Newborn Care: Global Situation and Practices in Pakistan
Monday, July 7th, 2008Muhammad Umair Mushtaq, a fourth year MBBS student from Allama Iqbal Medical College in Pakistan, writes on newborn care in Pakistan, including the challenges of the current health care system and recommendations for possible solutions.
About 4 million newborns under 4 weeks old perish each year, accounting for 37% of all under-five deaths.[1] Nearly 75 % die in the first week and 40% in the first 24 hours after birth. Newborns in developing countries are eight times more likely to die than newborns in industrialized countries.[2] Ninety-nine percent of all newborn deaths occur in developing countries.[3]
Pakistan has a population of about 160 million and a per capita GDP of 736 US$, with only 2.4% of GDP being spent on health.[4] The current newborn health status of Pakistan is characterized by a high incidence of low birth-weight babies and neonatal mortality. About 0.3 million newborns die each year (Figure 3) with a neonatal mortality rate of 57 per 1000 live births (Figure 2) . About 19% of all newborns have low-birth weight and only 16% of all babies are exclusively breastfed.[5] Neonatal diseases are a major cause of mortality, with 55.7% deaths among children under-5 years.[4] Pakistan is a signatory to the Millennium Development Goal targets of reducing maternal and infant mortality by 66-75% by the year 2015.[6]
To achieve the Millennium Development Goals related to newborn health, many international organizations are working in collaboration with national governments to improve mother and newborn health, such as Partnership for Maternal, Newborn and Child Health (PMNCH), United Nations Development Fund, United Nations Children’s Fund (UNICEF), and World Health Organization (WHO).
In most instances, neonatal deaths result from poor maternal care during pregnancy, poor hygiene during delivery, unskilled management of complications, harmful traditional practices, inadequate newborn care, and lack of access to emergency care. 15% of newborn infants weigh less than 2,500 g, the proportion ranging from 6% in developed countries to more than 30% in least developed parts of the world, the main cause being preterm birth.[2] In Pakistan, intrapartum or early postnatal deaths are common and the perinatal mortality rate is 59 per 1,000 total births.[2] This is mostly due to maternal infections or nutrient deficiency and an absence of appropriate obstetric and neonatal care. In developing countries, asphyxia causes around 7 deaths per 1,000 births, whereas in developed countries this proportion is less than 1 death per 1,000 births. 26% of newborn deaths occur as a result of severe infections like sepsis and pneumonia.[2] Exact figures are not known for Pakistan, but the situation is not much better. Globally, neonatal tetanus causes 7% neonatal deaths. Although neonatal tetanus has been eliminated from many countries by maternal tetanus toxoid (TT) immunization, there are over 50 countries where, in some districts, the proportion of cases of neonatal tetanus is 1 per 1k000 births.[2] In Pakistan, about 80% of newborns are prevented from neonatal tetanus by TT immunization, but cases are frequent in remote and rural areas.[7]
Table 1: Estimates of stillbirths, early neonatal, perinatal and neonatal mortality rates and numbers, 2000


