Cross-National Systematic Review of Neonatal Mortality and Postnatal Newborn Care: Special Focus on Pakistan

Abstract

The latest nationwide survey of Pakistan showed that considerable progress has been made toward reducing all child mortality indicators except neonatal mortality. The aim of this study is to compare Pakistan’s under-five mortality, neonatal mortality, and postnatal newborn care rates with those of other countries. Neonatal mortality rates and postnatal newborn care rates from the Demographic and Health Surveys (DHSs) of nine low- and middle-income countries (LMIC) from Asia and Africa were analyzed. Pakistan’s maternal, newborn, and child health (MNCH) policies and programs, which have been implemented in the country since 1990, were also analyzed. The results highlighted that postnatal newborn care in Pakistan was higher compared with the rest of countries, yet its neonatal mortality remained the worst. In Zimbabwe, both mortality rates have been increasing, whereas the neonatal mortality rates in Nepal and Afghanistan remained unchanged. An analysis of Pakistan’s MNCH programs showed that there is no nationwide policy on neonatal health. There were only a few programs concerning the health of newborns, and those were limited in scale. Pakistan’s example shows that increased coverage of neonatal care without ensuring quality is unlikely to improve neonatal survival rates. It is suggested that Pakistan needs a comprehensive policy on neonatal health similar to other countries, and its effective programs need to be scaled up, in order to obtain better neonatal health outcomes.

Mortality at the Pediatric Emergency Unit of the Mohammed VI Teaching Hospital of Marrakech

“…The causes of this neonatal mortality were dominated by neonatal infections, prematurity and perinatal asphyxia. Although, this rate is high, it joins the data of other studies [7,8,[18][19][20]. Neonatal mortality is a real tragedy of the public health especially in developing countries, even with its drop in all of the regions of the world.…”

Mortality at the pediatric emergency unit of the Mohammed VI teaching hospital of Marrakech

“…Neonatal mortality is a real tragedy of the public health especially in developing countries, even with its drop in all of the regions of the world. Between 1990 and 2017, the global rate of neonatal mortality dropped by 51% going from 36.6 deaths in 1990 to 18 per 1000 deaths in 2017 [22]. Although, a lot of substantial progress has been made to reduce the neonatal mortality in 1990, more efforts should be made to achieve the sustainable development goal by 2030 [22].…”

“…Between 1990 and 2017, the global rate of neonatal mortality dropped by 51% going from 36.6 deaths in 1990 to 18 per 1000 deaths in 2017 [22]. Although, a lot of substantial progress has been made to reduce the neonatal mortality in 1990, more efforts should be made to achieve the sustainable development goal by 2030 [22]. A global approach containing all of the mothers' and the newborns' aspects of health, with an improvement of the environmental and socioeconomic conditions of the mom, follow-ups of the pregnancy, medicalisation of the births and an improvement of the care given to the newborn seem necessary knowing that prematurity and perinatal asphyxia are still the main causes of mortality.…”

Measuring coverage of WHO recommended Essential Newborn Care practices in the squatter settlements of Islamabad Capital Territory in Pakistan.

“…While Pakistan has shown progress in reducing child mortality, signi cant challenges exist in reducing the neonatal mortality rate, which shows minimal improvement compared to infant mortality and underve mortality (13). Serial data from demographic health surveys conducted in Pakistan shows a NMR of 55 deaths per 1,000 live births between 1992 to 2012 which improved to 42 deaths per 1,000 live births in the most current 5-year period (14,15).…”