The National and International Services provided

For the Reduction of Infant and Child Mortality

By
Ahmed Abed Ali Shaher
201217155
Supervised by

Abstract:
Child mortality rates have declined in all world regions, but the
world is not on track to reach the Sustainable Development Goal for child
mortality . Before the Modern Revolution child mortality was very high
in all societies that we have knowledge of – a quarter of all children died
in the first year of life, almost half died before reaching the end of
puberty 
Over the last two centuries all countries in the world have made
very rapid progress against child mortality. From 1800 to 1950 global
mortality has halved from around 43% to 22.5%. Since 1950 the
mortality rate has declined five-fold to 4.5% in 2015. All countries in the
world have benefitted from this progress
In the past it was very common for parents to see children die,
because both, child mortality rates and fertility rates were very high. In
Europe in the mid 18th century parents lost on average between 3 and 4
of their children.
Infant mortality – death:
Infant mortality – death among children not yet one year of age,
reflects the effect of economic, social and environmental conditions on
the health of mothers and infants, as well as the effectiveness of health
systems. Child mortality – death among children not yet 5 years of age an
indicator of child health as well as the overall development and well-
being of a population. As part of their Sustainable Development Goals,
the United Nations has set a target of reducing under age 5 mortality to at
least as low as 25 per 1 000 live births by 2030 (United Nations 2015).
Over the 2000-16 period, infant mortality rates have roughly halved in the
Asia/Pacific region, but huge cross-national disparities exists across
countries. Advanced economies have the lowest infant mortality rates,
often lower than OECD average (4.0): Macau, China, Hong Kong, China,
Japan, and Singapore record infant mortality rates of around two deaths
per 1 000 live births (Figure 6.4). In contrast, low-income countries such
as Lao PDR, Myanmar, Papua New Guinea, Pakistan and Timor-Leste
have infant mortality rates exceeding 40 deaths per 1 000 live births.
Across the selected countries, the highest incidence of infant mortality is
recorded for children with mothers who low educational attainment and
little income who live in rural areas (Figure 6.5). While all the selected
countries show similar trends, the infant mortality discrepancies upon
socio-economic status of mothers were widest in Lao DPR (2011-12): the
infant mortality rate was 95 among low-income wealth families and 27
for high-income families; 96 for mothers with low educational attainment
and 32 for mothers with high educational attainment; and, 85 for mothers
in rural areas and 39 for mothers in urban areas.

Infant mortality rates implicitly capture a complicated story,

measuring much more than differences in health care across countries.
For example, these rates are affected by the socioeconomic status of
mothers and their children; we know that the age of the mother, birth
weight of the child, quality of nutrition for the mother, and other factors
are associated with mortality . Measurement differences in statistical
reporting of vital events also figure into these comparisons. However, it
would be a mistake to simply dismiss these measures. In assessing how
the United States stacks up against other countries, these statistics offer
opportunities to identify strategies for improving our health care system
and to learn from other countries that have been more successful.
To expand our knowledge about the reasons behind international
rankings, it is important to probe further. This article attempts some steps
in that direction by taking a closer look at the statistics—sorting out real
differences from artifacts of measurement, disaggregating the data where
possible, and examining differences in risk factors across countries. Even
industrialized countries differ substantially in approaches to treatment of
health problems, use of resources, and presentation of data. Because of
data limitations, we can only speculate on the impact of some of these
differences and cite some of the important literature in the area. Much of
the work in this area has focused on factors contributing to infant
mortality in individual countries.
Child mortality today is the lowest it has ever been. In less than
three decades child mortality has more than halved — from 12.6 million
in 1990 to 5.4 million in 2017. This is a huge accomplishment that should
not be overlooked.
Often, there are no definite ways to prevent many of the leading
causes of infant mortality. However, there are ways to reduce a baby’s
risk. Researchers continue to study the best ways to prevent and treat the
causes of infant mortality and affect the contributors to infant mortality.
Consider the following ways to help reduce the risk:

Preventing Birth Defects

Birth defects are currently the leading cause of infant mortality in

the United States.1 There are many different kinds of birth defects, and
they can happen in any pregnancy.

There are several things pregnant women can do to help reduce the
risk of certain birth defects, such as getting enough folic acid before and
during pregnancy to prevent neural tube defects. Learn more about
some risk factors for birth defects.

Addressing Preterm Birth, Low Birth Weight, and Their Outcomes

There is currently no definitive way to prevent preterm birth, the

second most-common cause of infant mortality in the United
States.1 However, researchers and health care providers are working to
address the issue on multiple fronts, including finding ways to stop
preterm labor from progressing to a preterm delivery and identifying
ways to improve health outcomes for infants who are born preterm.
Preterm infants commonly have a low birth weight, but sometimes full-
term infants are also born underweight. Causes can include a mother’s
chronic health condition or poor nutrition. Adequate prenatal care is
essential to ensuring that full-term infants are born at a healthy weight.
 There are some known risk factors for preterm birth—including
having had a preterm birth with a previous pregnancy—and women with
known risk factors may receive treatments to help reduce those risks. But
in most cases, the cause for preterm birth is not known, so there are not
always effective treatments or actions that can prevent a preterm
delivery. 

Researchers and health care providers are also working to

understand the health challenges faced by infants born preterm or at a low
birth weight as a way to develop treatments for these challenges. For
instance, preterm infants are at high risk for serious breathing problems as
a result of their underdeveloped lungs. Treatments such as ventilators and
steroids can help stabilize breathing to allow the lungs to develop more
fully. In addition, studies suggest that infants born at low birth weight are
at increased risk of certain adult health problems, such as diabetes, high
blood pressure, and heart disease.

Getting Pre-Pregnancy and Prenatal Care

During pregnancy, the mother’s health, environment, and

experiences affect how her fetus develops and the course of the
pregnancy. By taking good care of her own health before and during
pregnancy, a mother can reduce her baby’s risk of many of the leading
causes of infant mortality in the United States, including birth defects,
preterm birth, low birth weight, Sudden Infant Death Syndrome (SIDS),
and certain pregnancy complications.

Women don’t need to wait until they are pregnant to take steps to
improve their health. Reaching a healthy weight, getting proper nutrition,
managing chronic health conditions, and seeking help for substance use
and abuse, for example, can help a woman achieve better health before
she is pregnant. Her improved health, in turn, can help to reduce infant
mortality risks for any babies she has in the future. Learn more about pre-
pregnancy care.

Once she becomes pregnant, a mother should receive early and regular
prenatal care. This type of care helps promote the best outcomes for
mother and baby. Learn more about prenatal care.

Creating a Safe Infant Sleep Environment

SIDS is defined as the sudden, unexplained death of an infant

younger than 1 year of age that remains unexplained even after a
thorough investigation. SIDS is the third-leading cause of infant mortality
in the United States. SIDS is one type of death within a broader category
of causes of death called sudden unexpected infant death (SUID). The
SUID category includes other sleep-related causes of infant death—such
as accidental suffocation—as well as infections, vehicle collisions, and
other causes. As SIDS rates have been declining in the last few decades,
rates of other sleep-related causes of infant death have been increasing.
Accidental injury is the fifth-leading cause of infant mortality in the
United States.

Although there is no definite way to prevent SIDS, there are ways

to reduce the risk of SIDS and other sleep-related causes of infant death.
For example, always placing a baby on his or her back to sleep and
keeping baby’s sleep area free of soft objects, toys, crib bumpers, and
loose bedding are important ways to reduce a baby’s risk. 8 The NICHD-
led Safe to Sleep® campaign (formerly the Back to Sleep campaign)
describes many ways that parents and caregivers can reduce the risk of
SIDS and other sleep-related causes of infant death.
Using Newborn Screening to Detect Hidden Conditions

Newborn screening can detect certain conditions that are not

noticeable at the time of birth, but that can cause serious disability or
even death if not treated quickly. Infants with these conditions may seem
perfectly healthy and frequently come from families with no previous
history of a condition.

To perform this screening, health care providers take a few drops of

blood from an infant’s heel and apply them to special paper. The blood
spots are then analyzed. If any conditions are detected, treatment can
begin immediately. Most states screen for at least 29 conditions, but some
test for 50 or more conditions. Infants who are at increased or high risk
for a condition because of their family history can undergo additional
screening—beyond what states offer automatically—through a health
care specialist. Since this public health program was initiated 50 years
ago, it has saved countless lives by providing early detection and
intervention and by improving the quality of life for children and their
families.

References:

1. Hoyert, D. L., & Xu, J. (2012). Deaths: preliminary data for

2011. National Vital Statistics Reports, 61(6). Retrieved July 23,
2013,
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DF - 891 KB)
2. Peleg, D., Kennedy, Colleen, M., & Hunter, S.K. (1998).
Intrauterine growth restriction: Identification and
management. American Family Physician, 58(2), 453–460.
3. Hovi, P., Andersson, S., Eriksson, J. G., Järvenpää, A. L., Strang-
Karlsson, S., Mäkitie, O., et al. (2007). Glucose regulation in
young adults with very low birth weight. New England Journal of
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4. Steward, A.J. et al. (1995). Antenatal and intrapartum factors
associated with SIDS in New Zealand Cot Study. Journal of
Paediatrics and Child Health. 31(5), 473-478.
5. Iyasu et al. (2002) Risk factors for SIDS among Northern Plains
Indians. Journal of the American Medical Association, 288, 2717-
2723.
6. American Academy of Pediatrics Task Force on Sudden Infant
Death Syndrome. (2011). SIDS and other sleep-related infant
deaths: Expansion of recommendations for a safe infant sleeping
environment. Pediatrics, 128, 1030-1039.