National programmes for maternal and newborn care need to be integrated as maternal and child health in Pakistan still present a sorry state. In terms of infant mortality, Pakistan ranks 183rd out of 220 countries around the globe.
Health experts believe that investment in maternal and child health as a central focus in public health policy is critical. In Pakistan, the maternal mortality ratio ranges from 350-400 per hundred thousand births while infant mortality rate is 77 per thousand live births and under-five mortality rate is 94 deaths per 1,000 live births. Statistics reveal that one in 11 children born in Pakistan die before his fifth birthday.
Over half of deaths under five occur during the neonatal period (under 1 month) while 26% occur during the postneonatal period. Infant and child mortality has hardly changed in over a decade and newborn deaths account for large percentage of the under-five mortality in the country.
“Each year an estimated more than 400,000 children under the age of five die and nearly 16,500 mothers die from pregnancy-related causes in our country that is 36 maternal deaths occur per day, three deaths every two hours, which ranks 183rd out of 220 countries in terms of infant mortality,” said Professor of Community Medicine Dr Muhammad Ashraf Chaudhry while talking to ‘The News’ on poor condition of maternal and child health in Pakistan adding 10 per cent mothers die on their way to healthcare facility due to lack of proper transportation.
“Maternal mortality ratio in rural areas is almost double than that of urban areas,” said Dr Ashraf adding according to Unicef, a woman in Pakistan has a one-in-31 lifetime risks of death from causes related to pregnancy and childbirth.
At the global level, every minute a woman dies in pregnancy or childbirth; over 500,000 every year. In addition, for every woman who dies in childbirth, around 20 more suffer injury, infection or disease - approximately 10 million women each year. “Every year, over one million newborn die within their first 24 hours of life for lack of quality of care and ninety-nine percent of deaths occur in developing countries,” responded Dr Ashraf to a query adding Millennium Development Goal 5 (MGD 5) aims to improve maternal health and reduce maternal mortality by 75% by 2015 and MGD 4 aims to reduce child mortality.
“Currently, the main health problems affecting the health of the mother and the child in Pakistan revolve round the triad of malnutrition, infection and the consequences of unregulated fertility,” he said and added that associated with these problems is the scarcity of health and other social services in vast areas of the country together with poor socio-economic conditions.
Direct causes of maternal deaths are haemorrhage, hypertensive diseases, eclampsia (very high blood pressure leading to seizures), sepsis, abortions, and obstructed labour and ruptured uterus. “Postpartum haemorrhage is the leading cause of maternal deaths, followed by puerperal sepsis and eclampsia. Obstetric bleeding (postpartum and ante partum haemorrhage) is responsible for one third of all maternal deaths,” said Dr. Ashraf adding all this might be due to poor quality emergency care and maternal health services in the country.
Indirect causes of maternal deaths are complications of infectious diseases such as hepatitis, cancer, tuberculosis, and gastrointestinal disorders. “Pakistan has been witnessing an increasing prevalence of hepatitis,” said Dr Ashraf adding risk factors associated with maternal mortality and morbidity are young age marriages, marriages below 18 years, unbooked status (women who have not registered themselves for antenatal care), high parity (women who had more than five deliveries), short birth interval below 24 months, poor previous pregnancy outcome, poverty, illiteracy and delay in seeking care/or inappropriate care.
Responding to a query, he said that major causes/risk factors for childhood morbidity and mortality include low birth weight, malnutrition, birth asphyxia, sepsis, prematurity, diarrhoea, pneumonia, injuries, malaria, measles, and meningitis. “Children of very young and very old women experience the highest risk of death,” he said adding public should be made aware that the length of birth interval has a significant correlation with a child’s chance of survival. Mother’s level of education is also strongly linked to child survival. Size of the child at birth also has a bearing on childhood mortality rates. “Children whose birth size is small have a 68% greater risk of dying before their first birthday than those whose birth size is average. Probability of dying in early childhood is much greater if they are born to mothers with high parity. Sixty-two children per thousand fall in the high-risk category in Pakistan,” said Dr Ashraf.
“Although the current picture is gloomy, one must not get disappointed,” said Dr Ashraf while talking of the remedies and added vast majority of maternal deaths could be prevented if women have access to quality family planning services, skilled care during pregnancy, childbirth and the first month after delivery. “15% pregnancies and childbirths need emergency care because of risk that is difficult to predict and a working health system with skilled personnel is key to saving these women’s lives.”
Majority of deaths in children can also be prevented by early and exclusive breastfeeding, provision of clean drinking water, hand washing after toilet, vaccination (especially measles and polio), vitamin A supplementation, use of insecticide treated nets to prevent malaria and dengue and prevention and treatment of HIV/AIDS, he said adding the high rates of maternal and child deaths are convincing that national programs for maternal and newborn care need to be integrated and also scaled up if Pakistan is to meet its Millennium Development Goals 4 and 5.
Nearly three-fourth deaths occur during delivery and the postpartum period. High quality care during these periods - especially to prevent and manage postpartum haemorrhage - is crucial to prevent deaths. “Although Pakistan has initiated National Maternal, Neonatal & Child Health programme worth billions of rupees budget, but so far this programme has failed to bring down maternal and child mortality in the country,” said Dr. Ashraf adding some impressive examples from the region, such as Karalla and Sri Lanka however indicate that it is possible to improve maternal and child health.
He added that sustainable long-term investment is needed to reduce the burden of morbidity and mortality among women and children. “To achieve desired results, males should also be involved in women’s health programs as in Iran, where it is mandatory for young man and woman to attend a marriage course before entering wedlock.”
source:www.thenews.com.pk
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