RATODERO: Pakistan Demographic Health Survey 2006-07 (PDHS) has reported that infant and child mortality has hardly changed in over a decade. For the most recent five-year period preceding the survey, infant mortality is 78 deaths per 1000 live births and under-five mortality is 94 deaths. Estimated 56% of under-five deaths occur during the neonatal period and 26% during the post-neonatal period.
Newborn mortality rate of Sindh is 53 per 1000 live births. Major reasons for public health facilities under performance are shortage of human resources, inadequate clinical governance in facilities, inadequate supportive supervision and inadequate resources.
Global evidence suggests that over 50% reductions in neonatal mortality can be achieved with an integrated, high coverage programme of universal outreach and family-community care. In the context of Pakistan, due to low level of skilled birth attendants, post natal care and newborn care coverage, many newborn die at homes without contact with health interventions. Even the new born who manage to get to health facilities in Pakistan do not fare well. Neonatal mortality among hospital admitted newborn in Pakistan has been reported to in the range of 9% to 39%. A study of newborn admission and mortality in a referral hospital in Bahawalpur, Punjab province between 2005 and 2008 showed that 19.71% of the total children admitted were neonates, and mortality rate among those admitted was 15.62%. Over the three years period, overall child mortality among admitted children reduced but newborn mortality did not.
In newborn care unit at LMCH Jamshoro, about 70-90 newborn are admitted per month and about 100 newborns are brought to the OPD per month. Major burden of newborn admissions, births and OPD load is dealt by two units of LMCH at Hyderabad, where more than 7000 babies are born each year. About 3000 newborn are admitted in two sick newborn units of paediatrics department.
Major features of these units are over-crowding, lack of infection control and lack skilled nursing staff (one nurse taking care of entire paediatrics unit each shift) resulting in newborn admission case fatality up to 30%. Similar situation is reported from tertiary care teaching hospitals in Larkana and Shaheed Benazirabad.
A major contributor to the high newborn case fatality rate among admitted newborns in these hospitals is the severe shortage of nursing care providers. One of the three hospitals reported having seven nurses to 66 Specialists doctors plus 21 post-graduate trainee doctors. Doctor to nurse ratio in two other hospitals too favour doctors indicating a major structural problems in these hospitals. All these three hospitals report this gap in nursing care provider stemming from the approved.