The incidence of morbidities in a cohort of neonates in rural Gadchiroli, India: Seasonal and temporal variation and a hypothesis about prevention

Abstract

Background: The incidence of morbidities among home-cared neonates in rural areas has not been studied. Objectives: 1. To estimate the incidence of various neonatal morbidities and the associated risk of death in home-cared neonates in rural setting. 2. To estimate the variation in the incidence of neonatal morbidities by season and by day of life. 3. To identify the scope for prevention of morbidities and suggest a hypothesis. Study design: A prospective observation study nested in the first year of the field trial in rural Gadchiroli, India. Trained village health workers in 39 villages observed neonates at the time of birth and in subsequent eiht home visits up to 28 days. We diagnosed 20 neonatal morbidities by using clinical definition. The data were analyzed for the incidence, case fatality, and relative risk of death and for the seasonal and day-wise variation in the incidence of morbidities. Results: We observed total 763 neonates in 1 year. The incidence of morbidities was a mean of 2.2 morbidities per neonate. The case fatality in 13 morbidities was >10%. Only 2.6% neonates were seen of treated by a physician, and 0.4% were hospitalized. Hypothermia, fever upper respiratory symptoms, umbilical and skin infections, and conjunctivitis showed statistically significant seasonal variation. Although the morbidities were concentrated in the first week of life, new cases continued to appear throughout the neonatal period. Various morbidities showed different distribution of incidence during 1 to 28 days. Conclusions: A large burden of disease occurs in rural home-cared, and many morbidities are associated with high case fatality. Some morbidities show strong seasonal and day-wise variation in incidence, indicating poor care at home. We hypothesize that changes in practices and better home-based care will prevent the seasonal and temporal increase in morbidities. Some morbidities may not be preventable and will need early detection and treatment. Therefore, frequent home visits by a a heath worker are necessary to indentify sick neonates. © 2005 Nature Publishing All rights reserved.