LAHORE: At a time when Pakistan was reporting third-highest number of neonatal mortality ratio (NMR) in the world, a newly-compiled study shows some ‘disturbing facts’ about the poor knowledge of its senior health managers and policy makers about the actual death rate, its factors and other necessary information.

The study “Situation Analysis on the Use of Chlorhexidine for Umbilical Cord Care 2014” was developed as a part of the “Improving Chlorhexidine Advocacy for Newborns Project”. It was funded by the Maternal and Newborn Health Programme and Research and Advocacy Fund and implemented by Mercy Corps, Pakistan.

Said to be first of its kind, the study is an attempt at judging level of information of senior health officials of the country about the fatal diseases, claiming lives of a large number of children. A copy of the report is available with Dawn.

Shockingly, the country-wide survey found out that the “awareness level” of the senior health managers in all four provinces, including the health directors general, about the neonatal mortality ratio, guidelines and measures to prevent deaths of babies, was not much better than that of low-profile workers like lady health workers, community midwives, traditional birth attendants and community women. “Most of them were unable to recall any of the guidelines, including of the World Health Organization (WHO) for newborn care”, the report says.

According to the report, the panel teams had interviewed policy makers/decision makers, provincial programme managers, district health managers, technical experts, public healthcare providers, community midwives, lady health workers, traditional birth attendants and community women.

It says out of the total newborns’ deaths in Pakistan, 30pc took place due to Sepsis. “It was particularly disturbing that technical experts had mentioned pyodine and spirit as the best antiseptics for cord care and these were being used even in many leading hospitals of the country”, the report says.

It mentions that many unhygienic or traditional techniques were also being used for cleaning and cutting of cord, including unclean cutters (knife, blade, scissors), clothes, desi ghee, ash, surma, mustered oil, cow dung, methylated spirit etc, instead of using sterilised instruments and recommended drugs.

“Out of the total respondents interviewed by the panel teams, 60pc were unaware of the neonatal mortality rate of their provinces, while only 40pc were able to tell an approximate figure of ten ratio of their respective provinces”, the study reveals the poor knowledge of the health department officials.

When asked about the reasons of neonatal mortality, almost all of them (90pc) mentioned sepsis as one of the major cause of deaths among children. “Half of the policy makers knew that the WHO guidelines for newborn care were available but none of them was able to name any of these”, the report says.

The other half either did not know whether the WHO guidelines were available (12pc) or stated that no guidelines for newborn care were available (38pc).

About the Chlorhexidine as an antiseptic for cord care, 90pc officials were aware of it and they stressed it should be included in the essential drug and purchase lists, while the respondents from Punjab stated it had already been included into the essential drug list.

During in depth interviews, 67pc of provincial programme managers were not aware of the NMR of their provinces, while only 33pc could tell an approximately figures of NMR.

“About 90pc of them identified birth asphyxia and sepsis as major causes of neonatal mortality although they were unable to quote the exact percentage of deaths caused by sepsis”, it says.

Of the total provincial programme managers interviewed by the panels, only 56 per cent were familiar with the availability of WHO guidelines for newborn cord care while the remaining expressed their ignorance.

“The managers of the Maternal and Newborn Child Health Programme from Punjab and Sindh were the only ones who were able to name and identify the purposes of these newborn guidelines”, the study says.

Similarly, the awareness level of the district health managers and the medical/technical experts was also not up to the mark. Only the managers from Punjab were able to quote the NMR of the province while those from Sindh, Balochistan and KP had no idea of the subject.

“All the interviewed district health managers were unable to state an average percentage of Sepsis disease to show its contribution towards NMR”, it says.

The health managers from the three other provinces, except from Punjab, were unaware of the WHO guidelines and their use for the training of health care providers. All of them were, however, aware that Chlorhexidine could be used as an antiseptic for cord care.

The panel also interviewed technical and medical experts of tertiary care hospitals of the provinces where the average number of deliveries ranged from 500 to 1,500 per month.

When asked about the different antiseptics they were using for cord care, 44pc stated pyodine and spirit, 33pc mentioned Chlorhexidine and 23pc named gentian violet (commonly named as Neeli Dawai).

“While further probing the use of antiseptics for cord care in their hospitals, the ctual practices of these experts contradicted their statements about best practice for antiseptics”, the report reveals.

Interestingly, of them, 55pc were using spirit for cord care. Similarly, 78pc of these experts were unaware of any national or provincial level WHO guidelines. Those who knew about the guidelines could not name any of the available instructions of the WHO for the purpose.

Published in Dawn December 4th , 2014