HIGHLIGHTS:
Millennium Development Goal Number 4 is to reduce the under-five mortality rate by two thirds between 1990 and 2015. Under-five mortality in Bangladesh at the start of the MDG period was measured at 133 deaths per 1000 live births. To meet MDG 4, this mortality needs to be reduced to approximately less than 50 by 2015.
Although child mortality rates in Bangladesh have decreased in recent years, they are still too high. Among child deaths, those that occur during the first month represent an increasing proportion, as child health interventions have been more effective for older infants and children above one year of age. Currently in Bangladesh more than 70% of all infant deaths are occurring in the first 28 days of life. Thus if we are to improve overall infant mortality, we will have to learn how to reduce the deaths in this age group.
ICDDR,B is embarking on major projects to find solutions to the high neonatal mortality that are cost-effective and reproducible.
Neonatal deaths are largely due to infections, asphyxia, birth trauma, and improper care of the newborn. ICDDR,B believes that with community based strategies many neonatal deaths can be prevented if proper care is given in a timely manner. With training, community workers can recognize and manage neonatal infections and begin early treatment. Mothers and caretakers can be trained to improve routine newborn care, such as feeding the baby and keeping it warm.
The Projahnmo project has been working with a rural community over two and a half years to reduce newborn mortality and to improve care behaviour related to maternal and newborn health. A package of services including message delivery, development of skills, provision of essential supplies and treatment of newborn infection have been delivered at household level to pregnant and recently-delivered women, newborns and families. Initial results have shown a 33% reduction in neonatal mortality in the home-care arm of the intervention.
Early deaths are often associated with unsafe delivery practices and specific care practices need to be introduced and adopted. Among interventions introduced, the one with most impact has been immunization of mothers with tetanus vaccine to prevent neonatal tetanus, but additional research is needed to save newborn lives.
Acute infectious diseases continue to cause many infant and child deaths, and many of these can be easily treated or prevented. Diarrhoea, pneumonia and malnutrition are major causes of morbidity and mortality.
Health services for infants and children in developing countries remain constrained by limited availability and access, poor quality and utilization. The Integrated Management of Childhood Illness (IMCI) strategy has been designed to provide good quality health care services for children through primary health systems for the most common and important illnesses. IMCI also focuses on improving health systems and community and family practices. There are still some questions about the design, content, delivery and effectiveness of IMCI though, so scientists at ICDDR,B have been evaluating its effectiveness. Interim results have been extremely useful in influencing national policy on IMCI implementation and the final results will demonstrate impact on under-five mortality, and other health indicators of children.
New problems are being recognized as increasingly important, such as drowning which is now a leading cause of death among 1 to 4 year olds children in Bangladesh. Child development is another emerging area as the focus shifts from mere child survival to the development of these children to their full potential through appropriate caring practices, stimulation and nutritional interventions.
To achieve success in MDG 4 in Bangladesh, we must reduce neonatal mortality, improve nutrition during the early months of life, prevent and treat the most common life-threatening infectious diseases, and develop strategies for reducing drowning. The interventions needed include a package of services in the community to make deliveries safer for both mother and child, to prevent and manage any complications or any illnesses that occur in the first few days of life.
Greater efforts are needed to improve rates of exclusive breast feeding and introduce proper complementary feeding. While maintaining the gains made with current vaccines and vitamin A programmes, new vaccines for pneumonia and diarrhoea are needed, as are renewed efforts to better manage pneumonia. Implementation of zinc as treatment for every episode of diarrhoea will be a critical new programme for the nation and Bangladesh has the opportunity to be a leader with this new strategy.
