This document discusses the determinants of under-five child morbidity and mortality in Nepal. It defines key terms like child, infant, and under-five mortality rates. The major causes of under-five mortality in Nepal are identified as low birth weight, birth asphyxia, infections, hypothermia, congenital abnormalities, malnutrition, acute respiratory infections, diarrhea, and measles. The document also discusses social and environmental factors that indirectly impact child health outcomes, like maternal health, education, family size, and cultural practices. Statistics from the Nepal Demographic and Health Survey 2016 are presented on trends in childhood mortality and its relationship to factors like residence, birth order, and maternal age.

1. Determinants of under five children
morbidity and mortality
1
Ram Singh Chaishir
BPH 32 batch
CDPH,IOM,TU
Roll no: 696

2. content
 Definition of child and child health
 Terminologies relating to child health
 Childhood Mortality Indicators
 Key findings NDHS 2016 relating to child health
 Determinants of Neonatal Mortality in Nepal
 Cause of child morbidity and mortality
 Reference
2

3. Child
 A human being below the age of 18 years unless under
the law applicable to the child”- UN convention on child
right
 A child is a person 19 years or younger unless national
law defines a person to be an adult at an earlier age –
WHO
3

4. Contd..
 A child is generally anyone between birth and puberty or in the
developmental stage of childhood, between infancy and adulthood
Biological Definition
 A child is considered an adult after undergoing a rite of passage,
which may or may not correspond to the time of puberty –Cultural
Definition
4

5. Contd..
In our context
 "Child" means a minor not having completed the age of 16 year -
Children's Act, 2048 (1992), 2049/2/7 (Ma y 20, 1992 A.D .)
 "Children" means persons who have not completed the age of
eighteen years - Act Relating to Children, 2075 (2018) ,
2075/06/02 (18 September 2018)
5

6. Child health
 Child health is a state of physical, mental, intellectual, social and
emotional well-being and not merely the absence of disease or
infirmity. Healthy children live in families, environments, and
communities that provide them with the opportunity to reach
their fullest developmental potential.
- WHO
6

7. Child health major focus on
 Neonatal
 Infant
 Under five children
7

8. Terminologies
 Neonate : Baby after birth to before reaching 28 completed days
of age.
 Infant : An infant is a child younger than one year of age.
 Child : Baby between first and the fifth birthday.
 Under 5 child : Baby between birth and the fifth birthday.
8

9. Infant and child mortality
Infant and child mortality is relevant to a demographic
assessment of a country’s population and is an important
indicator of the country’s socioeconomic development and quality
of life.
9

10. Birth
Still Birth
Infant Mortality
Post –Neonatal Death
Neonatal Death
Late Neonatal
DeathEarly
Neonatal
Death
Perinatal Death
28 wks of
gestation
7 days 28 days 1 year
10
Mortalityinandaroundinfancy
Source: K Park, 23rd Edition, 2015

11. Childhood Mortality Indicators
 Neonatal mortality: The probability of dying within first month
of life.
 Post neonatal mortality: The probability of dying between the
first month of life and the first birthday.
 Infant mortality: The probability of dying between birth and the
first birthday.
 Child mortality : The probability of dying between first and the
fifth birthday.
 Under 5 mortality : The probability of dying between birth and
the fifth birthday.
11

12. Early Childhood Mortality Rates for Five Years Preceding the
Survey
Source: Nepal Demographic and Health Survey, 2016
12

13. Key findings NDHS 2016
 U5 mortality declined by 67%, IMR by 59% and NMR by 58% from
1996 to 2016.
 Childhood mortality is highest in Province 7, where neonatal,
infant, and under-5 mortality rates are 41, 58, and 69 deaths per
1,000 live births, respectively.
 Childhood mortality rates are higher, by 10 deaths per 1,000 live
births, in rural areas than in urban areas. Neonatal, infant, and
under-5 mortality rates are 26, 38, and 44 deaths per 1,000 live
births, respectively, in rural areas, as compared with 16, 28, and
34 deaths per 1,000 live births in urban areas. (NDHS 2016)
13

14. Major cause of Infant and child morbidity and mortality in Nepal
Determinants of Neonatal Mortality in Nepal:
1. Low Birth Weight
2. Birth asphyxia and birth injuries
3. Infections, Neonatal tetanus
4. Hypothermia
5. Congenital abnormalities
6. Breast feeding
7. Traditional beliefs and practices
8. Neonatal health Services
14

15. Factors associated with the LBW babies :
 Low maternal weight, height and BMI, Birth of a previous preterm
infant, Birth interval of less than two years, Adolescent motherhood,
Maternal illiteracy, Rural residence, Minimal antenatal care etc .
 Low birth weight : 2500-1500 Gram birth weight
 Very low birth weight : 1000-1500 Gram birth weight
 Extremely low birth weight: <1000 Gram birth weight
15

16. LBW babies may be
 Preterm birth: Child born before 37th week of gestation thus has
not reached full maturity thus is smaller than term babies.
 Small for dates neonate / IUGR: Child whose intrauterine growth
has been hampered thus is smaller than 2 S. D. for its gestational
age at birth.
 According NDHS, 2016 the incidence of LBW in Nepal is 24%
which is double than of 2011.
16

17. Situation of LBW in Nepal
 Among children with a reported birth weight (61%), 12% were of
low birth weight (less than 2.5 kg). The survey also provided
information on mothers’ estimates of their baby’s size at birth.
Although mothers’ estimates of size are subjective, they can be a
useful proxy for the baby’s birth weight. Five percent of births
are reported as very small, 12% as smaller than average, and 83%
as average or larger than average.
NDHS 2016
17

18.  Root cause: poverty, illiteracy, political instability, quality of health
services.
 Underlying cause: Lack of education, lack of information,
insufficient access of health service , low health care seeking habit,
poor environment hygiene and sanitation, cultural factors etc.
 Direct cause: Disease and infections, congenital factors,
inadequate dietary intake etc.
18
Cause of child morbidity and mortality

19. Direct cause
Major cause
 Malnutrition
 Acute Respiratory Infection ( ARI)
 Diarrhea
 Malaria
 Measles
19

20. Malnutrition
 Scarcity of food
 Lack of purchasing power of the family
 Traditional belief and taboos about what the baby
should eat
 A serious obstacle to child survival, growth and
development in Nepal
 The most common forms are PEM and micronutrient
deficiency state ( Iodine deficiency IDD, vitamin A
deficiency VAD)
20

21. Situation of malnutrition in Nepal
 Overall, 36% of children under age 5 are stunted, with 12%
being severely stunted (too short for their age); 10% are
wasted, with 2% severely wasted (too thin for their height);
and 27% are underweight, with 5% severely underweight
(too thin for their age), while around 1% of the children are
overweight (heavy for their height)
NDHS 2016
21

22. ARI
 Leading cause of childhood mortality and morbidity
throughout the world
 Most death due to Pneumonia, occur in developing
countries like Nepal, where poor children’s immune systems
are already weakened by malnutrition and other diseases ,
including Malaria, Measles, HIV/AIDs etc
 Total ARI case in 2075/76 : 789777 DoHS annual report
2075/76
22

23. Situation of ARI in Nepal
DoHS annual report 2075/76
 Out of 789777 case 19.1% were categorized as
pneumonia, 0.27% were severe pneumonia.
 The incidence of pneumonia ( both pneumonia,
severe pneumonia) at national level was 83/1000
under 5 children’s.
23

24. Diarrhea
 Dehydration caused by severe diarrhea is a major cause of
morbidity and mortality among young children.
 Exposure to diarrhea-causing agents is frequently related to the
use of contaminated water and to unhygienic practices in food
preparation and disposal of excreta.
 The prevalence of diarrhea has decreased steadily from 28 % in
1996 to 8 % in 2016 (Nepal).
 Infants who are not breastfed are 7 times more likely to die
of diarrhea and 5 times more likely to die of pneumonia
than infants who are exclusively breastfed.
24

25. Malaria
 Fever is a major manifestation of malaria and other acute
infections in children
 Malaria and fever contribute to high level of malnutrition and
mortality
 Since malaria is a major contributory cause of death in infancy and
childhood in many developing country like Nepal, presumptive
treatment of fever with antimalarial medication is advocated in
many country where malaria in endemic
25

26. Current situation of malaria in Nepal 26
https://www.researchgate.net/journal/1475-2875_Malaria_Journal

27. Source: Malaria micro stratification report 2019
27

28. Measles
 Caused by a virus measles is highly communicable and is
transmitted by contact with nasal or throat secretions emitted
through sneezing or coughing of infected person
 Complications that develop with measles, such as pneumonia and
diarrhea , as undernutrition, contribute to fatalities for children in
developing countries
 Nearly 90% of all death due to measles occur to children under
age of five
28

29. Indirect cause of child morbidity and mortality
Factors related to MOTHER
 Lack of care of mother during antenatal period
 Low child rearing capability of the mother
 Ignorance and illiteracy of mother
 Poor health during pregnancy and during lactation period
 Age of mother and parity mother is too young or too old (<18 years
and >35 years), mother has 4 or more children
 Under planned reproduction and lack of proper spacing less than 24
month after previous birth, multiple birth, high fertility
29

30. Under five mortality and Mother’s age
at Birth
 Mortality rates are lower for children whose mothers were age
20-29 when they were born than for children born to women
below age 20 or age 30-39. For instance, the neonatal mortality
rate is 21 deaths per 1,000 live births for children whose mothers
were age 20-29 when they were born, as compared with 39 and
31 deaths per 1,000 live births, respectively, for children whose
mothers were less than age 20 and age 30-39.
(NDHS
2016)
30

31. Under-five mortality and Birth Order
31
NDHS 2016

32. Factors inherent in child
32
 Heredity / congenital defects, Rh incompatibility
 Nonhereditary (PEM, Anemia)

33. Social, environmental and cultural factors
33
 Physical factors (over crowding, unsafe water and food, insanitary
disposal of waste and excreta)
 Low education level of mothers
 Sex of the child (Neglect of female child),broken homes, taboos
 Breastfeeding practice, cord cutting practice (use of cow dong)
 Lack of availability of well organized maternal and child services
 Lack of community participation for maternal and child health
 Environmental stimulation: contact with people, TV, Radio etc

34. Economic factors
34
 poverty

35. Achieving Results
35
SAVING
A
NEW
BORN
Equity
Quality
health
care
Raising
awareness
Improving
skill
Political
commitment
Measuring
change

36. Reference
 Children's Act, 2048 (1992), 2049/2/7 (Ma y 20, 1992 A.D .)
 The Act Relating to Children, 2075 (2018), 2075/06/02 (18 September 2018)
 NDHS 2016
 DoHS Annual report 2074/75
 K Park, 23rd Edition, 2015
 https://www.researchgate.net/journal/1475-2875_Malaria_Journal
 https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/child-
health
 https://www.unicef.org/press-releases/2018-global-nutrition-report-reveals-malnutrition-
unacceptably-high-and-affects
 https://www.unicef.org/child-rights-convention/what-is-the-convention
 https://www2.slideshare.net/MohammadAslamShaiekh/determinants-of-child-health
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