Skip to main content

Institutional delivery: Despite of basic infrastructure, health centres show inertia towards using it

Counterview Desk
In a major critique of the much tom-tommed Chiranjeevi Project, which seeks to provide institutional delivery to Gujarat’s rural population, a recent study, “Infection control in delivery care units, Gujarat state, India: A needs assessment” by senior scholars Rajesh Mehta, Dileep V Mavalankar, KV Ramani, Sheetal Sharma and Julia Hussein has said that “simply incentivizing the behaviour of women to use health facilities for childbirth via government schemes may not guarantee safe delivery.”
The study reports that, although 70% of respondents, who included doctors and nurses, said “standard infection control procedures were followed, a written procedure was only available in 5% of facilities.” Worse, “alcohol rubs were not used for hand cleaning and surgical gloves were reused in over 70% of facilities, especially for vaginal examinations in the labour room.”
Then, “most types of equipment and supplies were available but a third of facilities did not have wash basins with hands-free taps. Only 15% of facilities reported that wiping of surfaces was done immediately after each delivery in labour rooms. Blood culture services were available in 25% of facilities and antibiotics are widely given to women after normal delivery.”
The study no doubt states that “Gujarat performs comparatively well compared with the rest of the country on many maternal health indicators“ with “health centres, family welfare centres and general hospitals widely found in urban areas, while the public health infrastructure in rural areas consists of primary health centres and community health centres.” 
Yet the fact is, “serious shortages of health professionals characterise especially the rural public health system. Much of the health infrastructure does not function due to these chronic staff shortages, and also because of the lack of drugs, supplies and equipment.”
During the field survey in Ahmedabad and Surendranagar districts it was found that in the preceding year, the primary health centres conducted between 5 and 77 deliveries, intermediate health facilities (private and public) between 450 and 600 deliveries, first referral units (health facilities providing government designated obstetric services) 550 to 840 deliveries and tertiary hospitals 800 to 1800 deliveries. More than 400 deliveries were carried out annually in 60% of facilities.
Half of the facilities had more than 20 beds, although 10% did not have designated maternity beds. A separate antenatal ward was available in 70% of the facilities and a separate postnatal ward in 20%. Ninety percent of facilities had a separate operation theatre and labour room. Two facilities (10%) had a combined labour room and operation theatre.
The study found that most facilities did not keep systematic data on infection rates in the maternity units. Delivery registers were seen during observation. “The registers contained information about delivery date and time, sex and birth weight of newborn and type of delivery, although details pertaining to indicators of infection and other crucial information for data analysis of clinical conditions was lacking. Where data was available, infection rates were found to be between 3% and 5%.”
It added, “In almost all health care facilities, the respondents reported that they and their staff routinely washed their hands before and after procedures, although only 75% of respondents reported vigorous rubbing of hands before conducting what were supposed to be aseptic procedures. Eighty percent of respondents believed that the frequency of hand washing in their facility was good, while the rest believed their practices were average.”
The study further said, “Soap and sterile gloves were reported as being widely available in 80% or more of facilities. Surgical gloves were washed and prepared for reuse in more that 70% of facilities, reportedly to limit costs. New sterile gloves were not available in the labour room. Staff present during the observation exercise said that vaginal examinations in the labour room were conducted with reused, washed or autoclaved gloves.”
Then, “sterile gloves were generally reserved for the operation theatre. For vaginal examination in some places, gloves were used after simple washing without autoclaving. Alcohol rubs were not used at all and not seen during the observation exercise. Running water was available in labour rooms and operation theatres in almost all facilities, although a third of facilities were observed not to have wash basins with hands-free taps.”
The study further said, “Protective clothing such as aprons, gloves, caps and face masks were available in over 80% of facilities, although some items such as nail brushes were present in only about 5% of facilities. Sterile gowns, linen packs, delivery packs and packs for Caesarean section were found in only 40-65% of facilities. Sterile disposable delivery kits (Mamta Kit) which are supplied for home deliveries, were found in 40% of the facilities. Autoclave machines were available in most facilities, but indicator paper only in 65% of the facilities. A register for recording of autoclaving was maintained in most facilities.”
The study also found that “thermometers were only available in 65% of facilities. Evidence that recording of temperatures was monitored (by bedside charts, clinical notes) was found in only 45% of facilities . Staff reported that blood cultures could be taken in only 25% facilities. In one facility, the interview revealed that swabs were collected for culture from different areas in the operation theatres on a monthly basis.”
The scholars reported, “Respondents indicated that antibiotics were freely available at the majority of facilities. Antibiotics were observed to be available on the wards. Researchers were told that antibiotics were given to most of the women undergoing (even normal) delivery by the oral route for 14 days or as a single intramuscular injection. A few facilities (15%) reported occasional difficulty in procuring antibiotics.”
The scholars concluded, “Our study shows that infection control is likely to be suboptimal in many delivery units in Gujarat. There is lack of a systemic approach to infection control in facilities with no set procedures for recording, analysis or follow up action. This is evidenced by the lack of standard guidelines and infection control committees, and poor data availability, feedback and audit in the majority of facilities, even in a relatively well performing state like Gujarat.”
They added, “Given the lack of information, underreporting of puerperal sepsis and other infectious complications relating to childbirth is likely. Record keeping, analysis and feedback of data needs to be improved. Criteria for diagnosis of puerperal sepsis should be uniformly laid down and communicated. Notification of puerperal sepsis should be encouraged.”
Further, “Although the increasing institutional delivery rates in Gujarat is likely to benefit the safety of mothers and babies overall, there is need for 'watchfulness' in the light of the transition to facility based childbirth. Studies from several countries have demonstrated that mothers who had planned home deliveries had fewer infections than those who delivered in hospitals. Contracting infections during childbirth in health facilities is a risk in Gujarat and India that is poorly documented. A focus on infection control during delivery and puerperal sepsis may help to improve quality of maternity care.”

Comments

TRENDING

India's GDP down by 50%, not 23%, job loss 200 million not 122 million: Top economist

By Our Representative  One of India’s topmost economists has estimated that India’s Gross Domestic Product (GDP) decline was around 50%, and not 23%, as claimed by the Government of India’s top data body, National Statistical Organization (NSO). Prof Arun Kumar, who is Malcolm S Adiseshiah chair professor, Institute of Social Sciences, New Delhi, said this was delivering a web policy speech, organised by the Impact and Policy Research Institute (IMPRI), New Delhi.

Youngest of 16 activists jailed for sedition, Mahesh Raut 'fought' mining on tribal land

By Surabhi Agarwal, Sandeep Pandey* A compassionate human being, always popular among his friends and colleagues because of his friendly nature and human sensitivity, 33-year-old Mahesh Raut, champion of the democratic rights of the marginalised Adivasi people of Gadchiroli, Maharashtra, has been in prison for over two years now.

India performs 'poorly' in Quality of Life Index, ranks 62nd out of 64 countries

Counterview Desk “Expat Insider”, which claims to be one of the world’s most extensive surveys about living and working abroad, in a survey of 20,259 participants from around the globe, has found that of the 64 destinations around the globe, has found that while Taiwan is the best destination for persons living outside their native country, closely by Vietnam and Portugal, India ranks 59th.

#StandWithStan: It's about Constitution, democracy and freedom of expression

By Fr Cedric Prakash SJ*  It is more than three weeks now: On the night of October 8, 2020, the 83-year-old Jesuit Fr Stan Swamy was taken into custody by the National Intelligence Agency (NIA) from his residence in Ranchi to an undisclosed destination. According to his colleagues, the NIA did not serve a warrant on Fr. Stan and that their behaviour was absolutely arrogant and rude.

Stan Swamy vs Arnab Goswami: Are activists fighting a losing battle? Whither justice?

By Fr Sunil Macwan SJ* It is time one raised pertinent questions over the courts denying bail to Fr Stan Swamy, who was arrested under the Unlawful Activities (Prevention) Act (UAPA), and granting it to Arnab Goswami, editor-in-chief of the Republic TV, arrested under the charge of abetting suicide of Avay Naik, who ended his life in 2018. It is travesty of justice that a human rights activist is not only denied bail but is also made to wait for weeks to hear a response to his legitimate request for a straw to drink water, while Arnab Goswami walks free.

Human development index: India performs worse than G-20 developing countries

By Rajiv Shah A new book, “Sustainable Development in India: A Comparison with the G-20”, authored by Dr Keshab Chandra Mandal, has regretted that though India’s GDP has doubled over the last one decade, its human development indicators are worse than not just developed countries of the Group of 20 countries but also developing countries who its members.

Namaz in Mathura temple: Haridwar, Ayodhya monks seek Faisal Khan's release

By Our Representative As many as 23 members of the Hindu Voices for Peace (HVP), including the founder president of the well-known Haridwar-based Matri Sadan Ashram, Swami Shivananda Saraswati, and a one of its top monks, Brahmachari Aatmabodhanand, have expressed their “dismay” over the arrest of Khudai Khidmatdar chief Faisal Khan and three others on charges of “promoting enmity between religions” and “defiling a place of worship” after they offered namaz in Mathura’s Nand Baba temple premises on October 29.

Buddhist shrines massively destroyed by Brahmanical rulers in "pre-Islamic" era: Historian DN Jha's survey

Nalanda mahavihara By Our Representative Prominent historian DN Jha, an expert in India's ancient and medieval past, in his new book , "Against the Grain: Notes on Identity, Intolerance and History", in a sharp critique of "Hindutva ideologues", who look at the ancient period of Indian history as "a golden age marked by social harmony, devoid of any religious violence", has said, "Demolition and desecration of rival religious establishments, and the appropriation of their idols, was not uncommon in India before the advent of Islam".

Government of India 'refuses' to admit: 52% of bird species show declining trend

Finn's Weaver  By Our Representative The Government of India has been pushing out “misleading” data on the country’s drastic wildlife decline, says a well-researched report, pointing towards how top ministers are hiding data on biodiversity losses, even as obfuscating its own data. It quotes “State of India’s Birds Report 2020” to note that of the 261 out of 867 bird species for which long-term trends could be determined, 52% have declined since the year 2000, with 22% declining strongly.

Swami Vivekananda's views on caste and sexuality were 'painfully' regressive

By Bhaskar Sur* Swami Vivekananda now belongs more to the modern Hindu mythology than reality. It makes a daunting job to discover the real human being who knew unemployment, humiliation of losing a teaching job for 'incompetence', longed in vain for the bliss of a happy conjugal life only to suffer the consequent frustration.