Death of over 100 infants in Kota hospital points to a pan-Indian problem

Swagata Yadavar
Since December 1, 2019, over 500 infant deaths were reported from just six government hospitals in Rajasthan and Gujarat.
In Rajasthan, over 101 infants died in Kota’s JK Lon Hospital, 102 died in Jodhpur’s Umaid and MDM hospitals, and 124 in Bikaner’s Sardar Patel Medical College in December. In Gujarat, 111 infants died at Pandit Deendayal Upadhyay Hospital in Rajkot and 85 died at the Ahmedabad Civil Hospital.
Across India, there were 721,000 infant deaths in 2018, as per the United Nations’ child mortality estimates. That’s 1,975 infant deaths every day, on average, in 2018.
“This [infant deaths] is not a Kota problem,” said Sunil Mehra, paediatrician and executive director of the non-profit MAMTA, which works on maternal and child health. “There are structural issues like lack of appropriate facility at primary centres, delays in referring patients [to specialists] and lack of transportation which lead to high infant deaths.”
IndiaSpend analysed health data from 13 states to understand why so many infants and children die across the country. States analysed include some of the poorest that form what the government calls the empowered action group or EAG – Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Rajasthan, Odisha, Chhattisgarh and Assam; as well as Maharashtra and Gujarat, which have been in the news for infant deaths in hospitals; and Goa, Kerala and Tamil Nadu, which have among the lowest infant mortality rates in the country.
The poor quality of health infrastructure, antenatal care, maternal health and postnatal care jeopardise the lives of children, our analysis shows. Infant deaths are more a symptom of deeper social problems such as malnutrition, sanitation and immunisation, rather than just medical aspects, said Dipa Sinha, assistant professor at BR Ambedkar University in Delhi. Since most of the deaths are from infections such as pneumonia, which can be treated at the primary level, the preventive and primary healthcare system in the country is broken, she said.
Highest rate in the world
In 2018, an estimated 882,000 children under five died in India, the highest in the world. With India’s large child population, this is despite the fact that the under-five mortality rate – 37 per 1,000 live births – was lower than the global average of 39 and has fallen from 126 in 1990.
Many of the deaths occur before children turn one. As many as 33 of 1,000 children died within one year of birth in 2017, a reduction by 42% in 11 years, according to data from the government’s Sample Registration System and as IndiaSpend reported in June 2019. However, there are huge variations across states, both in infant mortality rate and the causes of infant deaths. In 2017, Nagaland had the lowest IMR of seven, followed by nine in Goa, and 10 in Kerala, while Madhya Pradesh had the highest rate at 47.
Studies have shown that states with high infant mortality of 30-40 (per 1,000 births) have preventable causes of deaths such as diarrhoea and sepsis, said Chandrakant Lahariya, a physician and public health specialist. “The states with lower IMR like Kerala have other causes of deaths like congenital or genetic abnormalities,” he said.
Poor facilities
Since almost half of all under-five deaths are among newborns, many can be prevented by reaching higher coverage of good quality antenatal care, skilled care at birth, postnatal care for the mother and the baby, and care of small and sick newborns, said a 2019 report from the United Nations Children’s Fund.
The rate of Institutional deliveries doubled since 2005 from 38.7% to 78.9% in 2015-’16, which has helped reduce a large number of infant deaths, but the newborn care infrastructure has not kept pace with the increase in institutional deliveries, said Somashekhar Nimbalkar, a professor of paediatrics at Pramukhswami Medical College in Anand, Gujarat.
Most of the deaths – 57.9% – of children under five are among neonates – babies younger than 28 days – showed a 2019 study published in The Lancet. These deaths can be prevented with cost-effective interventions such as kangaroo care, where babies are kept in skin-to-skin contact with the mother, thermal control, breastfeeding support and basic care against infections and breathing difficulties, the report said.
The launch of facility-based newborn care under the National Rural Health Mission has created Newborn Care Corners at every point of childbirth, newborn stabilisation units at First Referral Units and special newborn care units at district hospitals across the country.
However, these care corners had more patients than they could handle, a shortage of physicians and hospital beds, and lack of mechanisms for timely repair of equipment, a 2016 study published in the Journal of Perinatology said.
(To be contd)