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THE sudden spike in newborn deaths in the districts of Vehari and Sargodha has focused media attention on the issue of mother and child health in a way not seen in recent years.
First, in September, eight newborn babies died in the district headquarter hospital Vehari. Although newspaper headlines mentioned the ‘mysterious’ nature of their deaths, there was nothing mysterious about them. Most media reports were consistent in suggesting a lack of oxygen and insufficient number of incubators as the cause. Not far behind was speculation of medical negligence, which such cases reflexively generate. As usual, prompt notice was taken of the tragedy and the concerned official duly suspended.
One month later, the same tragedy was repeated in Sargodha where 18 to 22 newborn babies died within the space of a week. With the death toll mounting, the chief minister reacted by suspending the medical superintendent. Here too, the cause of the deaths was the same: lack of oxygen and insufficient number of incubators, all made worse by some degree of medical negligence.
The hospital administration denied that the oxygen-incubator-medical negligence combination was the trigger for the sudden rash of deaths. With the intervention of the Supreme Court, the likelihood has increased that what led to them will come to light. However, irrespective of the speculation, these deaths have brought health systems and neonatal mortality in the country into sharp focus.
Pakistan tops the list of newborn deaths on the first day.
Neonatal mortality is linked with a number of factors. They range from maternal health, nutritional status, premature and low birthweight newborns, pre-existing and new infections, early marriage and pregnancy at a young age, lack of quality, accessible and affordable antenatal care, and low uptake of contraception and breastfeeding.
Pakistan has one of the highest neonatal mortality rates — ie the number of neonates dying within 28 days of their birth — in the world. Since 1990, Pakistan’s neonatal mortality rate has stayed almost unchanged at 55 newborn deaths per 1,000 live births. This shocking figure largely feeds into the worryingly high under-five mortality rate that stands at 274 per 10,000 live births.
According to a recent report by Save the Children, Pakistan tops the list of newborn deaths on the first day with 15 deaths per 1,000 live births. That, in layman’s terms, works out to a distressing 200,000 infant deaths on the first day of birth. Premature babies — born before 37 weeks — constitute the bulk of these deaths. Pakistan ranks eighth in the world with 15.8 premature babies per 100 live births against the global average of 10.
Yet these newborn deaths are eminently preventable with little investment and a little bit of planning and forethought. First, as highlighted by the deaths in Sargodha and Vehari, the state of newborn care has to be thoroughly studied, its status assessed and a holistic strategy chalked out.
Second, there must be huge investment in antenatal healthcare. This plays a vital role in lowering neonatal mortality by ensuring that mothers are healthy and informed about nutritional and other newborn-related aspects such as breastfeeding. It also prevents and lowers the incidence of pre-term and low birthweight babies.
Third, all births should be attended by skilled birth attendants. A major reason for neonatal mortality here is the abysmally low coverage of skilled birth attendants.
Fourth, management of pre-term, low birthweight and newborn babies is of utmost importance.
Fifth, highly skilled and well-equipped newborn hospital care is of critical importance. I suspect that in both the Sargodha and Vehari newborn deaths, the neonatal nurseries at the hospitals concerned were underequipped with few number of places in relation to the scale of referrals. In order to prevent such deaths from recurring it is vital that public-sector hospital services be adequately resourced, equipped and staffed taking into account growing demands for such services.
However, these interventions cannot in themselves make much of a difference unless the government invests and acts upon a well-integrated mother-newborn and child health programme joining up all tiers of the strategy into one seamless whole. If the mother and newborn aspects of the strategy are tackled head on, the third element ie child health will take care of itself.
The twin tragedies recently have placed the important policy issue of newborn care, funding and management on the policy agenda yet again. This opportunity should not be frittered away without drawing some lessons from it and putting in place an action plan to prevent recurrences. Moreover, this policy discussion should take place in the realm of a broader national conversation on tackling malnutrition, gender injustice, inequitable healthcare provision, appalling levels of household poverty and a disintegrating public health system.
The writer is a development consultant and policy analyst.
Twitter @arifazad5
Published in Dawn, December 21st, 2014
