LAHORE, Nov 12: Low birth weight, tetanus and birth asphyxia are causing almost two-thirds of around 270,000 neonatal deaths annually in the country. Some 60 per cent of these deaths occur during the first week of life.

The total neonatal mortality rate is roughly 10 times higher in Pakistan as compared to the developed countries.

The high rate of birth asphyxia is being compounded by the fact that babies are generally born at home and even if parents take their newborn to health facilities, most are not equipped to treat birth asphyxia owing to lack of equipment and medication.

This has been stated in a report on the “State of the World’s Newborns: Pakistan” launched by the Save the Children USA under its Saving Newborn Lives (SNL) initiative here on Monday.

The report, however, says that the data has been gathered from hospitals and a limited number of community-based studies. It is, however, a fact that around 82 per cent of births take place at home.

The report says that these deaths are all the more tragic for being largely preventable by low-cost and low-tech interventions well within the capacity of the existing health system. It emphasizes the need to increase the knowledge of essential newborn care and access to the means to save them.

The relevant studies show that approximately one-quarter of all Pakistani newborns are low birth weight which cause between half and three-quarters of all neonatal deaths. The data suggests a close correlation between low birth weight and maternal mal-nutrition coupled with social and economic status of mothers, specially the lack of education and empowerment.

In spite of longstanding efforts, Pakistan currently has the third highest burden of death owing to neonatal tetanus in the world. The World Health Organization estimates that 26,400 neonates died of tetanus in 1997, 26 per cent less than in 1990.

Other infections like diarrhoea (two to 21 per cent), acute respiratory infections (eight to 45 per cent), sepsis (nine to 73 per cent) and meningitis (two to seven per cent) still represent potentially lethal problems for neonates.

The report shows that only 52 per cent of all pregnant women in Pakistan are receiving anti-tetanus immunization.

It says that certain newborn care practices are also believed to contribute to high neonatal mortality. It is found that cord cutting and cord care are unhygienic and contribute to tetanus and other infections. The negation of newborn’s right to have exclusive and unsustained breastfeeding during the crucial first month also contribute in the neonatal deaths.

A study in Lahore found that only nine per cent of infants are being given exclusive breastfeeding at one month. On the whole, rural women seem to breast-feed more consistently than urban women. Colostrum, or first milk, is traditionally being discarded.

However, a recent data — 43 per cent of women in Karachi and 57 per cent of women in Jhelum —- suggests that this attitude is changing and mothers giving colostrum to their newborns.

The Save the Children has identified different risk factors contributing to high neonatal mortality in Pakistan. They include high percentage of home deliveries unattended by skilled care, birth interval of less than 24 months, pregnancy order greater than six, and maternal or paternal illiteracy.

MOTHERS AND NEWBORNS: The health of a mother is inextricably linked to the health and survival of the newborn. In this context, the low tetanus-toxoid immunization rate among pregnant women in Pakistan and the correspondingly high rate of neonatal tetanus (third highest in the world) are a cause for great concern.

Two other key factors in a mother’s health are nutrition and anaemia. The indicators show that nearly 40 per cent of pregnant women are malnourished and anaemic and eventually deliver low birth weight babies, which is considered as the main factor of neonatal mortality.

It is widely held that most women eat less during pregnancy while only 19 per cent report increase in their food intake; only 25 per cent take iron supplements, most beginning only in the sixth month, citing poverty and ignorance of the need for supplements as the main reasons.

In Pakistan, only 30 per cent of women seek any kind of antenatal care while only one-third of them seek care from dais (traditional birth attendants). Around 82 per cent deliveries are conducted at home, while only 18 per cent of these deliveries are attended by skilled staff. On the same pattern, only 11 per cent women get postpartum care. It is reported that dais often do not recognize common danger signs like prolonged or obstructed labor and antepartum haemorrhage.

The mother mortality in Pakistan is also among the highest in the region and has apparently not declined in the last four decades. The most common causes of maternal mortality are haemorrhage, sepsis, and eclampsia.

Studies have shown that newborns whose mothers die are eight times more likely to die themselves than those whose mothers live.

At the launching ceremony, Prof Dr Fehmida Jalil presented a situational analysis on the ‘Newborn health and survival in Pakistan’. She said the masses had inadequate information about newborn and maternal health.

Former health secretary Ismail Qureshi, Save the Children USA country manager Bruce Rasmussen and Dr Shaheena Ayaz, on behalf of the Punjab Health Services director-general, also spoke on the occasion.