Neonatal Mortality In Pakistan

Introduction:

According to the World Health Organisation (WHO), neonatal mortality is the unfortunate death of babies within first 28 days of their life. Sustainable development gaols (SDGs) are collection of total 17 global goals that are set by the United Nation General Assembly (UNGA), during 2015. These goals represent the agendas for 2030 which focuses on making universal call for ending the poverty, health issues and protect the planet with ensure the high level of peace and prosperity. These 17 goals are developed on the ideas of Millennium Development Goals (MDGs), in order to include the new areas such as innovation, sustainable consumption, climate changes and economic inequality. This assignment is going to make critical analysis of the topic” neonatal mortality in Pakistan”, with using relevant source of statistical and theoretical database. The Sustainable Development Goal (SDG) that is taken under this assignment is “Ensure healthy lives and promote wellbeing for all at all ages”. This assignment will discuss the challenges, barriers, solution and strategies for the topic as well as for the sustainable development goal (SDG) in Pakistan. Moreover, it will identify the relevant short and long terms strategies in order to implement the selected SGD in Pakistan, in order to reduce the neonatal deaths.

Neonatal death in Pakistan (Critical analysis):

According to Mersha et al. (2017), neonatal mortality is common in poorest countries such as Pakistan. From UNICEF report on child mortality it can be seen that Pakistan has the worst newly born mortality rate. The report also stated that children born in the poorest countries such as in Pakistan face the severe risk of neonatal death which is nearly 50 times more than the richest countries. On the contrary Oladosun (2016) argued that richest countries such as Hongkong, Kuwait, UAE, Singapore and Switzerland, also face the higher rate of infant mortality due to the negligence of parents, poor care from the caregivers and practitioners and health complication of the mother. From the UNICEF report, it is seen that in Pakistan the rate of neonatal mortality in one in 22 children, which is more than that in India and Bangladesh is. As mentioned by Stanak (2019), the reason behind this poor assistance to the pregnant woman, their malnutrition, lack of proper care and poverty. In Pakistan, 2.6 million babies die within 28 day of their birth, due to getting insufficient milk from their mothers. This is due to poor livelihood, lack of proper foods and nutrition and poor healthcare assistance to the mothers before and after the delivery. On the contrary, Merchant et al. (2017), argued that not only poor care and support from the caregivers but also the unhygienic living condition, unhealthy practices and lack of proper housing facilities to the pregnant mothers, are an important reason behind the neonatal deal with their children. World Health Organisation report on infant mortality shows that majority of the infant mortality in poorest countries such as Africa, Bangladesh and Pakistan, is associated with poor health of their mothers and inability of mothers to provide proper healthy and nutritious food to babies. Moreover, in Pakistan, more than 45% of the women residing in the below poverty line are highly prevalent to the breast infections, mastitis and cradle nipple, which make the mother unable to breastfeed their new-born. This is why Pakistan is reported to have the worst infant mortality rate. Education is one of the important aspects of the pregnant mother in order to make her updated about her own health and baby’s health. In Pakistan, lack of education for pregnant mother leads to high risk of neonatal mortality to newborn. From the statistical database on UNICEF, it is seen that the infant mortality rate in Pakistan is 52 deaths in 1000 live birth, in case if male, the neonatal mortality rate is 55 out of 100 live births and in case of the female, the death rate is 48 deaths per 1000 live birth. The State of world Children Report 2014 of UNICEF shows that, in rural and suburban areas of Pakistan the rate of infant mortality is more than the metropolitan cities. due to the increasing rates of infant mortality in rural and suburban areas, Pakistan shows higher infant mortality with 8.6% as per the UNICEF report (UNICEF, 2019).

From the above graph it is clear that, after Afghanistan, Pakistan represents the higher infant mortality rates than the other countries. UNICEF report shows that, in Pakistan majority of the new mothers residing in the rural and suburban, even in urban areas, lost their infants within 28 days of birth due to mal nutrition and health complication (UNICEF. 2018). It is estimated that, 86 infants died at neonatal age for every 1000 live births in Pakistan during 2012. Moreover, the UNICEF report also shows that, out of 4,604,000 new-borns 409,000 babies are died after birth in rural and urban areas in Pakistan, due severe infections, lung issues and respiratory problems. Sustainable development goals are referred to as the objectives that are undertaken by the government in order to promote the health wellbeing and improvement if the individual, society and entire community (Oladosun, 2016). For dealing with the neonatal mortality in Pakistan, the sustainable development goal tr has been undertaken is Ensure healthy lives and promote wellbeing for all at all ages. Pakistan government has undertaken effective strategies in order to achieve a sustainable development goal with 2030. From the WHO report it is seen that from year 2000 to 2010, the infant mortality rate in Pakistan has been reduced by 0.9% due to implementing effective strategies such as family welfare, health and wellbeing promotion, education for poor people, health assistance to poor mothers and free care facilities to new mothers. Pakistan government has developed the new-born and Child Health Programme, that catalyses the new-born service at both the local and community level. Since 2005, the donor funding for reducing the neonatal death in Pakistan increase in faster rate that assists the Pakistan government to provide the best care and assistance to both the new mothers and new-born baby. On the contrary Mersha et al. (2017), only providing care and health assistance to the mothers and baby is not enough for reducing the neonatal mortality, rather the initiatives need to be taken from the local to national level in order to educate the poor mothers and their families about how to take care of new-born. On supporting this viewpoint several studies suggest that, although Pakistan has taken new-born and childcare initiatives, the country faces several; challenges in order to implement them. Moreover, Ministry of health in Pakistan does not focus on the pathetic side of the community in which majority of pregnant women and new mothers are unable to access all the medicines, injections and healthy foods that are important for proper development and growth of foetus and new-born.

Importance of the topic:

The topic “neonatal mortality in Pakistan” is important which assist the learners to get comprehensive knowledge of the increasing of neonatal mortality in Pakistan. The increasing neonatal morality is Pakistan is a great concert that needs to be focused and revealed in proper manner. Through the selection of this topic, this assignment is able to highlight the social infrastructure of Pakistan and its effect on new mothers and new-born babies. Moreover, this topic is important for highlighting the challenges that Pakistan faces in terms of implementing strategies and in order to achieve the Sustainable development goals that have been taken by the government to reduce the neonatal mortality. Through using relevant sources and database, this assignment focuses on the main points of this topic such as the impact of social and economic factors on the health of newborn babies and new mothers. Through selecting this topic, the study would not only highlight the neonatal mortality issues in Pakistan but also shows how the poorest countries suffer from the ever-increasing infant death due to poor accessibility of healthcare facilities and proper carer assistance.

Why the topic / SDG is important for family health:

Pakistan has ranked 26 in the list of countries having the highest mortality rates in the world (UNICEF. 2018). UNICEF report also highlights the fact that, in most of the poor countries in the world, such as Pakistan, there is a huge disparity in the health condition of the family, especially of children and infants in different regions. Infants residing in the slums and rural areas in Pakistan are highly prevalent to the neonatal mortality and severe contamination of diseases. Through discussion of this topic, “neonatal mortality in Pakistan”, it is possible to highlight the challenges that are associated implementation of Sustainable Development Goals that are taken for reducing the neonatal mortality. The topic also enhances the public concern in Pakistan as well as in other poor countries suffering the neonatal mortality, regarding maintaining healthy practices in order to promote the family health and wellbeing. Moreover, the Sustainable development goal that is discussed in this assignment is helpful to cover the health needs of a poor family in order to make the baby and mother healthy and fit (WHO, 2016). Through undertaking the Sustainable development goals (SDG), it is possible to promote the health and wellbeing in the poor community of Pakistan. Under the sustainable development goals, health and social workers are obliged to provide free medicines, weekly check-ups and care assistance to pregnant women and new mothers in the poor family. For example, in UNICEF has conducted Health and family welfare policy, under which pregnant women and new mothers belonging to the poorest family in Pakistan can receive the antiretroviral therapy, pregnancy medicines and protein enriched foods at free of cost (UNICEF, 2019). Sustainable development goals have been taken for reducing morality, has represented the challenges and solutions associated with promoting healthy lives and wellbeing in the community. Moreover, the topic highlights the reason behind the increasing infant deaths and poor health of new mothers as well as pregnant women. The most common reason behind this increasing level of neonatal death and poor family health in Pakistan is poor access to proper healthcare facilities, malnutrition of the pregnant women, lack of care towards the new mothers and poor housing and sanitation process which have a severe impact on the family health.

Include the challenges, barriers, solution and strategies for the topic and SDG in Pakistan:

Different challenges can be faced in order to reduce the neonatal mortality in Pakistan and implement sustainable development goals for promoting family health. In Pakistan, the majority of the people belong to the lower socio-economic level, which affects the health and wellbeing of their family members. As stead by 0, neonatal mortality and Infants Death Syndrome is highly prevalent in poor countries in which women are unable to afford proper nutrition, healthcare facilities and education.

From the above graph it is clear that, the socio-economic condition of Pakistan is characterised by huge disparity income and economic status. 65% of the population resides under the poor economic background and only 15% of the population resides in the high-income status. This is due to lack of job opportunities, unemployment, lack of governmental support and poor educational system. The poor socio-economic condition is one of the potential challenges in order to reduce neonatal mortality and to implement sustainable development goals for promoting health and wellbeing. Pakistan faces severe poverty, unemployment and poor healthcare support, which results in rising mortality rates of infants, pregnant women and new mothers. From the UNICEF report, it is clear that more than 45 % of the pregnant women and mothers in Pakistan suffer from poor nutrition, lack of healthcare support and poor economic and emotional support from their family. As stated by Kumar et al. (2016), poor socioeconomic status of family affect the health of the newborn, as the mothers are unable to produce sufficient milk, due to poor nutrition and care. Therefore, for the socioeconomic status of Pakistan pose the severe barrier to implementing and archiving the sustainable development goals in order to reduce the rate of infant mortality and promote family health and wellbeing.

Lack of support to pregnant women:

According to the World Health Organisation report, the majority of the infant death is associated with the poor physical and psychological health of new mothers (WHO, 2018). As stated by Baqui et al. (2016), in the first 28 days of the birth of the baby, the new mothers need proper guidance, health assistance and family support. National Health Service (NHS) has developed the policy new mothers, in which the mothers would be provided with proper advice by the Health Care Executives regarding breastfeeding, maintaining hygiene for baby and ways of providing nutritious food to the baby. In Pakistan, the rising number of neonatal mortalities is due to the fact that majority if the new mothers can not the afford the post delivery service from caregivers which is important for proving proper knowledge to mothers regarding protecting their babies from any kind of infections and disease. Therefore, poor support to new mothers is potential challenges towards reducing the neonatal mortality in Pakistan.

Poor healthcare structure in Pakistan:

Although Pakistan has good healthcare facilities and a large number of hospitals situated in different regions, it is confined to the cities and urban areas. Moreover, in majority of the villages of Pakistan such as rural areas in Lahore, Rosool Pur, Basti Tabu and Mamu Kanjan, hospital have poor infrastructure the recent report from the World Health Organisation shows that majority of the rural and suburban areas of Pakistan, there are a huge shortage of doctors, skilled staffs, health executives and nurses.

Based on the report of World Health Statistics 2014, Pakistan shows highest rate of health inequalities die to the huge disparity in income level and economic status. Life expectancy at birth is 62 in case of males and in case of females it is 63 (WHO, 2018). The healthy life expectancy at birth for males is only 54 and in case of females in 52. The Health Statistics also shows that women residing in rural and sub urban areas suffers from mal nutrition, por health facilities and lack of nutritious foods during and after their pregnancy, which leads to death of both the mothers and babies. Pakistan government shows a huge level of negligence towards the healthcare structure, which is the potential reason behind the neonatal mortality and maternal death. Due to the poor healthcare system, it is highly difficult for the UNICEF to implement the Sustainable development Goals in order to reduce neonatal mortality.

Lack of education:

Education is important for improving public knowledge regarding the healthy practices, precautions for diseases, infection prevention and self-assessment of health. However, the majority of the women in Pakistan are unable to receive school education, due to family pressure and economic burdened. Lack of education poses potential barriers to reduce neonatal mortality in the country (Cheong-See et al. 2016). Illiterate mothers are more prevent to the disease, infection and poor health than the educated mothers. Majority of the new mothers and pregnant women in Pakistan do not have proper knowledge about the types of foods that they should take during pregnancy or the level of hygiene and sanitation they should maintain for protecting their babies from disease and infections. In Pakistan, the majority of the infant mortality occurs due to infection and disease development within the baby due to the unhealthy environment and unhygienic practices. Global Burden of Disease (GBD) study 2010 is one of the most important projects led by the Institute of Health Metrics and Evaluation at the University of Washington. GBD is the global systematic approach taken by the researchers of 50 countries in order to determine and quantify the trend and level of health loss in countries due to the disease, infections, injuries and risk factors (healthdata.org, 2018). In case of Pakistan the number of years of life lost (YLLs) represents the fact that, premature deaths and neonatal mortality in Pakistan are due to the ever increasing number of infections, respiratory issues, neonatal encephalopathy, birth trauma and birth asphyxia. Moreover, the GBD data also shows that, 25 most important causes of disease have been detected in Pakistan that act as important causative factors in developing risk of neonatal death in this country. From the database it is also clear that, in Pakistan males are highly prevalent to the neonatal mortality as compared to the females. The mortality rate of male of 1-4 years age is 41% as compared to the female with 35%. GDB database also shows that, causes of premature death and neonatal mortality in Pakistan is different disorders such as diarrheal disease, respiratory infections, tuberculosis, tetanus, meningitis (healthdata.org, 2018).

Rising unemployment in Pakistan:

Rising unemployment poses the potential barrier towards reducing neonatal mortality and promoting health as well as wellbeing in the country (Evans and Walker, 2018). In recent years Pakistan suffers from huge job crisis, which affects the socio-economic standard of the family. Majority of people residing in villages and slums are unable to manger proper food and medicines for their family members. This is the reason why the majority of the new mothers and pregnant women in slum and rural areas coin Pakistan suffer from \mal nutrition, poor health and maternal death. Deb to getting poor physical, mental, and healthcare support from the society, women suffer from an infection, cardiovascular disease and mastitis, which affect the health of their newborn. Unemployment and poverty lead to poor housing and sanitation to the family which enhances of contamination of different disease infections that leads to neonatal mortality and maternal deaths.

Millennium Development Goals: (MDG)

Pakistan currently works towards achieving the MDG (Millennium Development Goals). This goal has the target for reducing neonatal mortality and child deaths. Through setting this MDG, Pakistan is going to reduce the infant deaths to 46 per 1000 live birth from the 86 deaths per 1000 live birth. Moreover, Pakistan has developed MDG in order to increases measles immunisation to 100% by 2020 (un.org.pk, 2019). There are 5 targets in the global MDG that is associated with improving maternal health in order to reduce the death of the number of women who die during and after the pregnancy for lack of healthcare assistance, clinical support and proper medications. UNICEF has reported that, through setting the global MDG, Pakistan is able to reduce the maternal mortality to 260 per 100,000 live births in 2015, from the 280 per 100, 000 live births in 2012 (UNICEF, 2018). According to Nakimuli et al. (2018), in order to reduce the rate of neonatal mortality and promoting family health, it is important to provide the proper healthcare facilities to pregnant women. Through implementing these objectives of these goals, Pakistan has taken the Maternal Mortality target, in which it stipulates that 100% births should be attended by the skilled health professional in order to eliminate the risk of infant death or neonatal mortality (ncbi.nlm.nih.gov, 2018). Moreover, MDG has 6 aims in order to provide healthy lives, protection and proper healthcare facilities to the families and babies. Through setting MDG, Pakistan focuses on reducing the prevalence of malaria, HIV, cardiovascular disease, heart attacks and infection in the newborn as well as in the new mothers (ncbi.nlm.nih.gov, 2018).. Through providing proper vaccination and therapies, Pakistan focuses ion eliminating the risk of TB and other communicable diseases to new mothers and families, which can be an important cause of infant mortality.

Improving the healthcare system:

Pakistan government has taken initiatives under the MDG to improve the healthcare system in the country. UNICEF has reported that Pakistan needs a high-quality health care system in order to deal with increasing rates of infant mortality. Under Millennium development goals, Pakistan is going to implement the health and social care policies, 2018, in which it is mentioned that, hospitals and healthcare centres would be provided with smart techniques and medical instruments (ncbi.nlm.nih.gov, 2018). Under MDG, Pakistan Health Ministry focuses on developing the local healthcare centres in each rural area in order to provide affordable health facilities to poor mothers and newborn. Moreover, Healthcare executives are appointed for each village; in order to provide health education to families in order to assist the pregnant women and new mothers to get proper family support. Moreover, the Pakistan government has also taken initiatives for improving the quality of the healthcare system by appointing the high skilled health professional and staffs in hospitals.

Job Creation and poverty elimination:

Under the SDG (sustainable development goals), the Pakistan government has taken initiative for job creation in order to improve the socio-economic status of the country. As stated by Soofi et al. (2015), employment is important for the health and wellbeing of people, as it assists people to afford the healthcare service, nutritious foods and drinks for their family members. Millennium development goals not only focuses on reducing the infant mortality through developing health care system but also focuses on improving the economic status of people residing in the poor community (un.org.pk, 2019). UNICEF report has shown that the majority of infant death in Pakistan is due to poor housing, socio-economic status of the family and poor health of mothers. Therefore, the initiative taken by Pakistan for creating jobs and eliminating poverty would assist the poor people to get sufficient money in order to provide good health to babies and women in their families. Offering health education to new mothers and pregnant women is one of the important short terms goals taken under the SDG by Pakistan government. Through improving knowledge of new mothers, it is possible to provide better care and support to the babies. Pakistan would appoint Health care executives in each village who will provide the proper knowledge to women regarding the health and protection of the newborn, in order to reduce the neonatal mortality (ncbi.nlm.nih.gov, 2018). Appointing high skilled health professions in hospitals is important to short term goals taken by the Pakistan government in order to provide high-quality care and health support to the pregnant mothers and newborn, Providing free medicines and health checkups to poor mothers is an effective short terms initiative that is taken under SDG by Pakistan. Under this initiative, pregnant woman, infants and new mothers belonging to the poor families, would be provided with free health checkups, medicines and advice by the local health and social care staffs. This would reduce the chances of neonatal and maternal deaths.

Following recommendations can be made in order to reduce the neonatal death and promote the family health and welfare in Pakistan. Global action plan should be taken for preventing infections, diarrhoea, pneumonia and fever in babies. In this plan, mothers, newborn and infants would be included in order to get proper healthcare facilities such as regular checkups, free medicines and regular healthcare advice. Mothers and pregnant women can have the facility to collect proper food and medicines from local health and social care centres. Pakistan government should focus on providing proper vaccination facilities to the newborn and pregnant mothers in order to reduce neonatal and maternal mortality. DTaP vaccine for polio, Tetanus, vaccines for Hepatitis B, Polio and Pneumococcal disease, should be produced to the newborn by the local health care executives, in order to protect babies from any virus and infections. new mothers and pregnant women would be providing with proper health education for developing their knowledge about ways of protecting their newborn from any infections and disease. Moreover, health education to the family members would assist them to understand the importance of providing proper support to both new mothers and newborn in order to reduce the maternal and neonatal death.

Conclusion:

This assignment concludes that, Pakistan is reported to have high neonatal mortality rates. This is due to poor healthcare support, nutrition, education and job facilities to the majority of the people who reside in slums and village areas. Sustainable development Goal has been taken in order to reduce the neonatal death in Pakistan. However, there are several; barriers associated with reducing the neonatal death rate in Pakistan. Pakistan government set the strategies to implement and achieve the global millennium development goals, in order to protect the babied from infant death.

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