Child Mortality Statistics: Not just numbers

For Eastern  Mirror column

In my presentations, I point to the health statistics and say that these are not just numbers in a table, shades of colors in a chart, or dots in a map; but they are measures of human suffering. Behind such mathematical and statistical figures of our health and disease data are real people who either suffered or died. Chances are that in the process data entry, compilation, and reporting; health statistics can lose sight of this and reduce human suffering to nothing but statistical data to measure performance of various policies and programs. I say this, to also stress on the need for reliable data, because those who manipulate or give false reports are not simply playing with numbers, but with human lives. It is also a motivating force for me that even though I don’t work in a hospital anymore to treat patients; through the use of health data, I try to study the dynamics of human health and think of ways to lessen human suffering and death.

Everybody dies. But to let children die in millions from easily preventable causes is a heartache that the world still faces. The new UNICEF report released few days back is another one evidence of that sad reality. According to the report; last year, 6.9 million children died before reaching their fifth birthday. What is most disturbing is that out of these, 4.4 million kids died from diseases which could have been prevented.

The leading causes of the under-five deaths are:

1.      Pneumonia: 18%

2.      Preterm birth complications: 14%

3.      Diarrhea: 11%

4.      Complications during birth: 9%

5.      Malaria: 7%

These are not conditions which are difficult to treat or prevent. Yet we still let children die of these in millions. The report adds that more than a third of all under-five deaths are attributable to malnutrition. Improvement has been made but it is estimated that at the present rate, the Millennium Development Goal number 4 (to reduce under-five mortality by two-third between 1990 and 2015) is going to be missed. 24% of these deaths (maximum) occurred in our country. Our State of Nagaland fare better when compared with the national average. It is interesting to note that in Nagaland, in spite of the fact that the percentages of pregnant mothers who go for antenatal check up, mothers who deliver babies in health centers/hospitals, and children who are fully immunized, are all poor; Infant Mortality Rate (IMR) is two times lower than the national figure. IMR for Nagaland is 23 (No. of infant deaths per 1000 live births) against the national average of 47 as per Sample Registration System bulletin, December 2011. 

The State Human Development Report 2004 stated that low IMR can be explained by the unique culture, social capital, and dietary behavior of the Naga society. So, reducing IMR is not solely based on the provision of health services, but social and cultural factors also play a big role. Social, Economic and cultural conditions/ environment which improve health must be encouraged and actively promoted. However, from the trend over the years, it has been seen (see chart) that IMR for the State has stagnated while the national average has experienced steady decline. And 23 is still an unacceptable figure given that Goa has only 10, Kerala 13, Manipur 14, and other developed countries have lower levels. This demonstrates that factors which influence overall health status of infants are multi-factorial. The health services delivery has to improve given the poor service delivery indicators.

From the National Family Health Survey third round (NFHS III) which was carried out in 2005-06, it was observed that in Nagaland, children deaths are related to the educational status of the mothers. A child is more likely to die before his/her first birthday if the mother has received no formal education. So, protection of a child goes way back to sending the girl child to school. Kerala is a case in point where because of its high female literacy, reproductive and child health indicators comparable to those of developed countries can be achieved.

The quality of care that the mother receives during pregnancy is very important for the health of the child. The government is providing free antenatal check up and medicines like Iron and Folic Acid. Also cash incentives are provided to promote institutional delivery for the safety of both mother and child. The father also needs to be sensitized on the importance of maternal care and identification of complications in pregnancy as the NFHS found that majority of the fathers in Nagaland were not sensitized or informed on these things. Also too narrow spacing of births, or pregnancy before 20 and over 40 years of age are found to be related to infant deaths.

Vaccination against Polio, Diptheria, Whooping Cough, Tuberculosis, Tetanus, Measles, and Hepatitis B are made available in the health units. But the percentage of children who have received full immunization as per schedule is still low. The community must come forward in a bigger way to sensitize parents to ensure full immunization of their children.

 Early diagnosis and prompt treatment are important to prevent deaths. Children are more susceptible to infections and their bodies have lower immunity to fight illnesses and survive complications. Among the leading causes leading to death of under-five children listed above, pneumonia, diarrhea, malaria, etc are easily treatable when diagnosed early. But they lead to death because of delayed treatment when complications have set in. Increase in health consciousness and change in health seeking behavior through education and awareness on the one side, and improved services delivery on the other are required to tackle preventable deaths.

India has more malnourished children than Sub-Saharan Africa. Ironically in the face of poverty, tons of grains rot in FCI godowns due to abstract market and political complications. The paradox of India is that stunted, wasted, and underweight children live side by side with the stingiest billionaires in the world and a consumerist middle class whose mind is set on his own self interest. Although nutritional status of children in Nagaland is better when compared to the National average, NFHS III showed that 32.4%, 15.3%, and 31.8% of children under 3 years in Nagaland are stunted (too short for age), wasted (too thin for height), and underweight (too thin for age). These children are more likely to get sick, slower to recover, and die more often. Malnutrition can also affect mental growth and reduce ability to learn in school. Proper nutrition during pregnancy of the mother, and during the growing stages of the child are important to maintian a healthy adult life.

The hard statistical data as in the UNICEF report, the National Family Health Survey, and other annual reports and surveys must be translated into stories and lessons that guide us to plan what we must do to reduce human suffering and improve wellbeing.