List the causes of Neonatal mortality

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Causes of Neonatal Mortality (Indian Context)

Neonatal mortality refers to the death of a newborn within the first 28 days of life. In India, despite improvements in healthcare services, neonatal mortality remains a significant public health concern. The causes can be classified into direct medical causes, socio-economic factors, and health system-related issues.

1. Medical Causes (Biological and Clinical)

These are the direct physiological reasons responsible for neonatal deaths:

a. Preterm Birth Complications

  • Babies born before 37 weeks of gestation often have underdeveloped organs.
  • Leading complications include respiratory distress syndrome, hypothermia, feeding difficulties, and infections.

b. Birth Asphyxia (Perinatal Asphyxia)

  • Occurs when the baby does not get enough oxygen during birth.
  • Leads to brain damage and multi-organ failure.
  • Major cause in settings with delayed or poorly managed deliveries.

c. Neonatal Infections

  • Includes sepsis, pneumonia, and meningitis.
  • Caused by poor hygiene during delivery or after birth.
  • Higher risk in babies with low immunity or in environments with poor sanitation.

d. Low Birth Weight (Less than 2.5 kg)

  • Caused by prematurity or intrauterine growth restriction.
  • Low birth weight babies are vulnerable to infections, hypothermia, and breathing problems.

e. Congenital Anomalies

  • Birth defects like heart defects, neural tube defects, and chromosomal disorders (e.g., Down syndrome).
  • Many of these are preventable or manageable if diagnosed early.

f. Tetanus Neonatorum

  • Rare now due to immunization and institutional deliveries.
  • Caused by infection of the umbilical stump in unhygienic conditions.

2. Socio-Economic Causes

a. Poor Maternal Nutrition

  • Leads to anemia and low birth weight babies.
  • Malnourished mothers are more likely to have preterm or undernourished babies.

b. Lack of Antenatal Care

  • Without regular checkups, complications like high blood pressure or infections go unnoticed.
  • Delayed detection of high-risk pregnancies contributes to neonatal deaths.

c. Home Deliveries Without Skilled Birth Attendants

  • Increases risk of infection, asphyxia, and uncontrolled bleeding.
  • Common in remote or tribal areas.

d. Poverty

  • Affects access to healthcare, nutrition, and clean living conditions.
  • Poor families often delay seeking care due to financial constraints.

e. Early Marriage and Teenage Pregnancy

  • Teenage mothers are more likely to have complications like obstructed labor, premature births, and low birth weight babies.

f. Illiteracy and Lack of Awareness

  • Mothers may not recognize danger signs in newborns.
  • Reluctance to follow immunization or feeding guidelines.

3. Health System-Related Causes

a. Inadequate Health Infrastructure

  • Many Primary Health Centres (PHCs) lack neonatal care equipment or trained staff.
  • Delay in referral due to lack of transport or NICU availability.

b. Shortage of Trained Personnel

  • Lack of trained nurses, ANMs, or pediatricians, especially in rural areas.
  • Poor handling of high-risk deliveries or neonatal emergencies.

c. Delayed or Inadequate Emergency Response

  • Lack of timely intervention during complications like birth asphyxia or sepsis.
  • Delays in reaching a hospital due to geographical or transport issues.

d. Inadequate Follow-Up and Postnatal Care

  • Many neonates die at home due to lack of follow-up after early discharge.
  • Inadequate home-based newborn care and low coverage of ASHA visits.

4. Cultural and Traditional Practices

a. Unsafe Cord Care

  • Application of ash, cow dung, or oil on the umbilical stump increases infection risk.

b. Delayed Initiation of Breastfeeding

  • Delayed feeding increases risk of hypoglycemia and infection.
  • Prevalence of giving honey or sugar water instead of colostrum.

c. Superstitions and Myths

  • Beliefs like avoiding colostrum, not exposing babies to sunlight, or not allowing outside visits delay care-seeking.

5. Environmental Causes

a. Unhygienic Living Conditions

  • Overcrowding and poor sanitation increase exposure to pathogens.
  • Unsafe drinking water can lead to infections.

b. Pollution and Smoke

  • Indoor air pollution from chulhas (wood-burning stoves) causes respiratory issues in neonates.

Preventive Measures

To reduce neonatal mortality, the following steps are important:

  • Promotion of institutional deliveries under Janani Suraksha Yojana (JSY)
  • Skilled birth attendants (SBA) at every delivery
  • Early initiation of breastfeeding
  • Strengthening of SNCUs and NICUs
  • Training of ASHAs and ANMs for home-based newborn care
  • Awareness campaigns on maternal and child health
  • Universal immunization coverage through Mission Indradhanush

Conclusion

Neonatal mortality in India is caused by a mix of medical, social, and infrastructural factors. Most of these deaths are preventable with timely intervention, skilled care, and public health awareness. Empowering healthcare workers, improving maternal nutrition, promoting institutional deliveries, and community-based care are crucial to saving newborn lives.

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