STATE OF WORLD AND PAKISTANI CHILDREN

1
STATE OF WORLD AND PAKISTANI CHILDREN

• Compiled by
• Prof M Akbar Nizamani
• Professor and Chairman
• Department of Paediatrics
• LUMHS Jamshoro

2
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.

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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.

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STATE OF WORLD AND PAKISTANI CHILDREN

• GLOBAL6.6 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.

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4 million newborn deaths Why?almost all are
due to preventable conditions
Two thirds of all neonatal deaths are in LBW
infants
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Global Distribution of Causes of Child Deaths
2008
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Under Five Mortality
20-50 of the 8.5 million child deaths each year
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
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Global Causes of Under-Five Deaths in 2010
Through synergy with infectious diseases
undernutrition causes 35 of child deaths
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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

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Summary of Global Estimates in 2010
7.6 million deaths in children lt 5 years 7.6 million deaths in children lt 5 years 7.6 million deaths in children lt 5 years
64 (4.9 million) of deaths were from infectious diseases 64 (4.9 million) of deaths were from infectious diseases 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 40 (3.1 million) of deaths occurred in neonates 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
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Regional Causes of Deaths, 2010 Eastern
Mediterranean and SE Asia
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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)iii72iii87 Data source Pakistan
mortality estimates (Liu et al. 2012). Note
Severe infection includes sepsis, meningitis,
pneumonia and tetanus.
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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)

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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)

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40-Year Trend in Infant and Neonatal Mortality in
Pakistan
IMR has considerably declined NMR remained
constant in last three decades
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Trends in Childhood Mortality in Pakistan,
1990-2013
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(No Transcript)
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Neonatal and Under-Five Mortality Rates, 1990-2010
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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 public34 Pvt) Home 51 HF 59 (14P45 Pvt) Home 41
MMR (PDHS 2006) 276 314
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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.

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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

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PAKISTAN DEMOGRAPHIC AND HEALTH INDICATORS

• POPULATION180 MILLION(6th most populous country
  in the world).
• 146th on human development index out of 190
  countries.
• Decline in U5(95) and IMR(67Thousand 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

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PAKISTAN DEMOGRAPHIC AND HEALTH INDICATORS

• High fertility rate(4.8) Population explosion
• Low contraceptive prevalence(lt30)
• 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 ratio350/100,000 live
  births,25-30 thousand women die each year, one
  mother every 20 minutes.

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PAKISTAN HEALTH and DEMOGRAPHIC INDICATORS

• High U5,IMR,Perinatal and Neonatal mortality
  rates.
• LOW BIRTH WEIGHT 25-33
• Exclusive breast feeding25
• Severe and moderate malnutrition in U5 children
  40
• Per capita food production and calories100
• Safe drinking water ?,Sanitation rural 20.
• Immunization coverage 12-23months lt58
• 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.

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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.

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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.