STATE OF WORLD AND PAKISTANI CHILDREN

Compiled by:

Prof M Akbar NizamaniProfessor and Chairman Department of Paediatrics LUMHS Jamshoro

Learning Objectives To Know the definitions of mortality rates. To know the State of childhood deaths globally. To Know the common causes of deaths in

children globally and in Pakistan. To know the causes of death in neonates. To know how malnutrition plays important role in

childhood mortality. To know basic demographic Indicators of Pakistan To know that majority of causes of mortality and

morbidity are preventable.

Definitions Infant mortality rate: Number of deaths in infants

under one year of age per thousand live births per year.

Neonatal mortality rate: Number of deaths in newborn under one month of age per thousand live births per year.

Under 5 mortality rate: Number of deaths in infants under 5 years of age per thousand live births per year.

Perinatal Mortality Rates: Number of total deaths after 28 weeks of gestation up to first week of life per thousand total births per year.

STATE OF WORLD AND PAKISTANI CHILDREN GLOBAL:6.6 MILLION UNDER 5Y DEATHS

/YEAR (2010 Estimates R E Black et al) 0.63 MILLION /MONTH, 1.6 LACS/WEEK,23,000/DAY AND

16/MINUTE 0.35 MILLION PAKISTANI U5 CHILDREN

DIE /YEAR,1-2 CHILD EVERY MINUTE. Abut 100,000 in Pneumonia and about

80,000 I diarrhea.

4 million newborn deaths – Why?almost all are due to preventable conditions

Two thirds of all neonatal deaths are in LBW infants

Global Distribution of Causes of Child Deaths: 2008

60.7% of diarrhea deaths

57.3% of malaria deaths

52.3% of pneumonia deaths

44.8% of measles deaths

…are attributable to under nutrition

Caulfield et al, 2004

20-50% of the 8.5 million child deaths each year…

Global Causes of Under-Five Deaths in 2010

Through synergy with infectious diseases undernutrition causes 35%

of child deaths

Global distribution of deaths among children under five (2012)

6.6 million children died in 2012

More than half due to conditions that could be prevented or treated with access to simple, affordable interventions

About 45% of all child deaths are linked to malnutrition

Summary of Global Estimates in 2010

7.6 million deaths in children < 5 years

64% (4.9 million) of deaths were from infectious diseases

Pneumonia 18% 1.40 million

Diarrhea 10% 0.80 million

Malaria 7% 0.56 million

40% (3.1 million) of deaths occurred in neonates

PTB Complications 14% 1.08 million

Intrapartum-related complications

9% 0.72 million

Sepsis or meningitis 5% 0.39 million

Pneumonia 4% 0.33 million

Regional Causes of Deaths, 2010: Eastern Mediterranean and SE Asia

Estimated causes of mortality around the year 2010 for 194,000 neonatal deaths

Source: Khan A et al. 2012. Newborn survival in Pakistan: a decade of change and future implications. Health Policy and Planning 27(Suppl. 3):iii72–iii87 Data source: Pakistan mortality estimates (Liu et al. 2012). Note: Severe infection includes sepsis, meningitis, pneumonia and tetanus.

Birth Asphyxia Burden Pakistan

About 80,000 newborns die Equal number die as fresh still births Un specified number develop

impairement Services for physical and mental

impairement poorly developed (Bhutta et al, 2008)

Pakistan is not on track to achieve MDG 4 and 5

U5MR – 89 per 1,000 live births (slow decrease)

IMR – 74 per 1,000 live births (slow decrease; target is to reduce IMR to 40).

NMR – 55 per 1,000 live births (stagnant)

Two-thirds of children under one year die during first 28 days of life

Pneumonia and diarrhea are major killers of children under five.

Every hour in Pakistan: Three women die due to maternal causes

Only 52% delivered assisted by a skilled provider (13 percent point

increase)

Only 48% delivered at Health facilities (14 percent point increase)

40-Year Trend in Infant and Neonatal Mortality in Pakistan

120 114

95

78

57 59 55 54

125

63

0

50

100

150

200

1975-9 1980-6 1987-91 1992-8 2006-7

IMR NMR

IMR has considerably declined NMR remained constant in last three decades

Trends in Childhood Mortality in Pakistan, 1990-2013

Neonatal and Under-Five Mortality Rates, 1990-2010

PDHS 2013- Data (Sindh-Pakistan)

Indicator Pakistan Sindh

NMR (per 1000 live births)

55 54

IMR (per 1000 live births)

74 74

U5MR (per 1000 live births)

89 93

CPR % 35 30

TFR % 3.8 3.9

SBA % 73 78 (U 90 % R 65 %)

ANC (4 visits) 37 37

Place of delivery % HF 49 (15 public+34 Pvt)Home 51

HF 59 (14P+45 Pvt)

Home 41

MMR (PDHS 2006) 276 314

Morbidity Problems in Neonates: HIE Disability Fresh Stillbirths Problems in children: Post CNS infections sequelae Post vaccine preventable diseases sequelae Diarrhoea, infections, malnutrition cycle. Micronutritient deficiency, hidden hunger, low IQ ,

poor output. Discrimination against girl child. Unhealthy un

educated mother. Poor quality of life.

SINDH: child malnutrition rates very high

NNS (2002) reveals 13% global acute malnutrition (GAM) Pakistan; 18-23% in Sindh post flood.

Stunting : 50 %: Highest in south Asia (Only 17% in Srilanka)

Underweight : 50% Wasting: 18%

PAKISTAN :DEMOGRAPHIC AND HEALTH INDICATORS POPULATION:180 MILLION(6th most populous

country in the world). 146th on human development index out of 190

countries. Decline in U5(95) and IMR(67:Thousand live

births). PMR static at 54 : thousand total births High fertility rate at 4 and Birth rate remained

unchanged at 2.2% highest in Asia. Hence under 15 population at 43%. Massive addition of about 3million /year

PAKISTAN DEMOGRAPHIC AND HEALTH INDICATORS High fertility rate(4.8) : Population explosion Low contraceptive prevalence(<30%) Anemia in pregnancy 40%(3-4% maternal

deaths) Tetanus immunisation58%(Unicef,2002) Antenatal care received 28% and delivered at

home76% (GOP 2002) and attended by a trained birth attendant 20%.

Maternal mortality ratio:350/100,000 live births,25-30 thousand women die each year, one mother every 20 minutes.

PAKISTAN :HEALTH and DEMOGRAPHIC INDICATORS High U5,IMR,Perinatal and Neonatal mortality rates. LOW BIRTH WEIGHT :25-33% Exclusive breast feeding:25% Severe and moderate malnutrition in U5 children 40% Per capita food production and calories100% Safe drinking water ?,Sanitation rural 20%. Immunization coverage 12-23months <58% TT Vaccination of pregnant women31% Adult literacy rate35% Federal expenditure on health increasing but still only

0.7% of GNP. Little on women and children; More on security and debt servicing.

ALL IS NOT BLEAK Mortality rates declining except PMR Polio being eradicated ORS saving 1 million lives /year Vitamin A and Iodine supplements Television coverage very high Maternal and child health strategies in pre service

curricula. Training programs for LHW covering about 40% of

rural community and midwives. Child survival and health promotion strategies in -

corpora ting: IMNCI,ARI,CDD,EPI and Nutrition projects.

Summary Children, infants and neonates are dying in

large number in developing countries including Pakistan.

Malnutrition is the most important risk factor causing deaths in children.

Neonatal and peri natal mortality rates are not declining.

Demographic indicators of Pakistan are not good.

Majority of problems are easily preventable.