmental organisation, utilising Elliot’s action research model within the paradigm of critical theory. Phase 1 investigated the then current situation and established a potential solution to strengthening midwifery practice within Madhya Pradesh. This comprised an educational approach using a specifically designed self-directed distance learning programme focussing on normal pregnancy and childbirth. The distance learning programme was a hard copy workbook supported by a multimedia resource informed by the Rowntree and Analysis Design Development Implementation Evaluation models of educational material development. Phase 2 involved the use and evaluation of the distance learning programme with an initial primary group sample of 28 comprising auxiliary nurse midwives (22), lady health visitors (4) and staff nurses (2) in Madhya Pradesh. Fourteen auxiliary nurse midwife participants completed knowledge tests using a pre- and post-programme multiple choice question paper. This primary group negotiated a 3-day workshop to cover identified gaps within their original 12-week study period. Nineteen additional auxiliary nurse midwife participants joined this workshop (group 2). Results The multiple choice question test results indicated that the first group had poor knowledge of the normal process of pregnancy and childbirth. After the workshop, they marginally improved their personal performance scores. The second group demonstrated greater change, which suggests that coupling self-directed guided study material with an enabling, face-to-face environment can be successful. Conclusions Distance learning among auxiliary nurse midwives in central India may be enhanced when accompanied by face-to-face workshops. Partnership working – at organisational, team and individual levels, was a crucial, and empowering, component of this cross-cultural action research study. Both points have relevance for others undertaking similar studies.

Social accountability and education revives auxiliary nurse-midwife sub-centers in India, reduces travel time and increases access to family planning services

Background: Uttar Pradesh (UP) is the most populous state in India. The maternal mortality ratio, infant mortality rate and fertility rates, are all higher than the national average. Sixty per cent of UP inhabitants live in rural communities. Reasons behind the poor state of health and services in many areas of UP is inadequate knowledge and availability in communities of healthy behaviors and information on available government health services. Methods: World Vision Inc. implemented a three-and-half year mobilizing for maternal and neonatal health through birth spacing and advocacy project (MOMENT), partnering with local organizations in rural Hardoi and urban slums of Lucknow districts in UP. World Vision Inc. used print, audio and visual media, and house-to-house contacts to educate communities on timing and spacing of pregnancies, the benefits of seeking and using maternal and child health (MCH) including immunization, and family planning (FP) services. This paper focuses on World Vision’s Social Accountability strategy – Citizen Voice and Action (CVA) and interface meetings – used in Hardoi that helped, educate and empower Village Health Sanitation and Nutrition Committees (VHSNCs), and village leaders to access “Government Untied Funds” to improve community social and health services. Results: 40 VHSNCs were revived in 24 months. Nine local leaders accessed government untied funds. In addition, increased knowledge of the benefits of timing and spacing of pregnancies, MCH, FP services, and access to community entitlements, led the community to embrace, work together to contribute their time to rebuild and reopen 17 non-functional Auxiliary Nurse Midwife (ANM) subcenters. 17 ANMs received refresher training to provide quality care. Sub-center data showed 1,121 and 3,156 women opted for intra-uterine contraceptive device and oral pills respectively and 29,316 condoms were distributed. Conclusion: In Hardoi, UP, education, using CVA, and interface meetings are contributing to increasing the number of government sub-centers that integrate contraceptive services with others such as immunization and antenatal care, bringing care closer and more accessible to women and children, and reducing travel time and cost to families who would have otherwise sought these services from higher level facilities. Social accountability can help mobilize communities to contribute to improving services that affect them.