As a part of my assignment on applied epidemiology

1. TOPIC:
CHILD MORTALITY
Submitted by:
Dr. Kritika Sarkar

2. Introduction
◦ Child mortality refers to mortality of children under the age of 5.
◦ Of all children who die, most do not come close to their fifth
birthday: the younger a child is, the higher the risk of mortality.
◦ Three times as many children die in the first year of their lives
than in the next four years. And the majority of children who die
in their first year die in the neonatal period, the first 27 days
after birth.
◦ The global under-five mortality rate declined by 59 per cent
from 93 deaths per 1,000 live births in 1990 to 38 in 2019. On
average, 14,000 children under age 5 died every day in 2019,
compared to 34,000 in 1990.
◦ Children in sub-Saharan Africa continue to face the steepest odds
of survival in the world with an estimated 1 in every 13 children
dying before reaching age 5 in 2019.
◦ Case in point: Somalia with 117 deaths per 1000 live birth.
◦ If all countries reach the SDG child survival targets by 2030, 11
million lives under age 5 will be saved—more than half of them
in sub-Saharan Africa.
Source: https://childmortality.org/data

3. Somalia: Country profile
◦ The capital, Mogadishu.
◦ About three-fifths of Somalia’s economy is based on agriculture; however, the main economic activity is not crop farming but livestock raising.
◦ The Somali people are mostly clan-based Muslims, roughly two-fifths of the Somali population live permanently in settled communities; the
other three-fifths are nomadic pastoralists or agropastoral. The sedentary population chiefly occupies climatically and topographically favorable
regions in southern and northwestern Somalia, where rain-fed agriculture is possible and irrigation agriculture can be practiced along the
rivers. Their settlements consist of large clustered villages near the rivers and in the central agro-fertile area, as well as small hamlets farther
away. Only about two-fifths of the population is urban.
◦ Health indicators in Somalia are among the lowest in the world. The Somali population has an average life expectancy of about 50 years. Only
one in three Somalis has access to safe water; one in every nine Somali children die before their first birthday; and the maternal mortality ratio
is 850 deaths per 100 000 live births.
◦ The health care system in Somalia remains weak, poorly resourced and inequitably distributed. Health expenditure remains very low and there
is a critical shortage of health workers.
◦ Somalia has a relatively young population, more than two-fifths being under age 15.
◦ In the early 21st century, the country remained one of the poorest in the world, and its main sources of income came from foreign aid,
remittances, and the informal sector.
◦ The country’s currency, the Somali shilling, has been depreciating for years.

4. Data
(Source: UNICEF, WHO)

5. Goal
◦ In 2015, the world began working toward a new global development agenda, seeking to achieve, by 2030, new targets set out
in the Sustainable Development Goals (SDGs).
◦ The proposed SDG target for child mortality aims to end, by 2030, preventable deaths of newborns and children under 5 years
of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births and under-5
mortality to at least as low as 25 deaths per 1,000 live births.
◦ Specific target: Reduction of deaths caused by Pneumonia in under 5 children in Somalia.

6. Input
Resources
• Manpower (training,
capacity building,
doctors, community
workers, etc)
• Infrastructure (health
care centres,
laboratories,
hospitals, schools,
permanent homes
etc)
• Logistics (patient
mobility, vaccine
supply, etc)
• Nutitional
supplementation
Contributions
• Health education
• Diet counselling
• Food donation
• Financial aid
• Innovative
agricultural
techniques
• Industrial growth
• Foreign investments
• Nomadic
rehabilitation and
education
Investments
• Health infrastructure
• Vaccine supply and
other medications
• Funds for various
healthcare and
educational activities
• Diagnostic aids:
Chest radiography
(will tell the extent),
Sputum analysis
(type), etc.

7. Process
(Focus: Poor nutritional status, leading co-factor for pneumonia)
◦ In Somalia, nutritional deficiencies stemming from inadequate
maternal and child nutrition pose a serious problem that has
devastating consequences for infants, young children,
adolescent girls and women. It is estimated that undernutrition
causes 45 percent of all child deaths in settings like Somalia –
where the neonatal, infant and under-five mortality rates are
among the highest globally. 24 per 1000 live births, under five
mortality rate due to pneumonia in 2018. 21% of child deaths
were due to pneumonia in 2018, and it was the biggest killer of
children under-five in 2017  (Source: UNICEF)
◦ The presence of severe acute malnutrition can increase mortality
from pneumonia 15-fold, and in a score of mortality risk among
infants with pneumonia, very low weight-for-age and refusal to
feed contributed as much to mortality risk as hypoxia. (Source
The Lancet)
◦ Maternal nutrition should be of focus. Her befre and after
conception health should be taken in account

8. To combat pneumonia and save lives, it can be
possible through:
◦ Universal Health Coverage (UHC) and equitable access to quality primary health care to prevent, diagnose and treat pneumonia.
◦ Better immunization coverage to protect children from some of the leading causes of pneumonia. (pneumococcal conjugate vaccine, PCV
& pneumococcal polysaccharide vaccine, PPSV)
◦ Good nutrition to help their bodies to fight off infections and respond to treatment, as well as to prevent underlying causes of pneumonia.
◦ Improved water, hygiene & sanitation, and reductions in air pollution to help address risk factors that can cause pneumonia.
◦ Ensuring access to integrated service delivery and life-saving low cost antibiotics at the community level and
◦ Strengthening the availability and quality of referral level care.

10. Output
◦ Lower mortality rates of deaths caused by malnutrition and pneumonia.
◦ Improved health status of women and children.
◦ Vaccine preventable disease burden will be less.
◦ Reduction in morbidity due to nutritional conditions and pneumonia.

11. Outcome
◦ Lower mortality rates amongst children leading to a healthy future population and hence a better socio-economic situation for
Somalia.