Important parameters of child mortality:
Neonatal mortality rate: rate of death of neonates (0 – 28 days old babies)
Infant mortality rate: rate of death of infants (0 – 1 year old babies)
Under 5 child mortality rate: rate of death of neonates (2 – 5 year old babies)
Child = 2 – 1 1 year old.
Pakistan, with a total population of 197 million, is yet to solve its child and maternal mortality issues. According to the latest UNICEF reports, Pakistan lies as the worst countries in terms of new-born mortality rate. The table below lists the child survival statistics of Pakistan according to the IGME 2018 (UNICEF) compared to Ethiopia and India. The difference in indeed significant.
|Child Survival – UNICEF 2018||Pakistan||Ethiopia||India|
|Under-five mortality rate (U5MR), deaths per 1,000 live births||75||59||39|
|Number of under-five deaths||403,638||188,690||989,167|
|Infant mortality rate (IMR), deaths per 1,000 live births||61||41||32|
|Neonatal mortality rate (NMR), deaths per 1,000 live births||44||29||24|
|Under-five mortality rate (U5MR), deaths per 1,000 live births (male)||78||65||39|
|Under-five mortality rate (U5MR), deaths per 1,000 live births (female)||71||52||40|
According to an article published in Dawn, the ex-nutrition cell coordinator of Balochistan had mentioned that the province has a very high child mortality rate compared to the other provinces of the country. To understand why this is a fact, one must be aware of the factors that contribute to a high rate of neonatal, infant and child mortality.
In the context of Balochistan, the most prominent factors that lead to alarming child mortality rates are the lack of; Postnatal care of newborns within 2 days, breastfeeding habit of mothers and immunization follow ups (UNICEF report on Maternal and Newborn Health Disparities). Other causes include preterm birth complications, pneumonia, intraspartum-related events, neonatal sepsis, diarrhea and malaria.
According to the report, only 14.8 % of newborns in Balochistan receive postnatal care compared to Punjab were 51.3% newborns receive the facilities. In terms of breastfeeding, Balochistan’s 42.1% coverage is recorded for early initiation of breastfeeding while that in Gilgit Baltistan it is reported highest in Pakistan at 60.4%. The lowest stats have been reported in context of vaccination of newborns where only 48.9%, 37.7% and 23.2% newborns are vaccinated for BCG, DPT1 and Tetanus respectively. This when compared to Punjab has much better coverage at 91.6%, 87.2% and 73.8%.
Another important aspect of high child mortality rates in Balochistan is malnutrition. According to the ex-nutrition cell coordinator of Balochistan, 16 % children in the province face acute undernourishment while 40% were underweight (Dawn Sept 2018). Owing to this a nutritional emergency was declared in the province and steps are being taken by the government to counter to the issue.
Currently, the Balochistan Nutrition Project for Mother and Children (BNPMC) is the only extended program that is covering the nutritional needs of the province’s undernourished mother and child. The project was a success after its initial phase and now has been extended to most parts of the province. Fruitful results of its expansion are expected by health experts.
Most recently, the government of Balochistan has also payed close attention to the Mother and newborn child health (MNCH) program of the province. Awareness campaigns and supervision of mother and child health care facilities is a major part of the program. However, many child deaths go unreported for a variety of reasons, including lack of death registration and lack of data on child migrants. Without accurate data on child deaths, we cannot fully discover and combat the greatest risks to a child’s life.
Immediate and exclusive breastfeeding, skilled attendants for antenatal, birth, and postnatal care, access to nutrition and micronutrients, family knowledge of danger signs in a child’s health, improved access to water, sanitation, and hygiene and immunizations are also amongst the long-term solutions to deal with Child Mortality.
Promotion of the issue and training of employees in maternal and child health offers immediate solution. This includes working with communities to train and equip midwives and local health workers; with governments and corporate partners to provide supplies and resources to clinics and hospitals; and with parents to teach best practices in the care and nurture of their young children.
Keeping in view the depth of the issue, it is easily understandable that any efforts done to lower the mortality rates of child in the province will take a significant amount of time to make a difference. Hence, it is highly recommended that the programs such as the BNPMC and MNCH must be vigilantly continued and regular statistics are shared with the health experts to overview the indicators of success of the efforts. Moreover, the health budget must be adequately divided for all approaches being used to improve the rates of child mortality in Balochistan.