Focus on Newborn Survival Needed in Rural Pakistan. (Child Survival)

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Focus on Newborn Survival Needed in Rural Pakistan. (Child Survival)


Child survival programs in the developing world have typically focused on the post-neonatal period, the interval from one month of age to one year of age. This time of life has been targeted because cost-effective treatments and preventive medicine, such as childhood immunization and oral rehydration, exist for the most common ailments that occur then. These interventions, which gained momentum in the 1980s and continue today, have significantly reduced infant and child deaths in much of the developing world. As deaths in the postneonatal period become less common, however, an increasing proportion of infant deaths occur in the neonatal period, the first month of life. Limited data exist on the causes of neonatal death in developing countries. To address this dearth of information, Population Council program associate Fariyal F. Fikree used population-based surveys and in-depth interviews to gather data on infant mortality in rural Pakistan. She collaborated with Syed Iqbal azam of Aga Khan University in Pakistan and Heinz W. Berendes of the National Institutes of Health.

Assessing infant mortality

The researchers conducted surveys and interviews in selected sites in Balochistan and North-West Frontier Province, including the Federally Administered Tribal Areas of that province. These surveys collected information on the level and clinical causes of maternal and infant mortality and their associated risk factors. The field work was conducted during 1990-91 in Balochistan, in 1991-93 in North-West Frontier Province, and in 1994 in the Federally Administered Tribal Areas. These largely rural regions were selected to reflect various levels of socioeconomic development, and accessibility, and availability of health care personnel. In all of these areas, 90 percent of births occurred at home with the assistance of traditional birth attendants or family members.

The results showed that as infant mortality decreased, the proportion of neonatal deaths rose. In Balochistan the infant mortality rate was 129 per 1000 live births; 51 percent of these deaths happened in the neonatal period. In the Federally Administered Tribal Areas, where the infant mortality rate was 106 per 1000 live births, neonatal deaths accounted for 57 percent of these deaths. In North-West Frontier Province, where infant mortality was lowest, 70 per 1000 live births, the proportion of infant deaths that occurred in the neonatal period was highest, 67 percent.

Tetanus

"We found that tetanus was the predominant cause of neonatal deaths in North-West Frontier Province, where it caused 23 percent of deaths in the first month of life, and in the Federally Administered Tribal Areas, where it caused 36 percent of neonatal deaths," says Fikree. Tetanus was less common in Balochistan, causing only 5 percent of neonatal deaths. …

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