CHILD MORTALITY AND NEPAL
Millennium Development Goal
REDUCE CHILD MORTALITY
Improving child health is taken as the important criteria for the health development in general and is seen not only as the goal in itself. There have been remarkable and visible improvements in some of the indicators of child health globally. Service provisions like immunization, oral re-hydration and other, essential for the child survival, are substantially increased. Some concrete results have been achieved for this MDG. Between 1990 and 2000 under-five mortality declined by 11 percent worldwide. There was the decline in the global child deaths from diarrhoea by half during the decade of 1990-2000, which saved about one million lives. Underweight among the children in developing countries fell from 32 to 28 percent.
TARGET: To Reduce the under -five Child Morality by two thirds
There has been a considerable decline in the case of child morality within last three decades.
Reason for the reduction was the control over some of the deadly diseases like chicken pox, malaria, cholera and other highly deadly diseases. The rate of under-five child morality differs from different region from rural to urban. As per report the morality rate is higher in rural areas as compared to urban areas.
Nepal has made significant progress in reducing the infant mortality rate (IMR) and under-five mortality rate (U5MR) in recent years. By 2006, the national IMR had decreased to 48 deaths per 1,000 live births and the U5MR had decreased to 61 deaths per 1,000 live births (Ministry of Health and Population, MOHP et al. 2007). Trend analysis of data from 1995 to 2005 suggests that the IMR declined by 39 per cent and the U5MR by 48 per cent over the period. A recent survey in rural locations of 40 districts shows that in these areas IMR has fallen to 41 deaths per 1,000 live births and U5MR to 50 deaths per 1,000 live births.
Analysis of the IMR and U5MR for Nepal shows that there are important disparities by gender, caste, ethnicity, and geographic location. Data from 2006 show little difference in the national IMR and U5MR between girls and boys (MOHP et al. 2007); however, the Nepal Family Health Programme survey shows that in rural areas gender disparity is still quite significant, with infant mortality 1.18 times higher for females than for males and under-five mortality 1.19 times higher.
Although immunization against measles for children aged 12–23 months reached 85 percent in 2006 (Ministry of Health and Population, MOHP et al. 2007), it declined to 83 per cent in 2007-08 (Department of Health Service, DOHS 2008) and recorded a slight improvement in 2009 to 85.6 per cent (Nepal Family Health Programme, NFHP 2010). There are also disparities in access to anti-measles vaccination in terms of boys and girls, rural–urban residence, ecological zone, and development region (MOHP et al. 2007).
Supportive Environment for Controlling Child-5 morality:
To control morbidity and mortality among children, the government has initiated several child-survival programmes including the Community-Based Integrated Management of Childhood Illness (CB-IMCI), the Community-Based Newborn Care Package (CB-NCP), and the National Immunization Programme (NIP). The CB-IMCI package has recently been expanded to all 75 districts. Based on the National Neonatal Strategy 2004, the government is piloting the CB-NCP in 11 districts. This programme promotes the use of skilled birth attendants during delivery, and provides community-based counselling, treatment and referral of sick neonatal.
The NIP, including vaccination against measles, is a high-priority government programme, and covers the entire country free of cost. Nepal has made landmark progress in relation to child survival. In recognition of this, it received an award at the International Partners’ Forum held in Hanoi in November 2009. The Ministry of Health and Population (MOHP) has also been awarded by the Global Alliance for Vaccine and Immunization(GAVI).
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). The present pace of reduction in the IMR and U5MR cannot be sustained unless reduction in the neonatal mortality rate is accelerated. The most common causes of neonatal deaths are infection, birth injury and birth asphyxia.
The challenges faced during the process of overcome the serious concern were:-
- Ensuring adequate nutrition to children and developing locally sensitive nutrition program.
- Investing a higher level of public expenditure on health and investing on areas having above rate of child morality.
- Raising the quality of health services.
- Reducing the cost of medicines.
- Developing authority responsible for health programs and awareness.
- Increasing people awareness by providing campaigns regarding child morality.
- Developing appropriate strategies to address the high prevalence of neonatal morality.
Although the budget for child health has risen in recent years, little effort has been made to mobilize local resources such as block grants provided by the government through the Ministry of Local Development and resources generated by the local bodies for child health. In fact, spending by local bodies on basic health has been minimal and not guided by health indicators.