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Infant and Child Mortality

Assessment

Zaınab M. Al-Khuzamee

Department of Pediatric Nursing, University Ahi Evran

Student ID:201217158

Dr. professor HİLAL SEKİ ÖZ

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Introduction

Iraq, after many years of wars and sanctions that began in 1985 and continue to this

day, have exhausted the infrastructure, economy, and health institutions directly, which led to

the deterioration of health services provided to society, and the impact was great on children

under the age of five. Due to the economic sanctions imposed on the country in the nineties,

the import of many materials necessary for the survival of children, including milk, medicine

and vaccines, was stopped, which led to an increase in deaths among children. soon after the

war, in early 1991, a group of American researchers conducted a rapid evaluation of

children's welfare and health services and discovered "tragic proportions of deprivation.

(Harvard Study Team,1991). A few months later, the International Study Team (IST), a

group of researchers from around the world, performed a nationally representative household

survey on infant mortality. The survey took place over a two-week stretch in late 1991 and

asked for births that occurred after January 1, 1985.The data was analyzed using a total of 16

076 live births and 768 deaths. On this basis, the IST calculated that the under-5 mortality

rate (U5MR) was around 43 infant deaths per 1000 live births in the five years leading up to 1

January 1991, and around 128 per 1000 in the eight months That followed. The IST reported

that during these 8 months during which the world was affected by war, aerial bombardment,

internal rebellions, and mass displacement in addition to economic sanctions there were 46

900 additional infant deaths relative to what would have occurred if mortality had remained

at the 1985–1990 level. (Ascherio et al,1992).

In the Kurdish north, the most significant rise in U5MR was observed. The IST

admitted that the survey may have been skewed due to missed death dates for a large number

of children and the likely lack of deaths that occurred before 1990. With the sanctions still in

place, a letter from the UN's Food and Agriculture Organization (FAO) in Baghdad in 1995

announced the findings of a small survey conducted that year under the auspices of the UN's
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Food and Agriculture Organization (FAO), in collaboration with the Iraqi government, which

provided the field workers. The FAO polled households that had previously participated in

the IST survey in 1991. The U5MRs also suggested that infant mortality had increased

dramatically, from 33 per 1000 births before the sanctions to about 245 per 1000 afterward.

The authors estimated that the sanctions would result in 567 000 child deaths (Zaidi,1997).

This photograph drew international attention and influenced public opinion (Spagat,2010).

Evaluation of Maternal and Child health Care Services

Every year, approximately 32.4 million children are born with low birth weight,

defined as a weight below the 10th percentile for their gestational ages; additionally,

approximately fifteen million are born prematurely. In reality, low birth weight neonates

account for roughly 60% of neonatal deaths due to their prematurity. (Alsadi, 2017). Mother

and child care programs were declared as a core component of primary health care after the

Alma-Ata Conference in 1978. (PHC) (Myler, 2008). Maternal and child health care

programs have been identified as one of the most critical components for saving and

improving the health of mothers and children in both developing and developed countries in

the field of public health (LaRow, 2006). Maternal and child health care programs continue to

pose a greater challenge to the global and public health systems in developing countries (Peh,

2003). The leading causes of maternal and infant morbidity and mortality are poor health

habits and a lack of health care facilities during pregnancy and childbirth. The majority of

deformity and deaths in babies and mothers in developing countries are caused by

complications after the obstetric age. They are among the world's most intractable and

daunting health conditions (Ashford,1992). According to WHO figures from 2015, maternal

mortality in Iraq has decreased by 53.3 percent in the last 25 years, with an average annual

decrease of 3.1 percent from 1990 to 2015. According to the Global Burden of Disease
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(GBD) figures from 2015, infant mortality in Iraq has decreased by 33.5 percent in the last 25

years, with an average annual decrease of 2.7 percent between 1990 and 2015. Iraq has made

progress in reducing maternal and infant mortality, according to this data (Berman,1997).

Maternal care systems in Iraq face some of the same challenges as the primary health care

(PHC) system. These roadblocks are primarily related to ineffective health-care delivery,

such as ineffective use of health-care facilities, inadequate infrastructure, a poor referral

system, poor sanitation, and a lack of management guidance. Other problems include staffing

issues, such as health care professionals' lack of skills and qualifications, a lack of continuing

education training, and a lack of services, such as low-quality medical equipment and a lack

of resources. Maternal care programs are also hampered by inadequate leadership and

information technology (Berhe, 2017).

Factors contributing.

From 1990 to 2015, Millennium Development Goal (MDG) 4 aimed to reduce infant

mortality by two-thirds, while MDG 5 aimed to reduce maternal mortality by three-quarters.

Since 1990, global infant mortality has decreased by 49% and maternal mortality has

decreased by 45%, but the rate of reduction has varied by country, and 6.6 million children

and 300,000 mothers continue to die each year from preventable causes (Wang et al,2014;

Lozano et al,2011). The rate of mortality decline is not constant, and its connection to

economic, political, and health-care system change has shifted over time and between

locations. Over the last 40 years, countries with similar geography, wealth, U5MR, and MMR

levels have shown vast disparities in health growth (Verguet & Jamison, 2014). Several

studies have been conducted to account for historical success in a systematic manner

(Bokhari, Gai & Gottret,2007; Emmanuela, Krycia, Rafael & Christopher, 2010). The direct

connection between improvements in maternal and child health (MCH) and poverty reduction

has long been recognized. Better education, good governance, clean water, and less social
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disparities are all important social determinants of health (Chadwick,1843; Emmanuela et al,

2010; Farag et al,2013; Burström et al ,2005).

Health policy, of course, includes policies to improve education, governance, the

economy, the climate, and other social determinants of health, but it also includes policies to

improve education, governance, the economy, the environment, and other social determinants

of health. It is well recognized that the effect of health interventions and social and

environmental determinants (health determinants) on mortality changes over time

(Preston,1975). Between 1965 and 1975, developments in public health technology made

each dollar of national income growth a more significant contributor to infant mortality,

according to Preston's seminal paper. It was discovered that the decade from 1965 to 1975

had an especially strong impact on changing the GDP coefficient in deciding infant mortality.

Clearly, it was not ten orbits around the sun that increased the likelihood of lower mortality

than before. Rather, low-income countries adopted the recent fruits of new scientific

advances in sanitation, antibiotics, vaccines, and modern obstetrics during this decade. In the

1960s, advances in public health made it possible to use new income in ways that were not

possible a decade before, and GDP became a more influential social determinant of health.

There has been no systematic analysis on whether the impact factors of macro health

determinants are evolving since Preston's seminal paper.

Breastfeeding

Breastfeeding is one of the few treatments with survival advantages over the entire

lifespan of a child: newborn, youth, and adolescence. The World Health Organization (WHO)

and the United Nations Children's Fund (UNICEF) also suggest starting breastfeeding at a

young age, breastfeeding exclusively for the first six months of life, and continuing

breastfeeding until the child is 24 months old (WHO,2009). Despite this, worldwide
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breastfeeding rates remain poor. Just 43% of newborns in the world are breastfed within 1

hour of birth, and 40% of babies aged 6 months and under are exclusively breastfed

(Factsheet, 2014). Breastfeeding's impact on infant mortality has been studied in a variety of

studies. The Bellagio Child Survival Series, published in The Lancet in 2003, established

optimal breastfeeding as a crucial intervention that could prevent up to 13% of deaths among

children under the age of five (Jones, 2003). The Lives Saved Tool (LIST) was used in

subsequent reviews in the Lancet Neonatal Survival Series and Nutrition Series to model the

impact of scaling-up breastfeeding, and the role of breastfeeding in reducing neonatal, baby,

and child mortality was reaffirmed. According to recent reports, optimal breastfeeding could

prevent about 12% of deaths in children under the age of five each year.
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Reverences

Alsadi, E. (2017). Comparison study of causes and neonatal mortality rates of newborns

admitted in neonatal intensive care unit of Al-Sadder Teaching Hospital in Al-Amara

City, Iraq. International Journal of Pediatrics, 5(3), 4601-4611.

Ascherio, A., Chase, R., Cote, T., Dehaes, G., Hoskins, E., Laaouej, J., ... & Zaidi, S. (1992).
Effect of the Gulf War on infant and child mortality in Iraq. New England Journal of
Medicine, 327(13), 931-936.

Ashford, R. W., Desjeux, P., & Deraadt, P. (1992). Estimation of population at risk of

infection and number of cases of leishmaniasis. Parasitology today, 8(3), 104-105.

Berman, J. D. (1997). Human leishmaniasis: clinical, diagnostic, and chemotherapeutic

developments in the last 10 years. Clinical infectious diseases, 24(4), 684-703.

Bokhari, F. A., Gai, Y., & Gottret, P. (2007). Government health expenditures and health
outcomes. Health economics, 16(3), 257-273.

Burström, B., Macassa, G., Öberg, L., Bernhardt, E., & Smedman, L. (2005). Equitable child
health interventions: the impact of improved water and sanitation on inequalities in
child mortality in Stockholm, 1878 to 1925. American Journal of Public
Health, 95(2), 208-216.

Chadwick, E. (1843). Report on the sanitary condition of the labouring population og great:

Britain: supplementary report on the results of special inquiry into the practice of
interment in towns (Vol. 2). HM Stationery Office.

Emmanuela, G., Krycia, C., Rafael, L., & Christopher, J. L. M. (2010). Increased educational
attainment and its effect on child mortality in 175 countries between 1970 and 2009: a
systematic analysis. The Lancet, 376(9745), 959-74.

Factsheet, W. (2014). Infant and Young Child Feeding.

Farag, M., Nandakumar, A. K., Wallack, S., Hodgkin, D., Gaumer, G., & Erbil, C. (2013).
Health expenditures, health outcomes and the role of good governance. International
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Harvard Study Team. (1991). The effect of the Gulf crisis on the children of Iraq. New
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Jones, G., Steketee, R. W., Black, R. E., Bhutta, Z. A., Morris, S. S., & Bellagio Child

Survival Study Group. (2003). How many child deaths can we prevent this year? The

lancet, 362(9377), 65-71.

LaRow, J. M., DO, W. D., Elston, D. M., & Berger, T. G. (2006). Parasitic Infestations,

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Lozano, R., Wang, H., Foreman, K. J., Rajaratnam, J. K., Naghavi, M., Marcus, J. R., ... &
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Myler, P., & Fasel, N. (2008). After the Genome. Caister Academic Press, Norfolk.

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Preston, S. H. (1975). The changing relation between mortality and level of economic
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Spagat, M. (2010). Truth and death in Iraq under sanctions. Significance, 7(3), 116-120.

Verguet, S., & Jamison, D. T. (2014). Estimates of performance in the rate of decline of
under-five mortality for 113 low-and middle-income countries, 1970–2010. Health
policy and planning, 29(2), 151-163.

Wang, H., Liddell, C. A., Coates, M. M., Mooney, M. D., Levitz, C. E., Schumacher, A.
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and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden
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World Health Organization. (2009). Infant and young child feeding: model chapter for

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