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Lokvani Talks To Dr. Sunita Pereira

Nirmala Garimella

(This article is sponsored by New England Shirdi Sai Temple)

Sunita Pereira, MD is a Physician at Tufts Medical Center in the division of Newborn Medicine. As a Clinician Educator, she has a special interest in improving care and outcomes for the extremely Low Birth  Weight infant. She received her MBBS from Christian Medical College, Vellore, was trained in Pediatrics and Neonatal medicine at PGIMER, Chandigarh and then at The Floating Hospital for Children at Tufts Medical Center in Boston and is currently an Associate Professor of Pediatrics at Tufts University School of Medicine. She is an art enthusiast and is active in many philanthropic organizations. She is co-founder and Member of the Board of Directors of “Youth That Care”, and was a board member of New England WomenÂ’s Initiative, CARE USA and TEIA, Peaks Island. She is a member of the visiting committee for Asian, African and Oceanic art at the Museum of Fine arts. 

Please give us some background about the maternal health and neo natal mortality rate in India?

In India, each year a million newborn babies die before they are 1 month old.  This is almost 50% of the newborn deaths across the world. Neonatal Mortality Rate (NMR)  is the number of newborn deaths per 100,000 live births. In India this number is 29/1000. However the rate is much higher in the rural areas compared to the urban areas and varies from state to state, region to region. 

Similarly, 50,000 women die in pregnancy, childbirth or within 28 days of childbirth in India per year.  This is approximately 17-20% of the maternal deaths during pregnancy and childbirth in the world.  India has the highest MMR followed by Nigeria!  Despite 65% reduction in MMR since 1990, India lags behind in the UN mandated 75% reduction in MMR by 2015 (MDG5). The World Health Organization (WHO) reported that India’s MMR, which was 560 in 1990, reduced to 178 in 2010-2012.India’s MMR is reducing at an average of 4.5 per cent annually. However, it has to bring down the MMR at the annual rate of 5.5% to meet the Millennium Development Goal.

What is the main cause of this problem?

The problem of unacceptably high NMR and MMR is complex.  Poverty, malnutrition in childbearing women, access to healthcare; social issues such as lack of literacy especially health literacy, acceptance of institutional deliveries and family planning and acceptance of a girl child; environmental issues such as access to clean water and environment are some of the barriers to achieving MDG goals in India.

Can you tell us about AIF work in the area of maternal health and neo natal mortality?

In 2009, American India foundation (AIF), in partnership with TATA Steel’s Corporate Sustainability Initiative, SEARCH, an internationally recognized non Profit NGO, which pioneered home based neonatal care (HBNC), local and state government, started a pilot project in Jharkhand to reduce the NMR and MMR.  This project was called Maternal And Neonatal Survival Initiative (MANSI).  Jharkhand was chosen because of its extremely high MMR and NMR.  Some of the factors affecting NMR and MMR were, remoteness of the region, tribal population living in the Jungle, with lack of access to healthcare, poverty and lack of literacy.  Drs. Ajay and Rani Bang of SEARCH, provided expertise and the framework for home based neonatal care (HBNC) where local women from the community were trained as Sahaias.  Initially, time was spent in collecting baseline statistics and training women from the community in home based neonatal and maternal care; ensuring that these women (sahiahs) would be accepted by the community and would teach and empower the community in safe health practices around pregnancy and childbirth, ensure acceptance of the Government funded antenatal programs and also acceptance of institutional delivery instead of delivering at home.  Timely treatment of complications of pregnancy and delivery, institution of weighing all  babies , encouraging breast milk feeding, follow up of the newborn babies and mothers to pick up early signs of infection pneumonia or diarrhea etc. and early and adequate treatment of these illnesses.

What has been the results of this program?

The results of this pilot project were analyzed in 2014 and were impressive.  Neonatal mortality dropped by 30%, MMR dropped by 20% and antenatal care (at least 3 visits to a health care provided by an expecting mother) institutional delivery improved to almost 98%.  This was made possible in a tribal area where there was initially a distrust of outsiders but now there is acceptance and enthusiasm. 

How severe is this issue in India? What is the key to addressing this issues?

The issue of maternal and child health is interdependent. Poor maternal survival in pregnancy and childbirth is related to maternal malnutrition, poor literacy, social issues of low social status of women, inability to make health related decisions for themselves such as child spacing, poverty and ignorance. On the other hand, social acceptance, education and respect for the girl child can lead to better girl child survival, better child health and nutrition, improved out comes during childbearing age, decreased low birth weight of newborn babies (India leads in the low birth weight babies in the world), improved survival for their babies from morbidities due to improved literacy, improved cognitive health and a healthier and more productive society as a whole.  Healthcare is not about just access to a physician but also about educating the community about the social determinant of health and who better to teach this to the mothers, than someone from their own community, who speaks their own language and understands the barriers and thus can find solutions that will be accepted by the community.   A mother who feels assured that her baby will survive to be an adult can then be persuaded to accept spacing of children and once spacing and improved nutrition are achieved, improved child survival will follow.

How does AIF hope to work toward  this goal?

Building on the initial successes in Jharkhand, AIF plans to expand the MANSI project to areas of Uttar Pradesh, Rajasthan and Orissa where the NMR and MMR are unacceptably high.   Furthermore, AIF plans to show case the wonderful work done and success achieved in NMR and MMR in Jharkhand,  by hosting a Conference on MANSI in Boston on April 18th 2015.  The conference objectives are manifold.  Firstly, It will bring an awareness about the enormity of the problem of maternal and neonatal mortality in India.  It will target an audience of Indian diaspora, academics, philanthropic organizations, pharma and foundations so that AIF can engage and invite future collaborations and also raise funds for this very acute and distressing issue.  It also hopes to source new ideas for future improvements in this initiative so that we can accelerate the reduction in NMR to less than 20 per 1000 live births and also achieve further reduction in MMR.  AIF does not want to do this on its own.  It will partner with Indian corporate sector, Indian government and the local community and scale the lessons learnt in Jharkhand to other regions in India such that a positive momentum is created and Home Based Neonatal Care model is adopted in all states in India.   In 2002 Indian government requested Drs Bang to start training home based health care workers and every year new pilot sites are set up.

What are the panels and speakers who will keynote at the conference?

The Conference is being held at the MERCK research Laboratories Auditorium and we have an exciting program with speakers from India including Ms Johri, Project Director, MANSI who will speak about the MANSI project and Dr. Srinath Reddy, President, Public Health Foundation of India, who will discuss the barriers to achieving the United Nations’ fourth and fifth Millennial Development Goals in 2010 and 15. Dr. Gary Darmstadt, a neonatologist and Professor of Pediatrics, Stanford University and former Fellow at Bill and Melinda Gates Foundation who has done extensive work on this subject in India and  globally, will highlight the work in Sri  Lanka and Bangladesh where the NMR and MMR is lower than in India.  Dr. Katherine Semrau, Assistant Professor of Global Health, Boston University & Director of BetterBirth Program, Ariadne Labs, Boston, will discuss the role of social innovation and health literacy in this space.   Dr. Venkat Srinivasan, Vice Chair, Board of Directors, AIF and CEO of RAGE Frameworks, will discuss how innovation and internet technology can be used to improve the MANSI program. We are delighted to have Biren Bhuta and Sunil Bhaskaran from TATA Steel, who will discuss how they got involved with MANSI and the lessons for other corporate players.  We hope to wrap up this stimulating conference with a road map for the next phase of MANSI and create a momentum so that each year we can come back and report on the challenges and successes we have achieved.  We are delighted that our inaugural conference has been funded through a generous grant from MERCK.  The conference is free for all participants.

link to Mansi event page:  http://aif.org/event/aif-mansi-summit/

email to:  mansisummit@aif.org 

Location:  Research Laboratories - 33 Avenue Louis Pasteur, Boston, MA

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