Kota/New Delhi: The central government on Thursday rushed a multi-disciplinary expert team, including senior paediatricians, for gap analysis and suggesting measures to prevent infant deaths at Kota’s JK Lon Hospital that has seen 103 deaths since December 1, 2019.
Doctors at the hospital say the infants had low body temperature, and were suffering from lack of oxygen and glucose. On New Year’s Day (January 1) alone, three babies died at the hospital that is struggling to accommodate the rush of critically ill infants due to inadequate infrastructure and manpower.
An internal official note of the health department highlighted major lapses in infrastructure of the hospital and said out of 533 key equipment only 213 are available for use. The detailed note, accessed by HT, shows 14 out of 20 ventilators, 32 out of 38 pulse oximeters and 22 of 28 nebulizers are out of order. The note also says that 81 out of 111 infusion pumps, 14 of 22 BP instruments and all three portable X-ray machines are out of order.
The note says, “44 out of 71 warmers are not working. A warmer is used for three children and that’s one of the key reasons for the spread of infection.”
{{/usCountry}}The note says, “44 out of 71 warmers are not working. A warmer is used for three children and that’s one of the key reasons for the spread of infection.”
{{/usCountry}}Apart from these, phototherapy machines, suction machines, spirometer and some other machines are also in shortage as a large number of them is out of order. The note says that as against the rule of having 10 staff for 12 beds in neo-natal intensive care unit, the Kota hospital has 12 staff for 24 beds.
Officials said Lok Sabha Speaker Om Birla, who represents Kota constituency, has told the doctors not to wait for government order for repairing machines or renewing contracts. He told them money will be collected from people.
The deaths are largely among premature newborns and those with low birth weight, and most of them have been referred from other districts or hospitals in critical condition, say hospital authorities. Hypothermia (extremely low body temperature), hypoglycemia (very low levels of blood sugar) and hypoxia (inadequate oxygen supply) among these premature and low birth weight infants are the primary triggers that aggravate such medical conditions.
Child mortality is a public health concern in India with about 0.76 million babies dying in the neonatal period, and nearly 3.5 million babies being born premature, shows government data.
In September last year, The Lancet Child & Adolescent Health by the India State-Level Disease Burden Initiative report showed low birth weight prevalence in India in 2017 was as high as 21.4%.
“It is one of the major contributors of death and disability adjusted life years among other malnutrition-related problems. Inadequate maternal nutrition is one of the reasons,” said Lalit Dandona, Indian Council of Medical Research scientist and national chair of population health, during the release of the study.
The infant death toll in 2019 at the Kota Hospital has been 963, which hospital authorities claim has been the lowest in past six years.
“Most of the deceased infants are those who were referred from other districts of Rajasthan and even from the neighbouring state of Madhya Pradesh and were in critical condition,” said hospital superintendent Dr Suresh Chand Dulara.
Head of paediatrics department, Dr Amrit Lal Bairwa, said around 70%-80% are newborns at the JK Lon Hospital, of which at least 70%-80% are those who are either not born at the hospital or are referred from other hospitals.
Among the main causes behind infant deaths, Dr Bairwa said, was shifting babies to the hospital. Moving them in open jeeps or vehicles worsen their condition as they catch a cold which leads to hypothermia. “At least 35 degrees Celsius temperature should be maintained in the body of the infants,” he said.
Another cause of death among premature or low birth infants is hypoxia, which is the lack of sufficient oxygen in the body tissues to sustain bodily functions.
Dr Bairwa said that “hypoglycemia is also a reason for fatality of such weak infants as they face shortage of glucose in the body”.
“Lives of infants can be saved if they can be guarded against hypoxia, hypoglycemia and hypothermia,” he said. To put a check on such causes, Dr Bairwa said transport incubators should be used while referring the infant from peripheral hospital to keep the baby’s body temperature maintained or Kangaroo mother care procedure can also be adopted.
Kangaroo mother care is a method of care of preterm infants. The method involves infants being carried, usually by the mother, with skin-to-skin contact, he said. Hypoglycemia can be tackled by feeding mother’s milk or glucose before transportation of the infant for referral, he said.
Doctors recommend arrangement of an oxygen cylinder during transfer of babies from a small hospital to a bigger one.
They say infant deaths are higher at JK Lon Hospital because peripheral hospitals refer all critically ill infants there. Meanwhile, the facilities at the hospital seem insufficient in view of large number of referrals. The hospital has around 120 beds in each paediatric unit and around 200 beds in the gynaecology unit but need for extension of the hospital is being felt from long time.
At least two infants can be seen sharing a bed at the Hospital of Kota, with a similar situation in the warmers of the Neonatal ICU in the hospital.
A proposal for a 300-bed hospital for paediatrics was proposed in 2017 but it is awaiting an approval. Kota Government Medical College principal Dr Vijay Sardana said the space and the facilities deserve augmentation as they are insufficient to meet the demand.
“We are thinking over some proposals of either adding more beds or unit at the paediatric unit of the hospital,” he said.
The central expert team will reach Kota on Friday. “The team will carry out joint gap analysis along with the state Government in terms of clinical protocols, service delivery, manpower availability and equipment for maternal, newborn and paediatric care services in the Medical College Kota, Rajasthan; and will develop a joint action plan based on gap analysis for providing required technical and financial support to Kota Medical College…,” said Union health minister Harsh Vardhan.
The central team of experts includes Dr Kuldeep Singh, head, paediatrics, AIIMS Jodhpur, Dr Deepak Saxena, senior regional director, Rajasthan, Union health ministry, Dr Arun Singh, professor neonatology, AIIMS Jodhpur and Dr Himanshu Bhushan, adviser, National Health Systems Resource Centre.
Harsh Vardhan said he has spoken to chief minister Ashok Gehlot and assured him of all possible support to prevent further deaths.