Haq's Musings

Riaz Haq writes this data-driven blog to provide information, express his opinions and make comments on many topics. Subjects include personal activities, education, South Asia, South Asian community, regional and international affairs and US politics to financial markets. For investors interested in South Asia, Riaz has another blog called South Asia Investor at http://www.southasiainvestor.com and a YouTube video channel https://www.youtube.com/channel/UCkrIDyFbC9N9evXYb9cA_gQ

Showing posts with label IMR. Show all posts

Tuesday, March 19, 2019

Pakistan Survey Reveals Positive Trends in Children's Health

The latest national health survey in Pakistan indicates rising immunization rates, growing access to skilled health care and declining child mortality rates. However, the improvements in education and health care indicators in Pakistan are real but slower than in other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017. It is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018. One of the biggest challenges facing the PTI government led by Prime Minister Imran Khan is to significantly accelerate human development rates in Pakistan.

Pakistan Demographic and Health Survey:

PDHS (Pakistan Demographic and Health Survey) is a nationally-representative household survey that provide data for a wide range of monitoring and impact evaluation indicators in the areas of population, health, and nutrition. It is conducted about every 5 years.

The 2017-18 Pakistan Demographic and Health Survey (2017-18 PDHS) was carried out by the National Institute of Population Studies (NIPS), Islamabad, Pakistan. It involved 16,240 households. ICF provided technical assistance through The DHS Program, a project funded by the United States Agency for International Development (USAID) that provides support and technical assistance in the implementation of population and health surveys in countries worldwide.

Declining infant mortality rate:

The infant mortality rate (IMR), defined as the number of deaths in children under 1 year of age per 1000 live births in the same year, is universally regarded as a highly sensitive (proxy) measure of population health. A declining rate is an indication of improving health. IMR in Pakistan has declined from 86 in 1990-91 to 74 in 2012-13 and 62 in the latest survey in 2017-18.

Pakistan Child Mortality Rates. Source: PDHS 2017-18

During the 5 years immediately preceding the survey, the infant mortality rate (IMR) was 62 deaths per 1,000 live births. The child mortality rate was 13 deaths per 1,000 children surviving to age 12 months, while the overall under-5 mortality rate was 74 deaths per 1,000 live births. Eighty-four percent of all deaths among children under age 5 in Pakistan take place before a child’s first birthday, with 57% occurring during the first month of life (42 deaths per 1,000 live births).

Rising Vaccination Rate:

Vaccines are proven to prevent infectious disease and spread of such disease among children and the larger populations. Polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, rotavirus and Haemophilus influenzae type b (Hib) can now be prevented by vaccination.

Childhood Vaccination Rate in Pakistan. Source: PDHS

The latest PDHS survey indicates that 66% of the children in Pakistan have received all basic vaccinations, up from 35% in 1990-91 and 55% in 2012-13. Only 4% have had no vaccinations, down from 28% in 1990-91.

Pre-Natal and Delivery Care:

Access to proper medical care and hygiene during delivery can reduce the risk of complications and infections that may lead to death or serious illness for the mother, baby, or both (Van Lerberghe and De Brouwere 2001; WHO 2006). PDHS survey data show that in Pakistan, 69% of the births in the 5 years preceding the survey were delivered by a skilled provider, and 66% were delivered in a health facility.

Pre-Natal and Delivery Care in Pakistan. Source: PDHS

There has been steady improvement of the maternal health care indicator for women receiving ante-natal care (ANC) from a skilled provider, which increased from 26% in 1990-91 to 86% in 2017-18. Similar improvement in the percentage of deliveries at health facilities has been witnessed; these deliveries increased from 13% to 66%. Also, the percentage of births attended by skilled providers increased from 17% to 69% over the same period of time, according to PDHS 2017-18.

Birth Rates Declining:

Pakistan has seen a steady decline in fertility rates over time, from 5.4 births per woman as reported in the 1990-91 PDHS to 3.6 births per woman in the 2017-18 PDHS—a drop of about two births per woman in almost three decades. However, the decline is minimal in the recent period.

Total Fertility Rate (TFR) in Pakistan. Source: PDHS

There has been a consistent decrease in fertility among all age groups over the last four DHS surveys, though the decline is less pronounced recently.

Human Development Ranking:

It appears that improvements in education and health care indicators in Pakistan are slower than other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017. It is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018.

UNDP’s Human Development Index (HDI) represents human progress in one indicator that combines information on people’s health, education and income.

Pakistan's Human Development Growth Rate By Decades. Source: HDR 2018

Pakistan saw average annual HDI (Human Development Index) growth rate of 1.08% in 1990-2000, 1.57% in 2000-2010 and 0.95% in 2010-2017, according to Human Development Indices and Indicators 2018 Statistical Update. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018.

Child Nutrition in Pakistan. Source: PDHS

Child Nutrition:

PDHS survey shows that the nutritional status of children in Pakistan has improved over the last five years. The percentage of stunted children declined from 45% in 2012-13 to 38% in the 2017-18. A similar downward trend, from 30% to 23%, was observed for underweight children over the same period. Children who are wasted also declined from 11% to 7%. Children who are obese remained at 3% over this period.

Summary:

There are rising vaccination rates and growing access to skilled health care with declining child mortality in Pakistan, according to the latest national health survey in Pakistan. Neonatal mortality rate is down from 55 to 42 per 1,000 births in the last 5 years. Vaccination rates are up with 66% of the children in Pakistan having received all basic vaccinations in 2017-18, up from 35% in 1990-91 and 55% in 2012-13. Only 4% have had no vaccinations in 2017-18, down from 28% in 1990-91. Skilled health care professionals are delivering 69% of children now, up from 48% five years ago. 66% of children are now vaccinated, up from 54% five years earlier. Infant mortality rate (IMR) within first year of birth was recorded at 62 deaths per 1,000 live births, down from 74 in the last survey of 2012-13. Total Fertility Rate (TFR) has declined from 5.4 births per woman 990-91 to 3.6 births per woman in 2017-18. It appears that improvements in education and health care indicators in Pakistan are slower than other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017. It is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018. One of the biggest challenges facing the PTI government led by Prime Minister Imran Khan is to significantly accelerate human development rates in Pakistan.

Tuesday, February 20, 2018

How Can Pakistan Reduce High Rates of Infant Mortality?

Of every 1,000 babies born in Pakistan, 45.6 die before the end of their first month – 1 in 22, the highest infant mortality rate in the world, according to a United Nations Children's Fund report titled "Every Child Alive: The urgent need to end newborn deaths". Pakistan’s newborn mortality rate has declined by less than one quarter, from 60 in 2000 to 46 in 2016, according to UNICEF.

Highest Contributors to Newborn Deaths Source: UNICEF

Worst Countries:

Of the 2.6 million newborn dying each year worldwide, India tops with 24% share followed by Pakistan with 10%. Ten countries, Bangladesh, Ethiopia, Guinea-Bissau, India, Indonesia, Malawi, Mali, Nigeria, Pakistan and Tanzania account for more than half of the world’s newborn deaths, according to the report. Four of these 10 countries are in South Asia while the rest are in sub-Saharan Africa.

The percentage of mothers in Pakistan who gave birth in a health facility increased from 21 per cent to 48 per cent between 2001 and 2013, and the proportion of women giving birth with a skilled attendant more than doubled, from 23 per cent to 55 per cent over the same period. But despite these remarkable increases, largely the result of rapid urbanization and the proliferation of private sector providers not subject to satisfactory oversight, Pakistan’s very high newborn mortality rate fell by less than one quarter, from 60 in 2000 to 46 in 2016, according to UNICEF.

The report says that more than 80 per cent of newborn deaths can be prevented "with access to well-trained midwives, along with proven solutions like clean water, disinfectants, breastfeeding within the first hour, skin-to-skin contact and good nutrition."

Community-Based Health Care:

How can Pakistan increase the number of childbirths in the presence of skilled attendants? The best option appears to be a skilled midwives program along the lines of the Lady Health Workers (LHW) program that is considered effective in delivering health education and care to women in remote villages.

“It (LHW) is one of the best community-based health systems in the world,” said Dr. Donald Thea, a Boston University researcher, talking about Pakistan's Lady Health Workers Program. Thea is one of the authors of a recent Lancet study on child pneumonia treatment in Pakistan. He talked with the New York Times about the study.

Published in British medical journal "The Lancet", the study followed 1,857 children who were treated at home with oral amoxicillin for five days and 1,354 children in a control group who were given standard care: one dose of oral cotrimoxazole and instructions to go to the nearest hospital or clinic. The home-treated group had only a 9 percent treatment-failure rate, while the control group children failed to improve 18 percent of the time.

Community Midwives:

In response to the low levels of skilled birth attendance in rural Pakistan, the government has introduced a new cadre of community midwives (CMWs).

In 2008, Pakistan extended community-based health system with the introduction of an 18-month training program for community midwives. Then, in 2014, United Nations Population Fund – together with the Department of Health and Sindh Province’s Maternal, Newborn and Child Health program – launched a pilot effort to supplement the midwifery courses with hands-on training. Midwifery coaches visited the midwives’ clinics, offering guidance and mentorship, according to UNFPA. So far, over 300 midwives have benefitted from the coaching and mentorship program.

The Sindh UNFPA model needs to be scaled up across the country with the help of the federal and provincial governments in Pakistan.

Summary:

Pakistan is the riskiest country for newborns. Of every 1,000 babies born in Pakistan, 45.6 die before the end of their first month – 1 in 22, the highest infant mortality rate in the world, according to a United Nations Children's Fund report titled "Every Child Alive: The urgent need to end newborn deaths". Pakistan’s newborn mortality rate has declined by less than one quarter, from 60 in 2000 to 46 in 2016, according to UNICEF. The country's progress in reducing infant mortality rates has been very slow. There is an urgent need to improve the situation by by scaling up community-based midwife programs nation-wide.

PakAlumni Social Network