The document discusses child and infant mortality rates globally and in India. It provides definitions for under-five mortality rate, infant mortality rate, and neonatal mortality rate. The three main causes of under-five mortality are neonatal mortality (0-4 weeks), post-neonatal mortality (1-12 months), and factors like low birth weight, prematurity, and infectious diseases. While global under-five mortality has decreased 53% from 1990-2015, Africa still has the highest rate. India accounts for 20% of global under-five deaths despite its rate decreasing 61% from 1990-2015. Preventive measures discussed include prenatal nutrition, immunizations, breastfeeding, and improved access to primary healthcare.

1. CHILD MORTALITY
AND ITS
PREVENTION
BRIG HEMANT KUMAR

2. CHILD MORTALITY RATE
The ratio of under five child deaths registered in a
given year to the total number of live births
registered in the same year; are expressed as a
rate per 1000 live births.
UNDER FIVE MORTALITY RATE :
No. of deaths under five years of age in a year ×1000
Number of live births in the same year
2

3. CHILD MORTALITY RATE
Number of deaths under
Five years of age
Total live birth in the year
1000

4. INFANT MORTALITY RATE
It is the number of infant deaths
under one year of age per 1000
live births in one year.

5. INFANT MORTALITY RATE
Number of deaths under
one year of age
Total live birth in the year
1000

6. NEONATAL MORTALITY RATE
NMR
=
1000
No. Of deaths under 28
days of age
Total live births

7. Still
birth=
Fetal deaths
weighing over
1000gms at birth
Total live
+ still births
weighing over
1000gms at birth
1000

8. GLOBAL TRENDS
8

9. GLOBAL
CURRENT UNDER FIVE
MORTALITY RATE ???
9

10. GLOBAL U5MR
43/1000
6 MILLION
10

11. There were 5.9 million under five deaths
Globally during 2015,
Though the mortality rate has decreased by
53%, from 91 /1000 in 1990 to 43 deaths /
1000 in 2015.
The average annual rate of reduction in under-
five mortality has accelerated – from 1.8% a
year over the period 1990–2000 to 3.9% for
2000–2015 – but remains insufficient to reach
MDG 4
11

12. WHICH REGION
HAS HIGHEST
MORTALITY
???
12

13. African Region (81 per 1000 live births),
about 7 times higher than that in the
WHO European Region (11 per 1000
live births).
13

14. In 2015, the under-five
mortality rate in low-
income countries was
76 deaths per 1000
live births – about 11
times the average rate
in high-income
countries (7 deaths
per 1000 live births).
14

15. 15

16. INDIAN SCENARIO
16

17. India has the highest number of
child deaths in the world, with an
estimated 1.2 million deaths in 2015
— 20 per cent of the 5.9 million
global deaths.
17

18. Other countries in the top five for
number of deaths included: Nigeria
(7,50,000), Pakistan (4,31,000),
Democratic Republic of the Congo
(3,05,000) and Ethiopia (1,84,000).
18

19. WHAT IS INDIA’S
UNDER FIVE
MORTALITY RATE ??
19

20. 48/39
20

21. Globally the under-five child
mortality has reduced only by 48
per cent…whereas in India by
2015 we had reduced the under-
five child mortality by 61 per
cent,”

22. STATES ???
22

23. 23

24. INFANT MORTALITY
RATE
24

25. GLOBAL
SCENARIO
25

26. ??????????
26

27. 32
4.5m
27

28. Globally, the infant mortality
rate has decreased from an
estimated rate of 63 deaths per
1000 live births in 1990 to
32 deaths per 1000 live births in
2015. Annual infant deaths have
declined from 8.9 million in 1990
to 4.5 million in 2015.
28

29. National health programme for
children has led to a 68% drop in
India’s infant mortality rate (IMR),
But the IMR of 41 deaths per 1,000
live births is still worse off than
poorer neighbours Bangladesh (31)
and Nepal
29

30. CURRENT IMR
37/26
30

31. STATES
???
31

32. 32

33. CAUSES
OF
UNDER
FIVE MORTALTY
33

34. NEONATAL MORTALITY
(0-4 WEEKS)
POST-NEONATAL
MORTALITY
(1-12 MONTHS)
1. Low birth weight and
prematurity
2. Birth injury and difficult
labour
3. Sepsis
4. Congenital anomalies
5. Haemolytic diseases of
newborn
6. Conditions of placenta and
cord
7. Diarrhoeal diseases
8. Acute respiratory infections
9. Tetanus
1. Diarrhoeal diseases
2. Acute respiratory infections
3. Other communicable
diseases
4. Malnutrition
5. Congenital anomalies
6. Accidents
34

35. 35

36. FACTORS
AFFECTING
INFANT
MORTALITY
36

37. 1. BIOLOGICAL FACTORS
(a) Birth weight:
- babies of low birth weight
- and high birth weight are at special risk.
- causes: poor nutrition during pregnancy..
(b) Age of the mother:
- IMR are greater when the mother is
either very young or relatively older.
37

38. (C) BIRTH ORDER ???
38

39. - the highest mortality is found among
first born, and the lowest among
those born second.
- The risk of infant mortality escalates
after the third birth.
- the fate of fifth and later children
is always worse than the fate of the
3rd child.
39

40. (d) Birth spacing
- repeated pregnancies- malnutrition and anaemia
in the mother- predispose to LBW..
- prematurely weaned- PEM, diarrhoea and
dehydration.
(e) Multiple Pregnancies
- Infants born in multiple births face a greater risk
of death than do those in single births due to the
greater frequency of low birth weight among the
former.
40

41. (f)Family size
- the number of episodes of
infectious diarrhea, prevalence of
malnutrition, and severe respiratory
infections have been found to increase
with family size.
- fewer children-better maternal care, a
better share of family resources, less
morbidity and greatly decreased infant
mortality.
41

42. (g) High fertility
high fertility and high infant
mortality go together.
42

43. ECONOMIC FACTORS
The availability and quality of health care
and the nature of the child’s environment
are closely related to socio-economic
status.
43

44. 3. CULTURAL AND SOCIAL
FACTORS
(a)Breast feeding:
Early weaning and bottle-fed infants
living under poor hygienic conditions are
more prone to die than the breast-fed
infants living under similar conditions.
44

45. (b) Religion and caste
The differences are attributed to socio-
cultural patterns of living, involving age-old
habits, customs, traditions affecting
cleanliness, eating, clothing, child care
and almost every detail of daily living.
(c) Early marriages
..teen-age mother- greater risk of neonatal
and post-neonatal mortality.
45

46. (d) Sex of the child
Statistics show that female infant
mortality is higher than the male infant
mortality.
(e) Quality of mothering
(f) Maternal education
Women with schooling tend to marry later,
delay child- bearing and are more likely to
practice family planning.
46

47. (g) Quality of health care
Shortage of trained personnel like
dais, midwives and health visitors is
another determinant of high mortality
in India.
According to estimates only 47% of
the deliveries are attended by trained
birth attendants.
(f) Broken families
(g) Illegitimacy
47

48. (j) Brutal habits and customs
-depriving the baby of the first milk or colostrum,
frequent purgation, branding the skin,
application of cow-dung to the cut end of
umbilical cord, faulty feeding practices and
early weaning.
(k) The indigenous dai -..untrained
midwife- unhygienic delivery.
(l) Bad environmental sanitation
48

49. PREVENTIVE
MEASURES
49

50. 1. Prenatal nutrition
- improve the state of maternal nutrition..
2. Prevention of infection
- eg. Neonatal tetanus, UIP- protect
against 6 vaccine preventable diseases.
3. Breast feeding
- gastro-intestinal, respiratory infections and
PEM.
50

51. 4. Growth monitoring
- all infants should be weighed periodically and
their growth charts maintained.
- these charts help to identify children at risk of
malnutrition early.
5. Family planning
- smaller sib ship and longer spacing between
pregnancies are associated with improved infant
and child survival.
51

52. 6. SANITATION
- poor sanitation and environmental conditions
exposes the infant to various infections.
7. PROVISION OF PRIMARY
HEALTH CARE
- all those involved in maternity care (
obstetrician-local dai) should collaborate and
work together as a team.
52

53. 8.SOCIO-ECONOMIC
DEVELOPMENT
This must include spread of
education, improvement of
nutritional standards,
improvement of housing
conditions, the growth of
agriculture and industry .
53

54. 9. Education
Educated women generally do not have
early pregnancies, are able to space
their pregnancies, have better access to
information related to personal hygiene
and care of their children, and make better
use of health care services.
54

55. NHM
 1 Under the Millennium Development Goal
(MDG) 4 target is to reduce Child Mortality
by two-third between 1990 and 2015.
 In case of India, it translates into a goal of
reducing Infant mortality rate from 88 per
thousand live births in 1990 to 29 in
2015.

55

56. Promotion of institutional deliveries
through Janani SurakshaYojana.
Operationalization of sub-centres,
Primary Health Centres, Community
Health Centres and District Hospitals
for providing 24x7 basic and
comprehensive obstetric care
services.
56

57.  Antenatal, intranatal and postnatal care
including Iron and Folic Acid
supplementation to pregnant &
lactating women for prevention and
treatment of anaemia.
 Engagement of more than 8.9 lakhs
Accredited Social Health Activists
(ASHAs) to generate demand and
facilitate accessing of health care
services by the community.
57

58. 58