NEONATAL MORTALITY :A CHALLENGE TOWARDS THE ACHIEVEMENT OF MDG-4

PRESENTED BY: Group C2 BHARATI KC(09) SAMJHANA SHRESTHA(31) SEEMA GIRI(32) SUNIL KOIRALA(36)

INTRODUCTION
The term neonate is used for the newborn infant during 28 days period. Neonatal mortality refers to the probability of dying within the first month of life. Although being new born is not a disease, large number of children dies soon after birth: many of them in first four weeks of life (neonatal deaths) and most of those during the first week of life (early neonatal deaths).

The major causes of newborn deaths in Nepal are infection, birth asphyxia, preterm birth and hypothermia

Neonatal mortality and Millennium Development Goal-4

MDGs provide a framework for the entire international community to work together towards a common end making sure that human development reaches everyone, everywhere. Goal 4: Reduce child mortality Target Reduce by two-thirds, between 1990 and 2015, the under five mortality rate

Cont..
Neonatal mortality levels play an increasingly important role in child mortality. The proportion of child deaths that occurs in the neonatal period greatly influence the Millennium Development Goal-4 .

Neonatal mortality is a serious concern in Nepal, accounting for 69 per cent of IMR and 54 per cent of U5MR in 2006 (DOHS 2008). Hence MDGs of child survival cannot be met without substantial reductions in neonatal mortality

STATEMENT OF PROBLEM
30,000 children die each year in Nepal during their first month of life.

20,000 child dies in their first

week of birth

2/3rd

About 3-4 neonates dies each hour in Nepal

2/3rd 16,000 child dies within 24hrs of their birth

(National Neonatal Strategy 2004).

OBJECTIVES
General Objective: To study the situation of neonatal mortality as a challenge towards achieving MDG-4. Specific Objectives: To assess the trend of neonatal mortality from the year 1996 to 2010 A.D. To assess the required difference to meet MDG-4 2015 target. To determine the challenges influencing neonatal mortality ( Exclusive breastfeeding , safe motherhood services: ANC, place of delivery, PNC, Birth interval, Birth size)

METHODOLOGY
Study Area
The study area was Nepal.

Study design
The study design was cross-sectional descriptive type done with the help of secondary data.

Study duration
The study was conducted from the 25th November to 15th December.

Data Collection Procedure

The data were collected through systematic review secondary sources, including research, internet, journals and various reports

Cont..
Data Analysis Technique The collected data were analyzed in MS-EXCEL (Version 7) and represented in bar diagrams and tables using number and percentage. Limitation of the study The study was solely based on secondary data.

FINDINGS

Trend of Neonatal Mortality Rate in Nepal

60

50

50

Trend of NMR
39
33 33

rate/1000 live births

40

30

20

10

1991-1995

1996-2000

2001-2005

2006-2010

Source: NDHS Report 1996 to 2011

MDG Target for reducing Child Mortality Rate

Indicators Status at 1990 MDG Target to be achieved by 2015 Infant Mortality Rate 108 per 1000 live births 34 per 1000 live births

(IMR)
Under-five Mortality Rate (U5MR) 162 per 1000 live births 54 per 1000 live births

Neonatal mortality
Rate(NMR) (accounts for 69 per cent of

50 per thousand live births

16 per thousand live

births

IMR and54 per cent of

U5MR)

Trends of reduction in Neonatal mortality Rate

(1990-2010)
Mortality Indicators per thousand live births Differences between the years per Required 1000 live births difference to meet the MDG target 1991- 19962001- 20062010-2015(16) 1995 2000 2005 2010 (50) (39) (33) (33)

Neonatal Mortality Rate

11

17

Factors influencing NMR

NMR by birth size

60

56

per 1000 live births

50

40

30

27

20

10

Small/Very small

Average/Large

Source :NDHS 2006

NMR trend by birth interval

90 80
rate /1000 per live births

70 60 50 40
1996 2001 2006

30
20 10

0
1996 2001 2006

<2 84 80 63

2 to 3 46 34 25

4 + years 30 28 20

Source :NDHS 2006

Factors influencing NMR: presenting challenges towards the achievement of MDG-4

72

80
60
percentage

Challenge -1

Challenge-2

35

40
18

23

20
0
ANC(any) Births at health facility PNC Initiation of breast feeding within 1Hrs

Source: DHS 2006

DISCUSSION
The trend of neonatal mortality has been decreased from 50/1000 live births in 1996 to 39/1000 live births in 2001 while the NMR remained constant from 2006 to 2011.

While comparing our study with analysis of demographic and health survey from around developing world we found that neonatal mortality is reduced for preceding birth intervals of 3 years as compared with intervals of less than 2 years.

Cont..
Similarly while comparing our study findings with the evaluation study on Neonatal Mortality of Low Births Infants conducted in Bangladesh, we found that small birth size babies have higher risk of deaths influencing NMR Across 40 countries with DHS data between 1995 and 2003, more than 50% of neonatal deaths arose after a home birth with no skilled care while in our study only 18% of the child birth took place at health institution.

CONCLUSION
The trend of NMR remained almost constant without any slight reduction during the gap of four years presenting challenge towards the achievement of MDG-4 since reduction of child mortality largely depends on saving more new born lives. The trends in reduction of neonatal mortality followed decelerating pace but still 17% reduction in NMR is required to achieve the MDG target by 2015 i.e with in four years.

Cont..
Various factors such as birth size, birth interval, safe motherhood services (ANC, delivery services by health workers, PNC, breastfeeding) influenced NMR, thereby presenting challenges towards the achievement of MDG

RECCOMENDATIONS
A single approach focusing on reducing child mortality is not sufficient enough. DOHs should focus towards the improvement of new born health through employing integrated approach combining safe motherhood and family planning services. The focus should be given towards the improving neonatal health since MDG-4 couldnt be achieved without reducing NMR.

REFRENCES
Millennium Development Goals Indicators: The Official United Nations Site for MDG Indicators. [http://www.mdgs.un.org/unsd/mdg/Data.aspx]. UNICEF. State of the Worlds Children 2009. New York: UNICEF, 2009. NDHS ,2006 ,2011 ANNUAL REPORT 2066/67

Knowing is not enough, we must apply; Willing is not enough, we must do.

Thank you