It all about infant mortality

1. Infant mortality
What is infant mortality ?
Infant mortality is the death of an infant before the infant's first birthday .The occurrence of infant mortality
in a population can be described by the infant mortality rate (IMR), which is the number of deaths of infants
under one year of age per 1,000 live births .Similarly, the child mortality rate, also known as the under-five
mortality rate, compares the death rate of children up to the age of five In 2013, the leading cause of infant
mortality in the United States was birth defects. Other leading causes of infant mortality
include birthpsphyxia, pneumonia, neonatainfection, diarrhea, malaria, measles, malnutrition, congenital
malformations, term birth complications such as abnormal presentation of the fetus, umbilical cord
prolapse, or prolonged labor. One of the most common preventable causes of infant mortality is smoking during
pregnancy. Lack of prenatal care, alcohol consumption during pregnancy, and drug use also cause complications
that may result in infant mortality. Many situational factors contribute to the infant mortality rate, such as the
pregnant woman's level of education, environmental conditions, political infrastructure, and level of medical
support. Improving sanitation, access to clean drinking water, immunization against infectious diseases, and
other public health measures can help reduce rates of infant mortality. In 1990, 8.8 million infants younger than
one-year-old died globally out of 12.6 million child deaths under the age of five. More than 60% of the deaths of
children under-five are seen as avoidable with low-cost measures such as continuous breastfeeding, vaccinations,
and improved nutrition. The global under-five mortality rate in 1950 was 22.5%, which dropped to 4.5% in
2015. Over the same period, the infant mortality rate declined from 65 deaths per 1,000 live births to 29 deaths per
1,000. Globally, 5.4 million children died before their fifth birthday in 2017 by 2021 that number had dropped to 5
million children. The child mortality rate (not the infant mortality rate) was an indicator used to monitor progress
towards the Fourth Goal of the Millennium Development Goals of the United Nations for the year 2015. A
reduction in child mortality was established as a target in the Sustainable Development Goals—Goal Number 3:
Ensure healthy lives and promote well-being for all at all ages As of January 2022, an analysis of 200 countries
found 133 already meeting the SDG target, with 13 others trending towards meeting the target by 2030. Throughout
the world, the infant mortality rate (IMR) fluctuates drastically, and according to Biotechnology and Health
Sciences, education and life expectancy in a country are the leading indicators of IMR. This study was conducted
across 135 countries over the course of 11 years, with the continent of Africa having the highest infant mortality
rate of any region studied, with 68 deaths per 1,000 live births.
Classification
Infant mortality rate (IMR) is the number of deaths per 1,000 live births of children under one year of age. The rate
for a given region is the number of children dying under one year of age, divided by the
number of live births during the year, multiplied by 1,000.
Forms of infant mortality
Ÿ Perinatal mortality is late fetal death (22 weeks gestation to birth) or death of a newborn up to one
week postpartum.
Ÿ Neonatal mortality is death occurring within 28 days postpartum. Neonatal death is often attributed
to inadequate access to basic medical care, during pregnancy and after delivery. This accounts for 40–60% of infant
mortality in developing countries.
Ÿ Postneonatal mortality is the death of children aged 29 days to one year. The major contributors
to postneonatal death are malnutrition, infectious disease, pregnancy complications, sudden infant death syndrome,
and problems in the home
Causes
Causes of infant mortality, or direct causes of death, differ from contributions to the IMR, as contributing factors
raise the risk of death, but do not directly cause death. Environmental and social barriers that prevent access to
basic medical resources contribute to an increased infant mortality rate, 86% of infant deaths are caused

2. by infections, premature births, complications during delivery, perinatal asphyxia, and birth injuries. Many of these
common causes are preventable with low-cost measures
Main cause
o Premature births
Premature, or preterm birth (PTB), is defined as birth before a gestational age of 37 weeks, as opposed to full term
birth at 40 weeks. This can be further sub-divided in various ways, one being: "mild preterm (32–36 weeks), very
preterm (28–31 weeks) and extremely preterm (<28 weeks)".A lower gestational age increases the risk of infant
mortality.Infant mortality caused by premature birth is mainly attributed to developmental immaturity, which
impacts multiple organ systems in the infant's body.[34] The main body systems affected include the respiratory
system, which may result in pulmonary hypoplasia, respiratory distress syndrome, bronchopulmonary dysplasia (a
chronic lung disease), and apnea.[34] Other body systems that fully develop at a later gestational age include
the gastrointestinal system, the skin, the immune system, the cardiovascular system, and the hematologic system.
[34] Poor development of these systems increases the risk of infant mortality.
o Sudden infant death syndrome (SIDS)
Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant less than one year of age with no
cause detected after a thorough investigation. SIDS is more common in Western
countries. The United States Centers for Disease Control and Prevention report SIDS to be the leading cause of
death in infants aged one month to one year of life.Even though researchers are not sure what causes SIDS, they
have found that putting babies to sleep on their backs, instead of their stomachs, lowers the risk. Campaigns
like Back to Sleep have used this research to lower the SIDS death rate by 50%.Though the exact cause is
unknown, the "triple-risk model" presents three factors that together may contribute to SIDS: smoking while
pregnant, the age of the infant, and stress from conditions such as prone sleeping, co-sleeping, overheating, and
covering of the face or head. In the early 1990s, it was argued that immunizations could contribute to an increased
risk of SIDS; however, more recent support the idea that vaccinations reduce the risk of SIDS.
o Medicine and biology
Causes of infant mortality and deaths that are related to medical conditions include: low birth weight, sudden infant
death syndrome, malnutrition, congenital malformations, infectious diseases, and low income for health care
including neglected tropical disease.
o Low birth weight
Low birth weight makes up 60–80% of the infant mortality rate in developing countries. The New England Journal
of Medicine stated that "The lowest mortality rates occur among infants weighing 3,000 to 3,500 g (6.6 to 7.7 lb).
For infants born weighing 2,500 g (5.5 lb) or less, the mortality rate rapidly increases with decreasing weight, and
most of the infants weighing 1,000 g (2.2 lb) or less die. As compared with normal-birth-weight infants, those with
low weight at birth are almost 40 times more likely to die in the neonatal period; for infants with very low weight at
birth the relative risk of neonatal death is almost 200 times greater.
o Malnutrition
Malnutrition or undernutrition is defined as inadequate intake of nourishment, such as proteins and vitamins, which
adversely affects the growth, energy, and development of people all over the world.[49] It is especially prevalent
during pregnancy and in infants and children under 5 who live in developing countries within the poorer regions of
Africa, Asia, and Latin America.[50] Children are especially vulnerable as they have yet to fully develop a
strong immune system and are dependent on their parents to provide the necessary food and nutritional intake. It is
estimated that about 3.5 million children die each year as a result of childhood or maternal malnutrition,
with stunted growth, low body weight, and low birth weight accounting for about 2.2 million associated deaths.
[51] Socioeconomic and environmental factors contribute to malnutrition, as do gender, location, and cultural
practices surrounding breastfeeding.[52] It is difficult to assess the most pressing factor as they can intertwine and
vary among regions.

3. o Infectious diseases
Babies born in low- to middle-income countries in sub-Saharan Africa and southern Asia are at the highest risk of
neonatal death. Bacterial infections of the bloodstream, lungs, and the brain's covering (meningitis) are responsible
for 25% of neonatal deaths worldwide. Newborns can acquire infections during birth from bacteria present in the
birth canal, the person may not be aware of the infection, or they may have an untreated pelvic inflammatory
disease or a sexually transmitted disease. These bacteria can also move up the vaginal canal into the amniotic sac
surrounding the baby causing in utero transmission. Maternal blood-borne infection is another route of bacterial
infection. Neonatal infection is more likely with the premature rupture of the membranes (PROM) of the amniotic
sac.Seven out of ten childhood deaths are due to infectious diseases like acute respiratory
infection, diarrhea, measles, and malaria. Acute respiratory infections such as pneumonia, bronchitis,
and bronchiolitis account for 30% of childhood deaths; 95% of pneumonia cases occur in the developing world.
Diarrhea is the second-largest cause of childhood mortality in the world, while malaria causes 11% of childhood
deaths. Measles is the fifth-largest cause of childhood mortality.
o Environmental
The infant mortality rate is one measure of a nation's health and social conditions. Its causes are a composite of a
number rates that each have their own separate relationships with each other and with various other social factors.
As such, IMR can often be seen as an indicator to measure the level of socioeconomic disparity within a country
The burning of inefficient fuels doubles the rate of acute respiratory tract infections in children under 5 years old.
[18] People who live in areas where particulate matter air pollution is higher tend to have more health problems
regardless of age. The short and long-term effects of air pollution are associated with an increased mortality rate,
including infant mortality. Air pollution is consistently associated with postnatal mortality due to respiratory effects
and sudden infant death syndrome (SIDS). Specifically, air pollution is highly associated with SIDS in the United
States during the post-neonatal stage.[61] High infant mortality is exacerbated because newborns are a vulnerable
subgroup that is affected by air pollution.[62] Newborns who were born into these environments are no exception,
and pregnant women exposed to greater air pollution on a daily basis should be closely watched by their doctors,
including after the baby is born. Babies who live in areas with less air pollution have a greater chance of living until
their first birthday, meaning babies who live in environments with more air pollution are at greater risk for infant
mortality. Areas that have higher air pollution also have a greater chance of having a higher population density,
higher crime rates, and lower income levels, all of which can lead to higher infant mortality rates.
o Early childhood trauma
Early childhood trauma includes physical, sexual, and psychological abuse of a child
from birth to five years old. Trauma in early childhood has an extreme impact over the course of a lifetime and is a
significant contributor to infant mortality. Developing organs are fragile, when an infant is shaken, beaten,
strangled, or raped, the impact is exponentially more destructive than when the same abuse occurs to a fully
developed body.[fact or opinion?] Studies estimate that 1–2 per 100,000 U.S. children are fatally injured annually,
and it is reasonable to assume that these statistics underrepresent actual mortality.[66][67] Almost three-quarters
(70.6%) of child fatalities in FFY 2018 involved children younger than 3 years, and children younger than 1 year
accounted for half (49.4%) of all fatalities.[66] In particular, correctly identifying deaths due to neglect is
problematic, and children with sudden, unexpected deaths or deaths from apparently unintentional causes often
have preventable risk factors that are substantially similar to those in families with maltreatment.
o Socio-economic factors
is a major factor in infant mortality, both historically and today. Between 1912 and 1915, the Children's Bureau in
the United States examined data across eight cities and nearly 23,000 live births. They discovered that
lower incomes tended to correlate with higher infant mortality. In cases where the father had no income, the rate of
infant mortality was 357% higher than that for the highest income earners ($1,250+).[72]:5 Differences
between races were also apparent. African-American mothers experience infant mortality at a rate 44% higher than
average however, research indicates that socio-economic factors do not totally account for the racial disparities in
infant mortality
o War
Infant mortality rates correlate with war, political unrest, and government corruption.[18] In most cases, war-
affected areas will experience a significant increase in infant mortality rates. Having a war take place when
planning pregnancy is not only stressful on the mother and fetus but also has several detrimental effects.

4. Prevention and outcomes
To reduce infant mortality rates across the world, health practitioners, governments, and non-governmental
organizations have worked to create institutions, programs, and policies to generate better health outcomes. Current
efforts focus on the development of human resources, strengthening health information systems, health service
delivery, etc. Improvements in such areas aim to increase regional
health systems and aid efforts to reduce mortality rates.
o Policy
Reductions in infant mortality are possible at any stage of a country's development.[22] Rate reductions are
evidence that a country is advancing in human knowledge, social institutions, and physical capital. Governments
can reduce mortality rates by addressing the combined need for education (such as universal primary education),
nutrition, and access to basic maternal and infant health services. Focused policies has the potential to aid those
most at risk for infant and childhood mortality, including rural, poor, and migrant populations.
o Prenatal care and maternal health
Certain steps can help to reduce the chance of complications during
pregnancy. Attending regular prenatal care check-ups will help improve the baby's chances of being delivered in
safer conditions and surviving.[94] Additionally, taking supplementation, including folic acid, can help reduce the
chances of birth defects, a leading cause of infant mortality.[7] Many countries have instituted mandatory folic acid
supplementation in their food supply, which has significantly reduced the occurrence of a birth defect known
as spina bifida in newborns.[95] Similarly, the fortification of salt with iodine, called salt iodization, has helped
reduce negative birth outcomes associated with low iodine levels during pregnancy.Abstinence from alcohol can
also decrease the chances of harm to the fetus as drinking any amount of alcohol during pregnancy may lead to fetal
alcohol spectrum disorders (FASD) or other alcohol related birth defects.[97] Tobacco use during pregnancy has
also been shown to significantly increase the risk of a preterm or low birth weight birth, both of which are leading
causes of infant mortality.[98] Pregnant women should consult with their doctors to best manage any pre-existing
health conditions to avoid complications to both their health as well as the fetus's. Obese people are at an increased
risk of developing complications during pregnancy, including gestational diabetes or pre-eclampsia. Additionally,
they are more likely to experience a pre-term birth or have a child with birth defects.
o Nutrition
Appropriate nutrition for newborns and infants can help keep them healthy, and can help avoid health
complications during early childhood. The American Academy of Pediatrics recommends
exclusively breastfeeding infants for the first 6 months of life, and continuing breastfeeding as other sources of food
are introduced through the next 6 months of life (up to 1 year of age).[100] Infants under 6 months of age who are
exclusively breastfed have a lower risk of mortality compared to infants who are breastfed part of the time or not at
all.[101] For this reason, breast feeding is favored over formula feeding by healthcare professionals.
o Vaccinations
The Centers for Disease Control and Prevention (CDC) defines infants as those 1 month of age to 1 year of age.
[102] For these infants, the CDC recommends the following vaccinations: Hepatitis
B (HepB), Rotavirus (RV), Haemophilus Influenzae type B (HIB), Pneumococcal Conjugate (PCV13), Inactivated
Poliovirus (IPV < 18 yrs), Influenza, Varicella, Measles, Mumps,
Rubella (MMR), and Diphtheria, tetanus, acellular pertussis (DTapP < 7yrs).[103] Each of these vaccinations are
given at particular age ranges depending on the vaccination and are required to be done in a series of 1 to 3 doses
over time depending on the vaccination.[103]The efficacy of these vaccinations can be seen immediately following
their introduction to society.[104] Following the advent of the Pneumococcal Conjugate vaccine (PCV13) in the
United States in the year 2000, the World Health Organization (WHO) reports studies done in 2004 had shown a
57% decline in invasive[b] penicillin resistant strains of the disease and a 59% reduction in multi drug
resistant strains. This reduction was even greater for children under 2 years of age with studies finding an 81%
reduction in those same strains.As mentioned in a previous section, sudden infant death syndrome (SIDS) is the
leading cause of infant mortality between 1 month and 1 year of age.[37] Immunizations, when given in accordance
to proper guidelines, have shown to reduce the risk of SIDS by 50%.[40][105] For this reason, the American
Academy of Pediatrics (AAP) and the Center for Disease Control (CDC) both recommend immunizations in
accordance to their guidelines.
o Socio-economic factors

5. It has been well documented that increased education among mothers, communities, and local health workers
results in better family planning, improvement in children's health, and lower rates of children's deaths. High-risk
areas, such as Sub-Saharan Africa, have demonstrated that an increase in women's educational attainment leads to a
reduction in infant mortality by about 35%. Similarly, coordinated efforts to train community health workers in
diagnosis, treatment, malnutrition prevention, reporting and referral services has reduced infant mortality in
children under 5 by as much as 38%. Public health campaigns centered around the First 1000 days of life have been
successful in providing cost-effective supplemental nutrition programs, as well as assisting young mothers in
sanitation, hygiene and breastfeeding. Increased intake of nutrients and better sanitation habits have a positive
impact on health, especially for developing children. Educational attainment and public health campaigns provide
the knowledge and means to practice better habits and lead to lower infant mortality rates.
Differences in measurement
The infant mortality rate correlates very strongly with the likelihood of state failure, and is among the best
predictors thereof. IMR is therefore also a useful indicator of a country's level of health (development), and is a
component of the physical quality of life index.
The method of calculating IMR often varies widely between countries, as it is based on how they define a live birth
and how many premature infants are born in the country. Depending on a nation's live birth criterion, vital
registration system, and reporting practices, reporting may be inconsistent or understated .The reported IMR
provides one statistic which reflects the standard of living in each nation. Changes in the infant mortality rate
"reflect enduring social and technical capacities that become attached to a population".The World Health
Organization (WHO) defines a live birth as any infant born demonstrating independent signs of life, including
breathing, heartbeat, umbilical cord pulsation or definite movement of voluntary muscles.This definition is used in
Austria, and is also used in Germany, but with one slight modification: muscle movement is not considered to be a
sign of life.Many countries, including certain European states (e.g. France) and Japan, only count cases where an
infant breathes at birth as a live birth, which makes their reported IMR numbers somewhat lower and increases their
rates of perinatal mortality. In other countries, the Czech Republic and Bulgaria, for instance, requirements for live
birth are even higher.
Although many countries have vital registration systems and specific reporting practices, there are often
inaccuracies in the statistics, particularly in rural communities in developing countries. In those communities, some
other alternative methods for calculating infant mortality rate are used, for example, popular death reporting and
household survey. Studies have shown that when comparing three information sources—official registries,
household surveys, and popular reporters—the popular death reporters are the most accurate; popular death
reporters include midwives, gravediggers, coffin builders, priests, and others, essentially people who knew the most
about the child's death. In developing nations, access to vital registries, and other government-run systems which
record births and deaths, is difficult for poor families for several reasons. These struggles force families to take
drastic measures, like having unofficial death ceremonies for their deceased infants. As a result, government
statistics will inaccurately reflect a nation's infant mortality rate. Popular death reporters have first-hand
information, and, provided this information can be collected and collated, can provide reliable, accurate death
counts for a nation, as well as meaningful causes of deaths that can be measured and studied .
Infant mortality rate (IMR) is not only a statistic but also a reflection of socioeconomic development, as such it
effectively represents the presence of medical services in a country. IMR is an effective resource for health
departments making decisions on medical resource allocation, and also formulates global health strategies and helps
evaluate their success. The use of IMR helps solve the inadequacies of other vital statistic systems for global health
as most neglect infant mortality rates among the poor. There remains a certain amount of unrecorded infant death in
rural area as they either do not have the concept of reporting early infant death, or they do not know about the
importance of the IMR.