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The Incidence of Morbidities in a Cohort of Neonates in Rural Gadchiroli, India: Seasonal and Temporal Variation and a Hypothesis About Prevention

Journal of Perinatology volume 25, pages S18–S28 (2005)Cite this article

Abstract

BACKGROUND:

The incidence of morbidities among home-cared neonates in rural areas has not been studied.

OBJECTIVES:

  1. 1

    To estimate the incidence of various neonatal morbidities and the associated risk of death in home-cared neonates in rural setting.

  2. 2

    To estimate the variation in the incidence of neonatal morbidities by season and by day of life.

  3. 3

    To identify the scope for prevention of morbidities and suggest a hypothesis.

STUDY DESIGN:

A prospective observational study nested in the first year of the field trial in rural Gadchiroli, India. Trained village health workers in 39 villages observed neonates at the time of birth and in subsequent eight home visits up to 28 days. We diagnosed 20 neonatal morbidities by using clinical definitions. The data were analyzed for the incidence, case fatality, and relative risk of death and for the seasonal and day-wise variation in the incidence of morbidities.

RESULTS:

We observed total 763 neonates in 1 year. The incidence of morbidities was a mean of 2.2 morbidities per neonate. The case fatality in 13 morbidities was >10%. Only 2.6% neonates were seen or treated by a physician, and 0.4% were hospitalized. Hypothermia, fever, upper respiratory symptoms, umbilical and skin infections, and conjunctivitis showed statistically significant seasonal variation. Although the morbidities were concentrated in the first week of life, new cases continued to appear throughout the neonatal period. Various morbidities showed different distribution of incidence during 1 to 28 days.

CONCLUSIONS:

A large burden of disease occurs in rural home-cared neonates, and many morbidities are associated with high case fatality. Some morbidities show strong seasonal and day-wise variation in incidence, indicating poor care at home. We hypothesize that changes in practices and better home-based care will prevent the seasonal and temporal increase in morbidities. Some morbidities may not be preventable and will need early detection and treatment. Therefore, frequent home visits by a health worker are necessary to identify sick neonates.

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Author information

Authors and Affiliations

  1. SEARCH (Society for Education, Action and Research in Community Health), Gadchiroli, India

    Abhay T Bang MD, MPH, Hanimi M Reddy PhD, S B Baitule DHMS, M D Deshmukh MSc & Rani A Bang MD, MPH

Authors
  1. Abhay T Bang MD, MPH
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  2. Hanimi M Reddy PhD
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  3. S B Baitule DHMS
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  4. M D Deshmukh MSc
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  5. Rani A Bang MD, MPH
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Corresponding author

Correspondence to Abhay T Bang MD, MPH.

Additional information

This study was financially supported by The John D. and Catherine T. MacArthur Foundation, The Ford Foundation, Saving Newborn Lives, Save the Children, USA, The Bill and Melinda Gates Foundation, and The Rockefeller Foundation.

Appendix A1

Appendix A1

Diagnostic Definitions of the Neonatal Health Problems

  1. 1

    Birth asphyxia

    1. i)

      Mild: At 1 minute after birth, no cry, or the breath was absent or slow, weak or gasping.

    2. ii)

      Severe: At 5 minutes after birth, the breath was absent or slow, weak or gasping.

    3. iii)

      Indirect: In the absence of direct observations by VHWs about newborn's condition at 1 and 5 minutes, presence of the following:

      1. a)

        baby did not cry on its own, so the care provider had to make efforts to make the baby cry; and

      2. b)

        color of the umbilical cord was green or yellow.

  2. 2

    Preterm: Less than 8 months and 14 days (37 weeks) of gestation counted from the onset of the last menstrual period as per the history given by the mother.

  3. 3

    LBW: Weight less than 2500 g.

  4. 4

    Delayed breast feeding: Due to traditional practice, breast feeding not started in first 24 hours after birth, but baby licked/sucked the sweetened water.

  5. 5

    Problems in breast feeding: Presence of any one of the following:

    1. i)

      Baby did not suck breast for more than continuous 8 hours even when offered.

    2. ii)

      • Mother unable to breast feed, or

      • baby fed on extracted breast milk, goat, or cow milk, or by bottle, or on sweetened water beyond 3 days, or

      • inadequate breast milk evidenced by continuous crying of baby and failure to gain weight.

  6. 6

    Diarrhea: Watery, liquid motions three or more, or >9 motions of normal consistency in 24 hours, or mucus or blood in liquid stool.

  7. 7

    Neonatal sepsis (septicemia, meningitis, or pneumonia diagnosed clinically): Simultaneous presence of any two of the following six criteria any time during 0 to 28 days:

    1. i)

      Baby which cried well at birth, its cry became weak or abnormal, or stopped crying; or baby who earlier sucked or licked well stopped sucking, or mother feels that sucking became weak or reduced; or baby who was earlier conscious and alert became drowsy or unconscious.

    2. ii)

      Skin temperature >99 or <95°F.

    3. iii)

      Sepsis in skin or umbilicus.

    4. iv)

      Diarrhea or persistent vomiting or distention of abdomen.

    5. v)

      Grunt or sever chest indrawing.

    6. vi)

      Respiratory rate (RR) 60 or more per minute even on counting twice.

  8. 8

    Hemorrhage: bleeding from mouth, anus, eyes, nose, or in skin or in urine any time or vaginal bleeding after first week.

  9. 9

    Conjunctivitis: Mother complained of excessive discharge from the eyes of baby, and on examination, eyes were red and with purulent discharge or dried pus.

  10. 10

    Skin infection:

    1. i)

      Pyoderma: Pus, ulcer, boil, pustule in skin.

    2. ii)

      Intertigo: Excoriation with moist, cracked skin at skin folds.

  11. 11

    Abnormal jaundice: Skin or eyes yellow on the first day or yellowness persisted at 3 weeks, or when yellowness associated with sepsis.

  12. 12

    Meconium aspiration: History of difficult delivery or presence of birth asphyxia and respiratory distress (RR 60 or more; or severe indrawing of lower chest) started in first 24 hours after birth.

  13. 13

    Hyaline membrane disease: Respiratory distress started within 6 hours after birth in preterms baby.

  14. 14

    Pneumonia: RR 60 or more, persistent even when counted twice (Increased RR when associated with other signs symptoms of sepsis was included in neonatal sepsis).

  15. 15

    Upper respiratory symptoms: Cough or nasal discharge present for 3 days or more without respiratory distress or increased RR.

  16. 16

    Hypothermia: Axillary temperature <95°F.

  17. 17

    Umbilical infection: Pus discharge from umbilicus.

  18. 18

    Tetanus: Baby which earlier sucked well, stopped taking feeds from fourth day or more; and appearance of seizures, spasm and trismus.

  19. 19

    Convulsive Disorder: Seizures but baby conscious, alert and feeds well between seizures (excludes tetanus, asphyxia, sepsis).

  20. 20

    Unexplained fever: Axillary temperature >99°F without any attributable cause.

  21. 21

    Failure to gain weight: Total weight gain during 0 to 28 days <300 g.

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Bang, A., Reddy, H., Baitule, S. et al. The Incidence of Morbidities in a Cohort of Neonates in Rural Gadchiroli, India: Seasonal and Temporal Variation and a Hypothesis About Prevention. J Perinatol 25 (Suppl 1), S18–S28 (2005). https://doi.org/10.1038/sj.jp.7211271

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