How Can Pakistan Reduce High Rates of Infant Mortality?

[Riaz Haq]

Of every 1,000 babies born in Pakistan, 45.6 die before the end of their first month – 1 in 22, the highest infant mortality rate in the world, according to a United Nations Children's Fund report titled "Every Child Alive: The urgent need to end newborn deaths".   Pakistan’s newborn mortality rate has declined by less than one quarter, from 60 in 2000 to 46 in 2016, according to UNICEF.

Highest Contributors to Newborn Deaths Source: UNICEF

Worst Countries:

Of the 2.6 million newborn dying each year worldwide, India tops with 24% share followed by Pakistan with 10%. Ten countries, Bangladesh, Ethiopia, Guinea-Bissau, India, Indonesia, Malawi, Mali, Nigeria, Pakistan and Tanzania account for more than half of the world’s newborn deaths, according to the report.  Four of these 10 countries are in South Asia while the rest are in sub-Saharan Africa.

The percentage of mothers in Pakistan who gave birth in a health facility increased from 21 per cent to 48 per cent between 2001 and 2013, and the proportion of women giving birth with a skilled attendant more than doubled, from 23 per cent to 55 per cent over the same period. But despite these remarkable increases, largely the result of rapid urbanization and the proliferation of private sector providers not subject to satisfactory oversight, Pakistan’s very high newborn mortality rate fell by less than one quarter, from 60 in 2000 to 46 in 2016, according to UNICEF.

The report says that more than 80 per cent of newborn deaths can be prevented "with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition."

Community-Based Health Care:

How can Pakistan increase the number of childbirths in the presence of skilled attendants? The best option appears to be a skilled midwives program along the lines of the Lady Health Workers (LHW) program that is considered effective in delivering health education and care to women in remote villages.

“It (LHW) is one of the best community-based health systems in the world,” said Dr. Donald Thea, a Boston University researcher, talking about Pakistan's Lady Health Workers Program. Thea is one of the authors of a recent Lancet study on child pneumonia treatment in Pakistan. He talked with the New York Times about the study.

Published in British medical journal "The Lancet", the study followed 1,857 children who were treated at home with oral amoxicillin for five days and 1,354 children in a control group who were given standard care: one dose of oral cotrimoxazole and instructions to go to the nearest hospital or clinic. The home-treated group had only a 9 percent treatment-failure rate, while the control group children failed to improve 18 percent of the time.

Community Midwives: 

In response to the low levels of skilled birth attendance in rural Pakistan, the government has introduced a new cadre of community midwives (CMWs).

In 2008, Pakistan extended community-based health system with the introduction of an 18-month training program for community midwives. Then, in 2014, United Nations Population Fund – together with the Department of Health and Sindh Province’s Maternal, Newborn and Child Health program – launched a pilot effort to supplement the midwifery courses with hands-on training. Midwifery coaches visited the midwives’ clinics, offering guidance and mentorship, according to UNFPA. So far, over 300 midwives have benefitted from the coaching and mentorship program.

The Sindh UNFPA model needs to be scaled up across the country with the help of the federal and provincial governments in Pakistan. 

Summary:

Pakistan is the riskiest country for newborns. Of every 1,000 babies born in Pakistan, 45.6 die before the end of their first month – 1 in 22, the highest infant mortality rate in the world, according to a United Nations Children's Fund report titled "Every Child Alive: The urgent need to end newborn deaths".   Pakistan’s newborn mortality rate has declined by less than one quarter, from 60 in 2000 to 46 in 2016, according to UNICEF. The country's progress in reducing infant mortality rates has been very slow. There is an urgent need to improve the situation by by scaling up community-based midwife programs nation-wide.

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[Riaz Haq]

Community Outreach Program: Oral Health Based Education
Dental Team from Ziauddin College of Dentistry, Visits School

https://www.dentalnewspk.com/community-outreach-program-oral-health...


The department of Community & Preventive Dentistry, Ziauddin College of Dentistry in collaboration with Colgate Palmolive, organized a Community School Health trip on 26th January 2018, at Bahria Foundation Schools, to address the oral health needs of children from marginalized population.

The trip was lead by Dr.Sidra Mohiuddin (Assistant Prof & HOD), along with trained and calibrated lecturers of the department, Dr. Atiya Abdul Karim, Dr. Khizra Rehman ans Dr. Abeeha Zaidi.1

The aim of this community health based trip was to spread awareness amongst students and school teachers, regarding the importance of oral hygiene and its maintenance.

Free Dental check-ups were performed by students of 2nd year BDS(batch VIII), following World Health Organization’s Guidelines for oral examination in children (2013).

In addition to this, students of 2nd year BDS prepared posters based on oral health education and performed brushing techniques in front of the children to educate them in an effective manner.

At the end of the oral screening, an interactive session was held for the school teachers by Dr. Sidra Mouhiuddin (HOD-Community and Preventive Dentistry), during which, dissemination of oral health awareness via teachers, among their students was discussed. This area of discussion was stressed upon, as the teachers spend good 6 to 8 hours every day with their students.

The school administration was satisfied7 with the overall arrangements and services offered by Ziauddin College of Dentistry’s dental team.

As the day ended, kits inclusive of toothbrushes and toothpastes, by Colgate were distributed among school children in order to promote brushing habits and over all oral hygiene maintenance.

[Riaz Haq]

How #Bangladesh Drastically Cut Its Newborn Death Rate. What Can #India and #Pakistan Learn From it? #health #children

https://www.npr.org/sections/goatsandsoda/2018/02/25/587692950/how-...

There were some glimmers of good news in an otherwise grim report released by UNICEF this week documenting the alarmingly high death rate of newborns worldwide: Bangladesh has managed to cut its newborn mortality rate from 64.2 deaths per 1,000 live births in 1990 to 20.1 per 1,000 today. That's 1 in every 50 births. By comparison, in neighboring Pakistan (which has the worst odds of any country) 1 in every 22 newborns doesn't survive.

For a country as populous as Bangladesh that success has translated into a staggering number of lives saved. In 1990 241,000 newborns did not live through their first month. By 2016 that figure was down to 62,000.

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Mannan says a key factor was reducing the share of births that were taking place in homes instead of health-care facilities: "In 1990 about 90 percent of deliveries were happening in homes, basically just assisted by relatives [of the mother] who had no training."

Largely this was cultural, says Zaka. "If you look at all the countries in Asia it was pretty much the norm back then." There were also few birthing facilities available for people – particularly in rural areas. But even people who lived close by to a facility often eschewed it, says Mannan. "There were these beliefs that a woman should not expose herself to a male doctor."

As a result the most common cause of newborn deaths in Bangladesh back then was asphyxia — essentially a lack of oxygen brought on by obstructed labor. "When the labor is very prolonged and the woman is struggling alone at home there is often fetal distress," explains Zaka.

In fact this was even a problem in health facilities in Bangladesh – where medical staff often lacked the skills to ease the delivery or to revive a newborn.

But starting in 2010 the government of Bangladesh launched a multi-pronged effort to bring about change. Working with donor governments, including the United States, and international organizations such as UNICEF, Bangladesh trained workers at health centers on measures like infection control and resuscitation, opened many more facilities for childbirth – and just as important tried to convince families to use them.

Zaka says the effort was particularly helped by Bangladesh's "rich culture" of locally-based non-governmental aid groups including BRAC and the Grameen Bank. Both frequently partner with poor women. "There was a lot of [outreach] through those workers to promote better care [during delivery]," says Zaka. And today notes Mannan, only about 50 percent of births in Bangladesh are home deliveries.

Of course while that's a major improvement, it's hardly ideal. Zaka says one problem is that existing facilities are not open 24-7. "If there's a delivery at night, the facilities don't have the staffing to handle it."