24 February 2004	Tuesday	03 Muharram 1425

KARACHI, Feb 23: Low birth weight, tetanus and birth asphyxia are some of the major causes behind almost two-third of around 270,000 neonatal deaths annually in the country and 60 per cent of these deaths occur during the first week of life.

According to a report titled "State of the World's Newborns: Pakistan", 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 new-born to health facilities, most are not well equipped to treat birth asphyxia.

Though the report says that the data has been gathered from hospitals and a limited number of community-based studies, it remains a fact that around 82 per cent of births take place at home. The relevant studies show that approximately one-quarter of all Pakistani new borns are low birth weight which cause over half of neonatal deaths.

According to the report, these deaths are all the more tragic for being largely preventable by low-cost 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 data states that a close correlation exists between low birth weight and maternal malnutrition coupled with social and economic status of mothers, especially the lack of education and empowerment.

In spite of longstanding efforts, Pakistan currently has the third highest burden of deaths owing to neonatal tetanus in the world. The World Health Organisation estimates that 26,400 neonates died of tetanus in 1997. The report shows that only 52 per cent of all pregnant women in Pakistan are receiving anti- tetanus immunization.

It states that certain newborn care practices are also believed to contribute to high neonatal mortality and it is found that cord cutting is unhygienic and contributes to tetanus and other infections.

The negation of newborn's right to have exclusive and un-sustained breast-feeding during the crucial first month also contribute in the neonatal deaths, the report adds.

Another study conducted in Karachi found that only nine per cent of infants were being given exclusive breast-feeding for one month. On the whole, rural women seem to breast-feed more consistently than urban women. Colostrum is traditionally being discarded. However, according to recently collected data, some 43 per cent of women in Karachi and 57 per cent of women in Lahore have changed their attitude and mothers are giving colostrum to their newborns.

Save the Children, a non-governmental organization, 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.

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. Poverty and ignorance of the need for supplements are cited 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 daees (traditional birth attendants). Around 82 per cent deliveries are conducted at home, while skilled staff attends only 18 per cent of these deliveries. On the same pattern, only 11 per cent women get postpartum care.

It is reported that daees often do not recognize common danger signs like prolonged or obstructed labour and antepartum haemorrhage. The mother mortality in Pakistan, considered as the highest in the region, has apparently not declined in the last four decades and the most common causes of maternal mortality are haemorrhage, sepsis, and eclampsia. - PPI