Factors the Infant Mortality - Assignment Example

Journal Review 1. Explain why the infant mortality rates in both experimental and control groups (Table 1) declined during the period 1992-1996? Following the implementation of a two-phased project in 1992, data from house hold surveys conducted in the first phase (1992-1997) shows that there has been a decline in infant mortality rates between 1992 to 1996 in both control and experimental groups. It is worth noting, that the first phase of the two-phased pilot project integrated family planning, child immunization and a micro-credit program for poor women. Moreover, the strategy used in the first phase included door to door educational campaigns and the provision of non-clinical child immunization and family planning methods. As a result, the decline in infant mortality in both the experimental and groups can be attributed to the increasing use of contraceptives and the decreasing rate of fertility. The increasing use of contraceptives contributed to a decline in fertility, this implies that fewer children were born during this period hence the possibility of infant mortality was minimized. Similar to the experimental group, data presented in Table 1 shows that the number of children born in the control group also declined hence the possibility of infant mortality in the control was minimized. Furthermore, the decline in infant mortality rates in both the experimental groups can be attributed to the increasing trends of child immunization. 2. Given the high rates of immunization, the infant mortality rates are still unacceptably high. What do you think are the main causes of this high rate? While it must be acknowledged from the data collected in the project that the infant mortality rates actually declined in the experimental group from about 88.0 per thousand live births in 1992 to 62.0 in 1995-96 and from 81.0 to 54.0 in the control group for the same period (p. 1614), The Ministry of Health and Family Welfare still referred to both the infant and maternal mortality and morbidity rates as unacceptably high (p. 1618). This is an indication that immunization by itself is not sufficient in combating infant mortality rates but several underlying health issues need to be addressed before the mortality rates decrease significantly. The mortality rates could be accounted for by factors not addressed by immunization such as child malnutrition, reproductive tract infections, water and airborne diseases such as diarrhoea and tuberculosis, inadequate antenatal and postnatal care and delivery services and technologies which may lead to stillbirths and other preventable and treatable conditions which not addressed due to social and economic circumstances. According to the journal, the problem lies in the lack of awareness, inaccessibility of and underutilization of basic promotive, preventive and curative health services. The situation in Bangladesh is not unique, as it has been noted that child mortality rates in most developing countries remains unacceptably high since basic reproductive health services remain underserved or unserved for most of the poorer sections of the population (p. 1611). As indicated, even in areas with close proximity to health services, facilities and with a high density of health personnel such as doctors, nurses and paramedics, traditional medical practitioners dominate health service provision, modern prenatal and postnatal care remains rare and child birth deliveries occur in homes without the assistance of trained attendants. Among other factors, this has been attributed to sociocultural and informational constraints, such as lack of awareness of static health outposts and other clinical resources and a predisposition to private, unqualified and traditional forms of medicine and medical services due to their accessibility and affordability in peripheral communities which is a result of poverty and inaccessibility to rural health infrastructure for the poorest mothers (p.1612: 1619). In addition, it has been suggested that much of the resources and efforts of the health and population sector of the Government of Bangladesh were disproportionately dedicated to family planning programs at the expense of other essential basic reproductive health services such as prenatal and post natal care, child care and other preventive and curative services (p.1619). As a result, services such as immunization have made an insignificant dent in infant mortality rates. This calls for a refocusing 3. Will the Essential Services Package (ESP) have a significant impact on the infant and child mortality rates? Give reasons for your answer. The ESP is designed intended to address the deficiencies in provision of basic reproductive and health services. By approaching the problem of reproductive health from a developmental perspective and including a more comprehensive range of services such as micro credit, family planning, safe motherhood such as antenatal care and immunization, treatment of reproductive tract infections and child health services, the ESP is an improvement of the Government’s efforts which predominantly focused on family planning without resolving the underlying economic, social, cultural and demographic constraints facing poor women in Bangladesh. Therefore, the ESP will significantly reduce infant and child mortality rates in Bangladesh. As indicated from the assessment of the first phase EPI, the program has already achieved significant reductions in infant and child mortality rates (p. 1614). Therefore, it is expected that infant mortality rates, which are still unacceptably high, would further reduce with the implementation of the ESP in the second phase as the ESP will attempt to address some of the more deep rooted causes of high infant mortality such as unawareness to and inaccessibility of rural health infrastructure by the poorest communities. In addition, through the provision of micro-credit services to volunteers, the ESP is expected to bridge the gap between the poorest communities and static rural health services. Therefore, as shown from an analysis of the data in the pilot project, the ESP is reasonably expected to increase the penetration of basic reproductive health services and technologies to the poorest communities. This is expected to significantly contribute to reductions in infant mortality rates as it has been noted that even increasing the immunization rate under the first phase EPI could not significantly achieve this due to unawareness and inaccessibility of health services which is a result of the socio-cultural, informational and economic circumstances faced by the poorest communities. Furthermore, the homogeneity of Bangladesh in terms of socioeconomic conditions and characteristics increases the likelihood of replication of the success experienced under the pilot project in the experimental area in its application to the entire country (p. 1619-1620). 4. Comment on the nutritional component of the ESP- do you think it will have a significant impact on current high levels of child malnutrition? The ESP includes a nutritional component in terms of child health. This includes vitamin supplementation for infants and children from poorest communities at the static health centres and promotion of appropriate infant feeding including breast feeding (p. 1611). While not extensively addressed in the assessment of the potential of the ESP in the journal article, nutritional supplementation is expected to significantly reduce the high levels of child malnutrition. It has been noted that economic constraints on the poorest communities have negatively affected child nutrition as they are unable to provide infants and children with the balanced diet and often resort to unqualified traditional care providers which may only exacerbate the situation. Nutritional supplementation would therefore help circumvent economic constraints on the poorest that may not be able to afford the appropriate kind of food. Statistical evidence from Table 4 of the journal article also indicates the potential of nutritional supplementation in combating child malnutrition (p. 1617). The table predicts that among other factors, women under the ESP who are members of micro-credit NGOs are more likely to use the static health clinic for nutritional supplementation. This indicates the potential of reducing child malnutrition through nutritional supplementation as a component of the ESP. The increased use of health facilities for nutritional (vitamin) supplementation lowers the risk of children succumbing to nutrition-related diseases and subsequent death through diseases such as kwashiorkor, marasmus and marasmic-kwashiorkor. Education on proper breastfeeding techniques would also significantly lower the impact of child malnutrition. 5. The antenatal component of the ESP includes screening patients for high risk pregnancies and referring them. Comment on the effectiveness of this approach. The antenatal component of the ESP that involves screening patients for high risk pregnancies is an effective preventative measure, that when implemented effectively can help to avert and minimise mortality rates among both expectant mothers and infants. In most developing countries such as Bangladesh, mortality rates among both expectant mothers and infants are largely as a result of poor diagnosis of pregnancy risks. When pregnancy risk factors are detected at an early stage during the pregnancy, proper medical intervention can be administered to the patient in order to alleviate the risks or improve the condition. Moreover, when risks factors during the pregnancy are detected at an earlier stage, expectant mothers can be referred for treatment or educated on how they can manage their condition. The implementation of these interventions can help to alleviate further complications during pregnancies. In addition to this, these interventions can help to avert or minimise mortality rates among both expectant mothers and infants. Therefore, the antenatal component of the ESP that involves screening patients for high risk pregnancies is an effective preventative measure for preventing further pregnancy complications and averting or minimising mortality rates among both expectant mothers and infants. Nevertheless, in some cases this strategy may not effectively address the risks of infant mortality mainly because it does not incorporate a follow-up program. For instance, expectant women living in the rural areas may find it difficult to access referral health facilities based in sub-urban or urban areas due to the distance or socio-economic constraints. Hence, if this antenatal component of the ESP only includes screening patients for high risk pregnancies and referring them, in some instance it may not be necessarily effective when it comes preventing or minimising infant mortality , since it does include a follow-up program that ensures that expectant mothers receive suitable treatment. 6. What, if any, components of Essential Obstetric Care are present in the ESP? What impact do you expect on the high maternal mortality rate as a result of ESP activities? Essential Obstetric Care often includes a wide array of services such as family planning, antenatal and postnatal care. It focuses on pregnant women and seeks to diagnose and prevent obstetric risks. It also focuses on early identification, referral and treatment of women who have obstetric disorders or complications. In a case where any components of the Essential Obstetric Care (EOC) are present in the ESP, it is expected that the high maternal mortality rate would decline. Some of the major causes of maternal mortality often include obstetric disorders. Through the EOC, obstetric complications or disorders can be diagnosed, treated or referrals can be made for further treatment. This in turn can help to prevent or minimise the high rates of maternal mortality. Therefore, it is expected that when components of Essential Obstetric Care are present in the ESP the high mortality rate are bound to decline. 7. Comment on the long-term sustainability of using micro-credit loanees as ESP volunteers in the project. Using micro-credit loanees as ESP volunteers in the project is an efficient strategy of promoting the long-term sustainability of the project. Using this approach, recipients of micro-credit can be motivated to become adopters and motivators of family planning and basic reproductive health services. This will in turn ensure the speedy acceptance and utilization of the program. Furthermore, when recipients of micro-credit programs are trained they can become effective outreach volunteers. Micro-credit recipients trained to become outreach volunteers can help to enhance the speedy dispensation of information and the delivery of reproductive health care services and other cost-effective services. By using well –trained micro-credit recipients as outreach volunteers, the long-term sustainability of the program is secured. The increase of outreach volunteers can help to minimise costs of educating or sensitising women in developing countries about reproductive health issues. It can also alleviate the need for government support in addressing issue relating to reproductive health. Through these volunteers the program can be self-sustaining for a long period of time. Bibliography Amin, R., Pierre, M., Ahmed, A. & Haq, R., 2001, Integration of an Essential Services Packages (ESP) in Child and Reproductive Health and Family Planning with a Micro-credit Program for Poor Women: Experience from a Pilot Project in Rural Bangladesh. World Development Vol 29, No. 9, pp. 1611-1621. Read More