Temporary hospital and beds made by China to tackle corona can be the answer to tackle Kota and Muzaffarpur like children deaths in future

Temporary hospital and beds made by China to tackle corona can be the answer to tackle Kota and Muzaffarpur like children deaths in future

Dr KK Aggarwal

President Confederation of Medical Associations of Asia and Oceania, Heart Care Foundation of India and Past National President Indian Medical Association

India must learn how to tackle crisis from China the way they are managing coronavirus and bird flu.

1.     Chinese authorities-imposed lockdown measures on ten cities in an unprecedented effort to contain the outbreak of corona virus

2.     The china built a specialized hospital [Huoshenshan Hospital] built in just 10 days as part of China’s intensive efforts to fight corona virus. A second facility with 1,500 beds is also being opened.

3.     As severe acute respiratory syndrome, or SARS, spread in 2003, a facility in Beijing for patients with that viral disease was constructed in a week.

In India in five days the Army fixed and handed back the collapsed foot-over bridge at Jawaharlal Nehru stadium in 2010.

Then why India never thought of building makeshift ICUs to save 100 infants who were admitted at Kota’s J.K Lone hospital and died in in December 2019 AND to save 150 children in June 2019 who died of acute encephalitis syndrome in Muzaffarpur.

Most Kota infants’ deaths are occurring within 48 hours of admission

Most Kota infants’ deaths are occurring within 48 hours of admission

Dr KK Aggarwal

President CMAALO, HCFI and Past National President IMA

Net death rate of an institution is not the same as gross death rate. In Kota government hospital over 106 infants have died. If we want to do preventive Public Health audit, we need to compare the gross death rate with the institutional net death rate.  Both are different terminologies

Institutional net death rate does not consider deaths occurring in the first 48 hours of admission. It assumes that very sick and serious infants are unlikely to survive if they die within 48 hours of admission.

If the institutional death rate within 48 hours of admission is high efforts must be made in strengthening the pre-Hospital infrastructure and care.

In a tertiary care hospital with referral of most serious case about 43% deaths will took place in first 24 hours of life. Asphyxia and low birth weight are the main causes of death in early neonatal period, whereas sepsis had maximum contribution in deaths during late neonatal period.  Severe hypothermia, severe respiratory distress, admission within first 24 hours of life, absence of health personnel during transport and referral from any hospital have significant correlation with mortality.

In the present crisis at the JK lone Hospital in Kota more than 60% of the deaths have occurred within 48 hours of admission and cannot be there for accounted for the net death r. ate of the hospital.

The same indicates failure of prehospital Primary Health Care and a need for strengthening the village level care, prehospital urgent care services and the need for auditing the prescribed home care and institutional deliveries.

Solution

1.    To reduce the deaths occurring in first 48 hours also strengthen the prehospital neonatal care services

2.    To control crude death rate (all deaths after admission) strengthen the hospital care with enough staff and beds. The occupancy of NICU should be 75-80% and not 300% as in the present case