Neonatal deaths increase for 3 reasons

The rate of neonatal deaths in Bangladesh has increased over the past few years. The main causes of these deaths are asphyxia, sepsis, infectious diseases, underweight and other preventable causes.

The government’s programmes to tackle these problems are inadequate and sluggish.

The last Bangladesh Demographic and Health Survey (BDHS) carried out in 2017-18 stated that for every 1000 births, 30 infants died before they reached 28 days of age. In 2014, less than 2 in every 1000 births died.

Senior director of icddr,b’s maternal and child health division Shams El Arefin told Prothom that there are known ways to protect the life of newborns, yet the scope of government programmes in this regard is limited. These hardly have any impact or results.

According to BDHS, the overall infant mortality rate, that is, of infants under 5 years of age, has decreased somewhat.

For every 1000 births, there are 45 infant deaths. This was previously 46. But a large percentage of these deaths, 70 per cent, are neonatal. Out of every 1000 deaths, 38 infants die before reaching one year of age.

National Institute of Population Research and Training (NIPORT), under the health ministry, conducts this survey regularly. Another institute of the government, Bangladesh Bureau of Statistics (BBS) states that neonatal mortality and infant mortality rates are very low.

According to BBS’s latest Sample Vital Registration Statistics (SVRS), the neonatal mortality rate is 16 in every 1000 and for under-5 infants, 29 per 1000. However, SVRS is very limited in scope.

Professor of Dhaka University’s Health Economics Institute, Syed Abdul Hamid and professor of the Population Sciences Department Mohammed Mainul Islam have said the BDHS statistics are more reliable due to methodology and scope. The data for this survey is used internationally.

According to a press release of UNICEF on 31 December last year, over 8,000 children are born every day in Bangladesh, totally over 2.9 million a year. Based on BDHS statistics, neonatal deaths on average exceed 88,000 annually.

Causes of death and government steps

According to the BDHS report, one fourth of the newborn deaths occur due to asphyxiation at birth. Almost equally responsible for neonatal deaths are sepsis, pneumonia and other infections. And 17 per cent of the deaths occur due to premature birth and underweight.

There are several programmes of the health directorate and the family planning directorate on ground. Director of the maternal and child healthcare programme of the health directorate, physician Shamsul Huq, said that these programmes included safe delivery service, helping babies breathe, kangaroo mother care for underweight newborn infants and so on.

However, the ground reality shows that these programmes do not reach most of the people. Delivery at the health centres reduces neonatal mortality, but over half of the births take place at home, according to BDHS.

And 94 per cent of the deliveries at home are carried out by untrained persons. When complications arise, the lives of the mother and the child are at risk.

Two-thirds of the births in hospitals, clinics or health complexes take place in private establishments. A health researcher, on condition of anonymity, told Prothom Alo that many private clinics opt for caesarean section and if complications arise after the operation, they simply refer the patient to bigger hospitals.

The BDHS survey stated that around one fourth of the country’s infants are born underweight. They are under 2.5 kg at birth. They do not have adequate body heat and are also lacking in strength to breastfeed. Their chances of survival are low.

The health ministry’s hospitals provide Kangaroo Mother Care (KMC) service for underweight infants. The infants are kept in specially designed bags and placed close to the mother’s body for heat and breastfeeding.

Former chairman of Dhaka Medical College Hospital’s paediatric department, Abid Hossain Molla, told Prothom Alo that everyone knows what is to be done to save the lives of the newborn infants. Training is provided in this regard. There is also a decision to supply the required equipment and drugs. What is now needed is strict monitoring.

* This report appeared in the print version of Prothom Alo and has been rewritten in English by Ayesha Kabir