The document discusses infant and child mortality rates in Paraguay using data from various sources. It reports that the infant mortality rate in Paraguay is estimated to be 33.8 per 1000 live births but that reported data diverges significantly from estimates. The main causes of neonatal death are identified as birth injuries and preterm birth. The health sector response is described as fragmented and lacking coordination. Strategies to reduce infant mortality discussed include improving prenatal care, professional care during childbirth, and expanding access to healthcare.

1. Patricia Lima Pereira Student of Master in Social and Health Protection Institute of Public HealthJagiellonian University Medical College January 2009

3. 175 100 50 10 Population Reference Bureau 2008

4. Conception 28 weeks gestation Live birth One week after birth 28 days after birth One year Miscarriage Fetal mortality Perinatal mortality Infant mortality Post neonatal mortality Stillbirth Neonatal mortality Five years Child mortality Rajaratnam, Julie. Child Mortality. Research Methods for Developing Countries. University of Washington

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9. Rajaratnam, Julie. Child Mortality. Research Methods for Developing Countries. University of Washington

11. Estimated (from data of census 2002): 153.000 births Reported: 111.436 Occurred that year: 49.879 Dirección General de Estadísticas Encuestas y Censos. Estadísticas Vitales 2007.

14. Reported infant death: 492 Estimated infant death ( IMR = 33,8 x 1.000 birth alive) ≈ Between 3752 - 5171 Dirección General de Estadísticas Encuestas y Censos. Estadísticas Vitales 2007. Paho 2009

15. Reported infant, neonatal and postneonatal mortality. Paraguay 1960 - 2005 Organización Panamericana de la Salud, Unidad de Análisis de Salud y Estadísticas . Iniciativa Regional de Datos Básicos en Salud; Sistema de Información Técnica en Salud. Washington DC, 2007.

17. SOCIOECONOMIC DETERMINANTS Maternal factors Age Parity Birth interval Environmental Contamination Air / food / water Insect vector Nutrient deficiency Calories / Protein micronutrients Injury Accidental Intentional Personal illness control Healthy Sick Growth faltering Mortality Personal preventive measures Medical Treatment

18. Mendieta, E 2001 WHO. 2004

19. 1995 -1999 53 % Neonatal 35 % Birth injuries Mendieta 2000 1999 - 2003 60% Neonatal 39% Birth injuries PAHO 2009

28. Handler 2007; Donoso 2005 Prenatal care Smoking cessation Screening for variety of medical risks (e.g., hypertension, diabetes, STDS, HIV) Management of high-risk pregnancies Immunization against tetanus, diphteria, rubeola Nutritional supplementation Preterm birth prevention programs- (e.g., awareness of signs and symptoms of preterm labor, uterine monitoring programs) Average incidence of neonatal tetanus: 1-2 cases per year 36.8% of youths 13–15 years old in Asunción smoked. Girls smoke as much as boys Maternal mortality rate (1999):114.4 per 100,000 live births Vaccination coverage in women of reproductive age: 78% 32.5% pregnant women were underweight 94.2% of mothers received prenatal care at least once 68.6%, during the first trimester

32. WHO. Health statistics and health information systems. 2004

34. Arden Handler. New Approaches for Improving the Health of Mothers and Infants. Behm-Rosas H . Child survival: magnitude of the problem in Latin America. Salud Publica Mex. 1988 May-Jun;30(3):289-311. Bulletin of the Pan American Health Organization. 1981;15(1):73-6. Infant mortality in the Americas. [No authors listed] Cirera Suárez L. , Martínez López C. , Salmerón Martínez D. and Navarro Sánchez C. Perinatal mortality underreporting in obstetrics and neonatology. Anales de Pediatria 2008 69:2 (129-133) Del Popolo F., Oyarce A.M. y Ribotta B. Indígenas urbanos en América Latina: algunos resultados censales y su relación con los Objetivos de Desarrollo del Milenio. Notas de población N ° 8 6. C E PAL Donoso Siña, Enrique. Mortalidad perinatal en las Américas. Revista Chilena de Obstetricia y Ginecología 2005; 70(5) Health Situation Analysis and Trends Summary. Country Chapter Summary from Health in the Americas, 1998. Mendieta, E; Battaglia, V; Villalba, B. Mortalidad Neonatal en el Paraguay: Análisis de los indicadores. Revista de la Sociedad Paraguaya de Pediatría 2001 28: 1 Ministerio de Salud Pública y Bienestar Social. CALIDAD DE VIDA Y SALUD EN PARAGUAY. “Plan de Contingencia en Salud” Setiembre 2008 a marzo 2009 http://www.mspbs.gov.py/ver_noticia.php?id=2032 . Retrieved on 27 Dec 2009. 15:20. Mosley WH, Chen LC. An analytical framework for the study of child survival in developing countries. Population and Development Review, 1984, 10 (Supplement): 25–45. Pan American Health Organization “Health Systems Profile Paraguay” Washington, D.C.: PAHO, 2009 Rajaratnam, Julie. Child Mortality. Research Methods for Countries. University of Washington (ppt file) Rutstein SO . Mortality trends of young children in developing countries. IPPF Medical Bulletin. 1983 Dec;17(6):2-4. United Nations. Department of International Economic and Social Affairs. Population Division ; United Nations Fund for Population Activities UNFPA . Population Policy Compendium. 1982 May:1-7. University of Illinois School of Public Health. Maternal and Infant Mortality Summit. October 24, 2007. (Ppt file) Wegman, Myron E.,Infant mortality: Some international comparisons. Pediatrics, Dec96 Part 1 of 2, Vol. 98, Issue 6 Monitoring of the availability and use of health services with Essential Neonatal and Obstetric Care (ENOC) in Paraguayan health establishments, 2005.