Baseline Socio-Demographic and Mortality Profile of a Peri-urban Coastal Community in Karachi, Pakistan Before the Introduction of a Comprehensive Maternal, Newborn and Child Health Intervention Package

Abstract Objective Pakistan has the highest neonatal mortality rate and one of the highest under-5 mortality rates in the world, at 42 deaths and 74 deaths per thousand live births respectively. We undertook implementation of an evidence-based maternal, newborn and child health (MNCH) intervention package to reduce under-five mortality in Rehri Goth, a peri-urban coastal community on the outskirts of Karachi, Pakistan. This paper aims to present the socio-demographic and under-5 mortality profile of Rehri Goth prior to implementation of the intervention package. We conducted a detailed census of all households on socio-demographic variables. ResultsOver the course of the census period, 6,962 households were visited. The total population of Rehri Goth was found to be 42,980. The male to female ratio was 52:48. Among adults aged 15 years and above, 67.1% had no formal education. The neonatal mortality and under-five mortality rates were 59 and 109 deaths per 1,000 live births respectively. Rehri Goth has a baseline child mortality rate that is higher than the national average in Pakistan. This provides an opportunity to deliver an evidence-based, targeted MNCH package to reduce child mortality.

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Statement on Infant Mortality

PEDIATRICS ◽

10.1542/peds.78.6.1155 ◽

1986 ◽

Vol 78 (6) ◽

pp. 1155-1160

Author(s):

Keyword(s):

Mortality Rate ◽

Child Health ◽

Infant Mortality ◽

Neonatal Mortality ◽

Mortality Rates ◽

First Year ◽

Postneonatal Mortality ◽

Factors Affecting ◽

Live Births ◽

First Year Of Life

Why Is Infant Mortality Important? Rates of infant mortality are sensitive indicators of a broad range of factors affecting children's health. As such, infant mortality is the "tip of the iceberg" of child health problems, and changes in infant mortality are a signal of factors affecting child health more broadly. In addition to its role as a general gauge of child health, infant mortality itself represents an important health problem. It is well to remember that infant death rates are the highest of any age group less than 65 years. The message conveyed by infant mortality rates if better understood in terms of the causes of mortality at different times during the first year of life. Neonatal Mortality Neonatal mortality rate is defined as the number of infants dying between 0 and 27 days of life per 1,000 live births. These deaths in the first month of life reflect primarily factors associated with health of the mother before and during pregnancy and the special problems of the newborn. Deaths in this age range result chiefly from inadequate intruterine growth (prematurity, intrauterine growth retardation) and congenital anomalies. As a result, neonatal mortality rates provide an indicator of the factors affecting pregnancy, delivery, and the neonate and the adequacy of services in the prenatal, intrapartum, and neonatal periods. Postneonatal Mortality Postneonatal mortality rate is defined as the number of infants dying between 28 days and 11 months of life per 1,000 live births, ie, deaths occurring during the remainder of the first year of life.

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Scoping review protocol on maternal, newborn and child health research in Ethiopia

BMJ Open ◽

10.1136/bmjopen-2019-034307 ◽

2020 ◽

Vol 10 (7) ◽

pp. e034307

Author(s):

Grace J Chan ◽

Misrak Getnet ◽

Ronke Olowojesiku ◽

Thein Min-Swe ◽

Bezawit Hunegnaw ◽

...

Keyword(s):

Mortality Rate ◽

Child Health ◽

Maternal And Child Health ◽

Scoping Review ◽

Health Research ◽

Newborn And Child Health ◽

Live Births ◽

Review Protocol ◽

Child Health Research ◽

And Child Health

IntroductionThere has been a tremendous reduction in maternal and child mortality in the last decade. However, a significant number of deaths still occur disproportionately in low-income country settings. Ethiopia is the second-most populous nation in sub-Saharan Africa with a high maternal mortality rate of 412 deaths per 100 000 live births and an under-five mortality rate of 55 per 1000 live births. This study presents a scoping review protocol to describe the current knowledge of maternal and child health in Ethiopia to identify gaps for prioritisation of future maternal, newborn and child health research.Methods and analysesA search strategy will be conducted in PubMed/MEDLINE, EMBASE and the WHO African Index Medicus. Researchers will independently screen title and abstracts followed by full texts for inclusion. Study characteristics, research topics, exposures and outcomes will be abstracted from articles meeting inclusion criteria using standardised forms. Descriptive analysis of abstracted data will be conducted.Ethics and disseminationData will be abstracted from published manuscripts and no additional ethical approval is required. The results of the review will be shared with maternal and child health experts in Ethiopia through stakeholder meetings to prioritise research questions. Findings will be submitted to a peer-reviewed journal for publication, in addition to national-level and global-level disseminations.

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Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

10.21203/rs.2.11585/v2 ◽

2020 ◽

Author(s):

Lauren Yu-Lien Maldonado ◽

Julia J. Songok ◽

John W. Snelgrove ◽

Christian B. Ochieng ◽

Sheilah Chelagat ◽

...

Keyword(s):

Cohort Study ◽

Health Education ◽

Child Health ◽

Health Behaviors ◽

Pregnant Women ◽

Evidence Based ◽

Matched Cohort ◽

Western Kenya ◽

Newborn And Child Health ◽

And Child Health

Abstract Background: We launched Chamas for Change (Chamas), a group-based health education and microfinance program for pregnant women and their infants, to address inequities contributing to high rates of maternal and neonatal mortality in western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and uptake of evidence-based, maternal, newborn and child health (MNCH) behaviors. Methods: We prospectively compared the uptake of MNCH behaviors between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at health facilities in Busia County to participate in Chamas . Women enrolled in Chamas agreed to attend bi-monthly group health education and optional microfinance sessions for 12 months. We collected baseline sociodemographic data at study enrollment for each cohort. We used descriptive analyses and adjusted multivariable logistic regression models to compare outcomes across cohorts at 6-12 months postpartum, with α set to 0.05. Results: Compared to controls (n=115), a significantly higher proportion of Chamas participants (n=211) delivered in a facility with a skilled birth attendant (84.4% vs. 50.4%, p<0.001), attended at least four ANC visits (64.0% vs. 37.4%, p<0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p<0·001), and received a CHV home visit within 48 hours postpartum (75.8% vs. 38.3%, p<0·001). In our adjusted models, Chamas participants were nearly five times as likely as controls to deliver in a health facility (OR 5.07, 95% CI 2.74-9.36, p<0.001). Though not statistically significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls. Our sensitivity analyses revealed no significant difference in the odds of facility delivery based on microfinance participation. Conclusions: Chamas participation was associated with increased practice of evidence-based MNCH health behaviors among pregnant women in western Kenya. Our findings demonstrate this program’s potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect.

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Retrospective analysis of neonatal deaths secondary to infections in England and Wales, 2013–2015

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-319093 ◽

2020 ◽

pp. fetalneonatal-2020-319093

Author(s):

Godwin Oligbu ◽

Leila Ahmed ◽

Laura Ferraras-Antolin ◽

Shamez Ladhani

Keyword(s):

Mortality Rate ◽

Retrospective Analysis ◽

Neonatal Mortality ◽

Mortality Rates ◽

Neonatal Mortality Rate ◽

England And Wales ◽

Neonatal Deaths ◽

Live Births ◽

Extremely Preterm ◽

Related Mortality

ObjectiveTo estimate the overall and infection-related neonatal mortality rate and the pathogens responsible using electronic death registrations.DesignRetrospective analysis of national electronic death registrations data.SettingEngland and Wales.PatientsNeonates aged <28 days.Main outcome measuresOverall and infection-related mortality rate per 1000 live births in term, preterm (28–36 weeks) and extremely preterm (<28 weeks) neonates; the contribution of infections and specific pathogens; comparison with mortality rates in 2003–2005.ResultsThe neonatal mortality rate during 2013–2015 (2.4/1000 live births; 5095 deaths) was 31% lower than in 2003–2005 (3.5/1000; 6700 deaths). Infection-related neonatal mortality rate in 2013–2015 (0.32/1000; n=669) was 20% lower compared with 2003–2015 (0.40/1000; n=768), respectively. Infections were responsible for 13.1% (669/5095) of neonatal deaths during 2013–2015 and 11.5% (768/6700) during 2003–2005. Of the infection-related deaths, 44.2% (296/669) were in term, 19.9% (133/669) preterm and 35.9% (240/669) extremely preterm neonates. Compared with term infants (0.15/1000 live births), infection-related mortality rate was 5.9-fold (95% CI 4.7 to 7.2) higher in preterm (0.90/1000) and 188-fold (95% CI 157 to 223) higher in extremely preterm infants (28.7/1000) during 2013–2015. A pathogen was recorded in 448 (67%) registrations: 400 (89.3%) were bacterial, 37 (8.3%) viral and 11 (2.4%) fungal. Group B streptococcus (GBS) was reported in 30.4% (49/161) of records that specified a bacterial infection and 7.3% (49/669) of infection-related deaths.ConclusionsOverall and infection-related neonatal mortality rates have declined, but the contribution of infection and of specific pathogens has not changed. Further preventive measures, including antenatal GBS vaccine may be required to prevent the single most common cause of infection-related deaths in neonates.

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Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival

BMJ Global Health ◽

10.1136/bmjgh-2019-002214 ◽

2020 ◽

Vol 5 (1) ◽

pp. e002214 ◽

Cited By ~ 1

Author(s):

Nadia Akseer ◽

James Wright ◽

Hana Tasic ◽

Karl Everett ◽

Elaine Scudder ◽

...

Keyword(s):

Maternal Health ◽

Child Health ◽

Children And Adolescents ◽

Child Mortality ◽

Breast Feeding ◽

Low Income ◽

Mortality Rates ◽

Health Interventions ◽

Data Set ◽

And Child Health

IntroductionConflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, maternal, newborn and child health interventions between conflict and non-conflict low-income and middle-income countries (LMICs).MethodsWe carried out a time-series multicountry ecological study using data for 137 LMICs between 1990 and 2017, as defined by the 2019 World Bank classification. The data set covers approximately 3.8 million surveyed mothers (15–49 years) and 1.1 million children under 5 years including newborns (<1 month), young children (1–59 months) and school-aged children and adolescents (5–14 years). Outcomes include annual maternal and child mortality rates and coverage (%) of family planning services, 1+antenatal care visit, skilled attendant at birth (SBA), exclusive breast feeding (0–5 months), early initiation of breast feeding (within 1 hour), neonatal protection against tetanus, newborn postnatal care within 2 days, 3 doses of diphtheria, pertussis and tetanus vaccine, measles vaccination, and careseeking for pneumonia and diarrhoea.ResultsConflict countries had consistently higher maternal and child mortality rates than non-conflict countries since 1990 and these gaps persist despite rates continually declining for both groups. Access to essential reproductive and maternal health services for poorer, less educated and rural-based families was several folds worse in conflict versus non-conflict countries.ConclusionsInequalities in coverage of reproductive/maternal health and child vaccine interventions are significantly worse in conflict-affected countries. Efforts to protect maternal and child health interventions in conflict settings should target the most disadvantaged families including the poorest, least educated and those living in rural areas.

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Cultural Value Factors That Affect Mother and Child Health

Jurnal Perempuan ◽

10.34309/jp.v24i3.341 ◽

2019 ◽

Vol 24 (3) ◽

pp. 165

Author(s):

Inang Winarso ◽

Ressa Ria Lestari

Keyword(s):

Mortality Rate ◽

Child Health ◽

Infant Mortality ◽

Cultural Values ◽

Child Mortality ◽

Infant Mortality Rate ◽

Cultural Elements ◽

Mother And Child Health ◽

Mother And Child ◽

And Child Health

<p>Mother and child health as a key indicator of community welfare is measured by the Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR). But why have efforts to reduce MMR and IMR not yet reached the target? This research answers this question by using an approach of cultural values in mother and child health. The focus of this research is on the human life cycle starting from marriage, pregnancy, birth and death in Situbondo Regency, East Java and Ngada Regency, NTT. Research has found four cultural elements that predominantly influence health beliefs, family and community decisions in dealing with maternal and infant health problems. These cultural elements are the religious system, the kinship system, the knowledge system and the livelihood system. These four systems can increase or decrease the risk of maternal and infant mortality. The government must consider the cultural values of the community in making health policies. First, strengthen factors that reduce the risk of maternal and child mortality. Second, reduce the factors that increase the risk of maternal and child mortality.</p>

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Evaluation of a maternal, neonatal and child health intervention package in a rural district of Pakistan: a quasi-experimental study

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20195040 ◽

2019 ◽

Vol 6 (11) ◽

pp. 4682

Author(s):

Muhammad Atif Habib ◽

Kirsten I. Black ◽

Camille Raynes Greenow ◽

Mushtaq Mirani ◽

Sajid Muhammad ◽

...

Keyword(s):

Child Health ◽

Neonatal Mortality ◽

Continuum Of Care ◽

Health Intervention ◽

Intervention Package ◽

Local Evidence ◽

Quasi Experimental ◽

Care Practices ◽

And Child Health ◽

Child Health Intervention

Background: Pakistan is among the countries which have the highest maternal, neonatal and child mortality rates. Immediate efforts are required to enable Pakistan to achieve the health related sustainable development goals. The continuum of care interventions can substantially reduce the mortality burden, however local evidence to implement them is lacking in Pakistan. We implemented the maternal, neonatal and child health intervention package comprised of health facility strengthening, capacity building, continuum of care interventions and community mobilization and evaluated its effectiveness on maternal, neonatal and child health care practices and neonatal mortality.Methods: The intervention package was delivered through existing public health system in a rural district of Pakistan. We used a quasi-experimental design to assess the impact of interventions. Baseline and end line surveys were conducted and neonatal mortality was considered as the primary outcome measure. Data were analysed using bivariate and difference and difference analysis techniques.Results: We found a reduced risk of neonatal mortality (RR 0.704; 95% CI 0.557-0.889; p=0.0033), in intervention areas compared to control area. For secondary outcomes; including mortality for infants and under five children, antenatal care, skilled birth attendance, institutional deliveries, postnatal care, delayed bathing, inappropriate cord care practices, birth asphyxia, exclusive breastfeeding and immunization a significant difference (p<0.001) was observed in the intervention area compared to control area.Conclusions: This study provides local evidence from Pakistan that effective methods for delivering MNCH interventions within the existing health infrastructure can improve the MNCH outcomes especially in the rural areas.

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Association of maternal and child health related variables with decline in infant mortality rate in Punjab, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20175330 ◽

2017 ◽

Vol 4 (12) ◽

pp. 4558

Author(s):

Harjot Kaur ◽

Tarundeep Singh ◽

PVM Lakshmi

Keyword(s):

Mortality Rate ◽

Child Health ◽

Infant Mortality ◽

Maternal And Child Health ◽

Health Indicators ◽

Infant Mortality Rate ◽

Rapid Decline ◽

Live Births ◽

Children Ever Born ◽

And Child Health

Background: Infant mortality rate (IMR) is a sensitive indicator for monitoring child health and survival. Punjab state in North India is performing better than most of the other states in various health indicators. Punjab’s IMR has shown a rapid decline from 38/1000 live births in 2008 (Sample registration system (SRS) 2008) to 24/1000 live births in 2014 (SRS 2014). This study was planned to assess which of the maternal and child health services is associated with rapid decline in infant mortality rate. Methods: Association between various components of prenatal care, intranatal care and postnatal care, and child healthcare and socio demographic variables (taken from secondary data of District Level Household Surveys) and Infant Mortality Rate (taken from SRS) of Punjab was studied. Spearman correlation coefficient was calculated to measure the association between the variables. Results: Total fertility rate (TFR), women who had institutional deliveries, safe deliveries and mean children ever born are statistically significantly associated with decline in infant mortality rate. Conclusions: In Punjab, maternal and child health indicators are directly or indirectly associated with decline in infant mortality rate. Findings of the study demonstrate that the recent rapid decline in IMR of Punjab is strongly associated with increase in institutional deliveries and decline in TFR and the mean number of children ever born.

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State Reporting of Live Births of Newborns Weighing Less Than 500 Grams: Impact on Neonatal Mortality Rates

PEDIATRICS ◽

10.1542/peds.78.5.850 ◽

1986 ◽

Vol 78 (5) ◽

pp. 850-854

Author(s):

Ann L. Wilson ◽

Lawrence J. Fenton ◽

David P. Munson

Keyword(s):

Mortality Rate ◽

Neonatal Mortality ◽

Live Birth ◽

Mortality Rates ◽

World Health ◽

Neonatal Mortality Rate ◽

Live Births ◽

The World ◽

Definition Of ◽

Health Organization

The National Center for Health Statistics reports that in 1983 65% of all infant deaths in the United States occurred in the neonatal period. Of these reported neonatal deaths, 17% were of infants weighing less than 500 g at birth. There was, however, variation in state-reported incidence of live births of newborns in this weight cohort (0.2 to 2.2 per 1,000 live births). Thé states with the lowest neonatal mortality rate have the lowest incidence of birth weights less than 500 g (ρ = .77). If it is assumed that mortality for this weight category is nearly 100%, there is marked variation (5% to 32%) in the contribution of this weight cohort to a state's total neonatal mortality rate. Contributing to this variation may be definitions of live birth used by states. The World Health Organization defines a live birth as the product of conception showing signs of life "irrespective of the duration of pregnancy" and this definition is used by 33 states. Only one state (Ohio) includes the gestational criteria of "at least 20 weeks" in its definition of live birth. There is evidence to suggest that definitions are not uniformly used within individual states. For example, in 1983, 20 states did not report any live births with weights less than 500 g among their "other" populations of nonwhite, nonblack residents. Half of these states, however, use the World Health Organization definition of live birth. Despite the exclusionary wording in Ohio's definition of live birth, 16% of newborns who died in that state had birth weights less than 500 g. Inconsistency in state definitions and possible variations in reporting live births less than 500 g affect state comparisons of infant and neonatal mortality rates.

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