Under five mortality and its prevention

Under five mortality and its prevention

1. CHILD MORTALITY AND ITS PREVENTION BRIG HEMANT KUMAR

2. CHILD MORTALITY RATE The ratio of under five child deaths registered in a given year to the total number of live births registered in the same year; are expressed as a rate per 1000 live births. UNDER FIVE MORTALITY RATE : No. of deaths under five years of age in a year ×1000 Number of live births in the same year 4 April 2019 BRIG HEMANT KUMAR 2

3. CHILD MORTALITY RATE Number of deaths under Five years of age Total live birth in the year 1000

4. INFANT MORTALITY RATE It is the number of infant deaths under one year of age per 1000 live births in one year.

5. INFANT MORTALITY RATE Number of deaths under one year of age Total live birth in the year 1000

6. NEONATAL MORTALITY RATE NMR = 1000 No. Of deaths under 28 days of age Total live births

7. Still birth= Fetal deaths weighing over 1000gms at birth Total live + still births weighing over 1000gms at birth 1000

8. GLOBAL TRENDS 8

9. GLOBAL CURRENT UNDER FIVE MORTALITY RATE ??? 9

10. GLOBAL U5MR 43/1000 6 MILLION 4 April 2019 BRIG HEMANT KUMAR 10

11. There were 5.9 million under five deaths Globally during 2015, Though the mortality rate has decreased by 53%, from 91 /1000 in 1990 to 43 deaths / 1000 in 2015 . The average annual rate of reduction in under-five mortality has accelerated – from 1.8% a year over the period 1990–2000 to 3.9% for 2000–2015 – but remains insufficient to reach MDG 4 11

12. WHICH REGION HAS HIGHEST MORTALITY ??? 4 April 2019 BRIG HEMANT KUMAR 12

13. African Region (81 per 1000 live births), about 7 times higher than that in the WHO European Region (11 per 1000 live births). 13

14. In 2015, the under-five mortality rate in low-income countries was 76 deaths per 1000 live births – about 11 times the average rate in high-income countries (7 deaths per 1000 live births). 14

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16. INDIAN SCENARIO 16

17. India has the highest number of child deaths in the world, with an estimated 1.2 million deaths in 2015 — 20 per cent of the 5.9 million global deaths . 17

18. Other countries in the top five for number of deaths included: Nigeria (7,50,000), Pakistan (4,31,000), Democratic Republic of the Congo (3,05,000) and Ethiopia (1,84,000). 18

19. WHAT IS INDIA’S UNDER FIVE MORTALITY RATE ?? 4 April 2019 BRIG HEMANT KUMAR 19

20. 48/39 4 April 2019 BRIG HEMANT KUMAR 20

21. G lobally the under-five child mortality has reduced only by 48 per cent… whereas in India by 2015 we had reduced the under-five child mortality by 61 per cent,”

22. STATES ??? 4 April 2019 BRIG HEMANT KUMAR 22

23. 4 April 2019 BRIG HEMANT KUMAR 23

24. INFANT MORTALITY RATE 24

25. GLOBAL SCENARIO 25

26. ?????????? 4 April 2019 BRIG HEMANT KUMAR 26

27. 32 4.5m 4 April 2019 BRIG HEMANT KUMAR 27

28. Globally , the  infant mortality rate  has decreased from an estimated  rate  of 63 deaths  per 1000 live births in 1990 to 32 deaths  per 1000 live births in 2015 . Annual infant deaths  have declined from 8.9 million in 1990 to 4.5 million in 2015 . 28

29. National health programme for children has led to a 68% drop in India’s infant mortality rate (IMR), But the IMR of 41 deaths per 1,000 live births is still worse off than poorer neighbours Bangladesh (31) and Nepal 29

30. CURRENT IMR 37/26 4 April 2019 BRIG HEMANT KUMAR 30

31. STATES ??? 4 April 2019 BRIG HEMANT KUMAR 31

32. 4 April 2019 BRIG HEMANT KUMAR 32

33. CAUSES OF UNDER FIVE MORTALTY 33

34. NEONATAL MORTALITY (0-4 WEEKS) POST-NEONATAL MORTALITY (1-12 MONTHS) Low birth weight and prematurity Birth injury and difficult labour Sepsis Congenital anomalies Haemolytic diseases of newborn Conditions of placenta and cord Diarrhoeal diseases Acute respiratory infections Tetanus Diarrhoeal diseases Acute respiratory infections Other communicable diseases Malnutrition Congenital anomalies Accidents 4 April 2019 BRIG HEMANT KUMAR 34

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36. FACTORS AFFECTING INFANT MORTALITY 36

37. 1. BIOLOGICAL FACTORS (a) Birth weight: - babies of low birth weight - and high birth weight are at special risk. - causes: poor nutrition during pregnancy.. (b) Age of the mother: - IMR are greater when the mother is either very young or relatively older. 4 April 2019 37

38. (C) BIRTH ORDER ??? 4 April 2019 BRIG HEMANT KUMAR 38

39. - the highest mortality is found among first born , and the lowest among those born second. - The risk of infant mortality escalates after the third birth. - the fate of fifth and later children is always worse than the fate of the 3 rd child. 39

40. (d) Birth spacing - repeated pregnancies- malnutrition and anaemia in the mother- predispose to LBW.. - prematurely weaned- PEM, diarrhoea and dehydration. ( e) Multiple Pregnancies - Infants born in multiple births face a greater risk of death than do those in single births due to the greater frequency of low birth weight among the former. 40

41. (f)Family size - the number of episodes of infectious diarrhea, prevalence of malnutrition, and severe respiratory infections have been found to increase with family size. - fewer children-better maternal care, a better share of family resources, less morbidity and greatly decreased infant mortality. 41

42. (g) High fertility high fertility and high infant mortality go together. 42

43. ECONOMIC FACTORS The availability and quality of health care and the nature of the child’s environment are closely related to socio-economic status . 43

44. 3. CULTURAL AND SOCIAL FACTORS (a)Breast feeding: Early weaning and bottle-fed infants living under poor hygienic conditions are more prone to die than the breast-fed infants living under similar conditions . 44

45. ( b) Religion and caste The differences are attributed to socio-cultural patterns of living, involving age-old habits, customs, traditions affecting cleanliness, eating, clothing, child care and almost every detail of daily living. (c) Early marriages ..teen-age mother- greater risk of neonatal and post-neonatal mortality. 45

46. (d) Sex of the child Statistics show that female infant mortality is higher than the male infant mortality. ( e) Quality of mothering (f) Maternal education Women with schooling tend to marry later, delay child- bearing and are more likely to practice family planning . 46

47. (g) Quality of health care Shortage of trained personnel like dais, midwives and health visitors is another determinant of high mortality in India. According to estimates only 47% of the deliveries are attended by trained birth attendants. ( f) Broken families (g) Illegitimacy 47

48. (j) Brutal habits and customs -depriving the baby of the first milk or colostrum, frequent purgation, branding the skin, application of cow-dung to the cut end of umbilical cord, faulty feeding practices and early weaning. (k) The indigenous dai -..untrained midwife- unhygienic delivery. (l) Bad environmental sanitation 48

49. PREVENTIVE MEASURES 49

50. 1. Prenatal nutrition - improve the state of maternal nutrition.. 2. Prevention of infection - eg . Neonatal tetanus, UIP- protect against 6 vaccine preventable diseases . 3. Breast feeding - gastro-intestinal, respiratory infections and PEM. 50

51. 4. Growth monitoring - all infants should be weighed periodically and their growth charts maintained. - these charts help to identify children at risk of malnutrition early. 5. Family planning - smaller sib ship and longer spacing between pregnancies are associated with improved infant and child survival. 51

52. 6. SANITATION - poor sanitation and environmental conditions exposes the infant to various infections. 7 . PROVISION OF PRIMARY HEALTH CARE - all those involved in maternity care ( obstetrician-local dai) should collaborate and work together as a team. 52

53. 8.SOCIO-ECONOMIC DEVELOPMENT T his must include spread of education, improvement of nutritional standards, improvement of housing conditions, the growth of agriculture and industry . 53

54. 9. Education Educated women generally do not have early pregnancies, are able to space their pregnancies, have better access to information related to personal hygiene and care of their children, and make better use of health care services. 54

55. NHM 1 Under the Millennium Development Goal (MDG) 4 target is to reduce Child Mortality by two-third between 1990 and 2015. In case of India, it translates into a goal of reducing Infant mortality rate from 88 per thousand live births in 1990 to 29 in 2015. 55

56. Promotion of institutional deliveries through Janani SurakshaYojana . Operationalization of sub-centres, Primary Health Centres, Community Health Centres and District Hospitals for providing 24x7 basic and comprehensive obstetric care services. 56

57. Antenatal, intranatal and postnatal care including Iron and Folic Acid supplementation to pregnant & lactating women for prevention and treatment of anaemia. Engagement of more than 8.9 lakhs Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community. 57

58. Thank you 58