Bangladesh needs to reduce child mortality to achieve SDG

Bangladesh needs to reduce Neonatal Mortality Rates (NMR) to achieve the Sustainable Development Goals (SDGs) by 2030. The country has, however, made remarkable progress in the sector in comparison with the other countries in the South Asia region.

The neonatal mortality reduction rate in the country has to be increased to 4.6 per cent from its current rate of 3.6 per cent, reveals a study of Bangladesh Demographic Health Survey (BDHS).

The study revealed that though the overall child mortality rate has reduced in the country, neonatal mortality mortality rate in proportion to the under-5 mortality rate (U5MR) has soared up.

Of the child mortality rate, 39 per cent died within the age of 28 days in 1993 whereas this was 61 per cent in 2014. Of the 28-day-old neonatals, most die on the first day (37 per cent) of the birth.

Health directorate’s NBHP and IMCI programme manager M Altaf Hossain presented this picture of the neonatal mortality rate at a roundtable on Essential Newborn Care (ENC), organised on Thursday with support from Unicef at the initiative of Prothom Alo.

The discussion, held at the Prothom Alo office in Dhaka’s Karwan Bazar area, was moderated by the daily’s associate editor Abdul Qayyum.

The research also divulged that 88 per cent of neonatal deaths in Bangladesh are from three highly preventable causes: severe infection, asphyxia and complications of premature birth.

Uptake of five essential newborn cares (ENC) - immediate breast feeding, delay of first bath up to three days, drying within five minutes of birth, applying anti-infectious medicines after cutting the umbilical cord and use of safe delivery kits - can reduce the mortality rate, it said.

Speaking as chief guest, state minister for health and family welfare ministry, Zahid Malik, put emphasis on building awareness to reduce the child and neonatal mortality rate.

He said, “Mothers [expecting women] should be made aware about antenatal and postnatal care.”

The state minister also said, “Childbirth institutions must provide proper care, and those should be well-equipped with skilled manpower, proper medicine, infrastructure and proper instruments.”

“About 40 per cent women give birth to child at home. This number needs to be scaled up to prevent the child and neonatal mortality rate.”

Another aspect pertaining to the issue is child marriage. About 50 per cent marriages take place too early. Most of the women conceive before they are mentally and physically ready, the minister added.

Zahid Malik also said the government has trained about 1,500 midwives in proper childbirth methods. The required number is, however about 21,000, he added, quoting an UN survey.

BRAC’s health, nutrition and population programme’s (HNPP) Asadur Rahman focused on training people close to the new mothers. “In the context of Bangladesh, most of these women don’t have anything to say about neonatal health care.

Mothers-in-law, mothers, sisters-in-law and others take decisions.”

Health directorate’s MNC&AH line director Jahangir Alam Sarker said, “The government has devised the National Newborn Health Programme (NNHP).” He said, “We have been working with a view to take newborn health care to each doorstep with the help of NGOs and other development partners.”

Family planning directorate’s director (MCH-Services) and line director (MCRAH), Mohammad Sharif, said, “We have been providing free delivery kits, which include 15 necessary items, at about 2200 union health and family welfare centres.”

He also urged the state minister to arrange at least one ambulance for each union health and family welfare centres. “The ministry need to bear the cost of fuel and other expenses of the ambulance dedicated to pregnant women. This will change the whole scenario.”

Care Bangladesh’s programme director (health) Jahangir Hossain stressed the need for training family members of expectant mothers and the community about the five essential newborn cares (ENC), the rate of death will decrease.”

He also requested the development partners and NGOs to teach people about delaying in having their second child.

Putting emphasis on three-day delayed bath for the neonatal, Bangladesh Perinatal Society’s member secretary MAK Azad Chowdhury said, “We were the first people who persuaded the government to include 72-hour delayed bath in the health strategy.”

“We have been giving training to the government and non-governmental health professionals about neonatal care,” he added.

He further asked the professionals to check the blood group of the pregnant women as mother’s negative blood group can cause jaundice and other complications of the newborn.

“Besides, many hospitals do not have proper equipment to give medical care to the neonatal, if it suffers from any complexity. They send this newborn to BSMMU and other places. But, the health condition of the child already deteriorates on the way. This also has a role in increasing the death rate.”

ICDDRB’s senior director Shams L Arefin said while increasing primary health care activities in Khulna, Sylhet and other areas of the country where neonatal and child mortality rate are high, the authorities must not exclude Dhaka and Chittagong.

He also focused on functional integration among the different bodies working in the sector.

Paediatrician and Birdem Hospital’s director general Nazmun Nahar said, “Fathers also have to take the responsibility. They have to learn about the complications during pregnancy.”

Lamenting the fact that medical students are learning nothing about paediatrics, she called for a change in the medical college curriculum.

Pro vice-chancellor of Bangabandhu Sheikh Mujib Medical University (BSMMU) M Shahidullah asked the development partners to assist the government instead of introducing isolated programmes. “New programmes can be adopted if any new field emerges.”

He also thanked the government for the National Newborn Health Programme and asked all development partners to assist the government in implementing the NNHP.

Unicef health specialist Shamina Sharmin said, “Most of the neonatals die within the first 24 hours of their birth. If we can invest in saving the neonatals within the first day, the success will triple.”

Family planning directorate director general Kazi Mostafa Sarwar said, “Neonatals mainly die for three reasons - infection, asphyxia and complications of preterm birth. These are preventable. Awareness can prevent these deaths. Family planning directorate is trying to ensure ‘clean and safe delivery’ to decrease the child mortality rate.”

Health directorate director general Abul Kalam Azad said, “The research has to be in-depth and multidimensional. We must not raise health care activities only in Sylhet and Chittagong.”

“We have to go for universal health coverage. Each and every mother and child has to be brought under the coverage.”

He further said the directorate has begun a multipurpose health volunteer service as it focused on coordinated effort.

The health DG also requested the development assistants to help the government implement multipurpose health volunteer service to reduce the mortality rate of not only children, but of mothers also.