Child Mortality, Past Present future

1. Child Health
DR AMIR NASIR

2. Topics
Definitions & some key facts
Major causes of child mortality.
Determinants of child health.
Interventions to improve child health.
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3. Why Child Health
Children are most vulnerable segment of society
Higher risk of morbidity/mortality
Global share of morbidity and mortality
Majority conditions are preventable
Indicative of health of society

4. Definitions &
Epidemiology

5. Stillbirth
Infant Mortality
Neonatal Death Post-neonatal Death
Early
neonatal
Death
Perinatal Death
Late neonatal
death
28 weeks
of gestation
Birth 7 Days 28 Days 1 Year
MORTALITY IN AND AROUND INFANCY; TERMINOLOGY
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6. Indicators of child mortality
Indicator Definition
Under 5 mortality Rate (U5MR) Deaths under 5 years/ 1000 live births
Infant Mortality Rate (IMR) Deaths under 1 year / 1000 live births
Neonatal Mortality Rate (NMR) Deaths upto 28 days after birth / 1000 live births

7. How big is the problem
Year Under 5 deaths
1990 12.7 million
2010 7.1 million
2012 6.6 million
2015 5.9 million

8. Neonatal deaths
2.7 million neonatal deaths every year
50% of all neonatal deaths occur in first 24 hours
75% of all neonatal deaths occur in first week
1 million neonatal deaths occur on the day of birth

9. More than half of under 5 deaths are preventable with simple interventions
Children in sub-Saharan Africa are more than 14 times more likely to
die before the age of 5 than children in developed regions

10. 45%
55%
Proportion of neonatal & post-neonatal
deaths
neonatal deaths
post neonatal deaths

15. Inequity
99% of childhood deaths occur in low & middle income countries
42% in Asia
51% in Africa
93% combined in Asia & Africa

20. Causes of
Child Mortality

21. 5 leading Causes of under 5 mortality
Leading causes of death in children under 5 years are
1. Prematuriy…………………………………………(18%)
2. Pneumonia ……………………………………….(16%)
3. birth asphyxia ………………………………… (11%)
4. diarrhoea …………………………………………..(9%)
5. Malaria ……………………………………………….(5%)

22. Important causes by age
NEONATAL PERIOD
Prematurity
Birth asphyxia
POST NEONATAL PERIOD
Pneumonia
Diarrhea
Malaria

25. Malnutrition Contributing to U 5 Mortality, 2008 (percent)

26. Determinants of
Child Health

27. Determinants of Child Mortality
1. Biological
2. Socio-economic
3. Cultural

28. Biological
Birth Weight: low birth weight (< 2.5 kg) & high birth weight (> 4 kg)
Age of The Mother : <19 years) or >over 30 years
High Fertility
Repeated pregnancies
Birth Spacing: < 1 year = 2-4 times risk
Mutiple Births: more risk due to low birth weight
Family Size: 3 or more children, more frequent/prolonged illness
Birth Order: Mortality risk increased after the third birth.

29. Socio-economic Factors
Low income countries
Rural areas
Low education
Nutrition
Breast & formula milk use
Health care quality
Environmental conditions
Violence (wife beating, infanticide)

30. Cultural Factors
Religion
Customs
Early marriages
Sex of child
Quality of mothering
Traditions affecting
cleanliness,
eating,
clothing,
child care

31. Interventions & Results
Future Targets

32. MDG 4: Reduce child mortality
Target 4 A: Reduce by two-thirds, between 1990 and 2015, the under-
five mortality rate
Indicator 4.1 Under-five mortality rate
Indicator 4.2 Infant mortality rate
Indicateur 4.3 Proportion of 1 year-old children immunized against
measles

33. WHO strategies
To deliver these interventions, WHO promotes four main strategies:
1. Appropriate home care & timely treatment of complications for newborns
2. Integrated management of childhood illness (IMCI)
3. Expanded programme on immunization;
4. infant and young child feeding

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40. Simple, effective proven measures to
reduce U5MR
Vaccines
Antibiotics
micronutrient supplementation,
insecticide-treated bed nets,
improved family care
Hand washing with soap
Breast feeding practices
Oral rehydradion therapy
Empowering women,
removing financial and social
barriers to accessing basic services,
developing innovations that make
the supply of critical services

41. Integrated Management of Childhood
illness (IMCI)
Integrated approach to child health
Focus on well being of whole child instead of one disease
Aims to reduce death, illness & promote growth in under 5
Preventive & curative services implemented by families, communities,
health facilities
Has been introduced in 75 countries

42. IMCI Strategy
Strategy includes 3 main components
Improved skills of health care staff
Improved overall health systems
Improving family & community health practices

46. Progress in Pakistan
Year U5MR
1990 139
2000 112
2015 81
42% reduction

47. Reduction in neonatal Mortality
Year Neonatal Deaths
1990 5.7 million
2015 2.7 million

48. MDG4, 1990-2015
62 /195 countries achieved MDG target 4 of 2/3rd reduction in U5MR
74 /195 countries have reduced U5MR by half
10 of the 12 low-income countries that achieved MDG4 are in Africa.

50. MDGs end (2015) …. SDGs Begin

51. Sustainable Development Goals
SDGs ……….. 17 Goals ……… 169 targets
SDG 3 “Ensure healthy lives & promote wellbeing, for all, at all ages”
Target 3.2 …… By 2030, end preventable deaths of newborns and children
under 5, to reduce neonatal mortality to 12 /1000 and U5MR to 25 /1000 .

52. Sustainable Development Goals
SDG target for U5MR is at least 25 / 1000 for all countries
Currently 79 countries have U5MR above 25 / 1000
47 countries are unlikely to achieve the target till 2030 if current trends
continue

53. Global Initiatives to achieve SDGs
1. "ending preventable maternal mortality" and "every newborn
action plan" to promote universal coverage of high quality maternal
and newborn care;
2. the “Global Action Plan for the Prevention and treatment of Pneumonia
and Diarrhoea“ (GAPPD)
3. a "comprehensive implementation plan on maternal, and infant and
young child nutrition" to reduce under nutrition and obesity;

54. Global Initiatives to achieve SDGs
4. the "Global Technical Strategy for Malaria" to reduce global
malaria case incidence and mortality by 2030
5. the "Global Vaccine Action Plan" to prevent childhood diseases
through vaccination
6. the United Nations Decade of Action on Nutrition 2016–2025 to
eradicate hunger and prevent all forms of malnutrition worldwide.

55. Global Action Plan for the
Prevention & treatment of
Pneumonia & Diarrhoea (WHO)
Peumonia & diarrhea together cause 29% of
under 5 deaths
Deaths of 2 million children annually
Targets (for 2025)
Reduce pneumonia deaths to < 3 / 1000
Reduce diarrhea deaths to < 1 / 1000

57. ENAP Targets
Year
Neonatal mortality rate
(NMR)Target
Still birth rate
(SBR)targt
2020 15 / 1000 14/ 1000
2025 12 / 1000 11/ 1000
2030 9/ 1000 9/1000
2035 7/1000 8/1000

61. Pakistan Perspective

62. MDG 4 progress in Pakistan

63. Deaths by age period (Pak)

64. U5MR inequities (Pak)

65. U5MR by region in Pakistan

66. Causes of U5MR in Pakistan

67. Nutritional status Pakistan

68. Thank You

69. References
http://data.worldbank.org/indicator/SH.DYN.MORT
http://www.who.int/en/
http://www.childmortality.org/
https://data.unicef.org/topic/child-survival/under-five-
mortality/