single digit imr (infant mortality rate) in kerala : dream or reality ?

You have to dream

before your dreams can

come true.A.P.J.Abdul Kalam

SINGLE DIGIT IMR IN KERALA :Dream or Reality

-Dr.Arjun.B (Final Year)

Contents

• IMR – What & Why ?

• Numbers : Past & Present

– India story

– Kerala story

• Kerala – Cause analysis

• Making dreams come true – how ?

• Conclusion

Infant Mortality Rate

• “Ratio of infant deaths registered in a given year to the total

number of live births registered in the same year;

• usually expressed as a rate per 1000 live births

• STRICTLY SPEAKING – NOT A ‘RATE’,

Infant Mortality Rate = Deaths among Children <1 year

Number of live birthsx1000

BUT A ‘RATIO’

Health Indicators

INFANT MORTALITY RATE

IMR – more than just deaths

• Proxy indicator of population health

• Reflect the socio-economic development of a country

• Sensitive indicator of perinatal care

• Sensitive indicator of the availability, utilization and

effectiveness of health care service and medical technology

Why focus on infant deaths

• Largest single age-category of mortality

• Deaths are due to a particular set of diseases & conditions; different

from adults

• Effect of health programmes on infant mortality is quick compared to

general death rate

• Affected by

– Biological

– Economic

– Social

Numbers : Past & Present

Global IMR trend

Source : United Nations Population Division's World Population Prospects

• 1965 – 114.8

2015 – 31.7

Year

IMR

GLOBAL

• 8.1% of all deaths

• 75 % of Under-5 deaths

• 4,500,000 Infant Deaths in 2015

Source : UN Inter-agency Group for Child Mortality Estimates

IMR – 31.7 / 1000 live births

12,329 Infants die every Hour

• HIGHEST – Angola (96)

• LOWEST (2)

– Japan

– Norway

– Singapore

– Sweden

– Finland

IMR trend in India

Source : United Nations Population Division's World Population Prospects / SRS 2014

• 1965 – 153

2015 – 38

Year

IMR

13 % of all Deaths,

as against 8.1% at global level.

HIGHEST – MP (52)

LOWEST :•Goa•Manipur•Kerala

SRS 2014 – 39 (R – 43; U – 26) (10) (11) (12)

Source : SRS

INFANT Deaths – A closer look

0 - 7 8 - 28 29 - 365

SRS 2014

Neonatal Mortality Rate

(NMR)

Early Late

Post-Neonatal Mortality Rate

365 days

12

5 1

6

6

Trend of Child Mortality Rates in India

SRS 2000 - 2012

Kerala – Setting Targets !

• 2/3 reduction by 2020 and, 50% reduction by 2030

• 2/3 reduction of

– IMR from 12 to 8 by 2020 and 6 by 2030,

– NMR from 7 to 5 by 2020, 3 by 2030,

– <5MR from 14 to 9 by 2020 and 7 by 2030

Target 3.2: By 2030 end preventable deaths of newborn and

children under-5 years (NMR<12 & U5MR to 25/1000 livebirths)

What are the infants dying of ?

Source : IAP report on ‘Why infants continue to die in the state of Kerala?”

[1]

[2]

[3]

≤28 days 75%

>28 days 25%

Source : *CBHI Health Profile 2015, *Census India report on Causes of death 2010-2013

Making Dreams come True – How ?

When the nation goes right, we go left !

• Interventions need to be catered for the state

• Eg.

– ITN for prematurity, (No endemic malaria)

– JSY to improve Institutional delivery, (Kerala 99.9%)

*CES- 2009

1.Prematurity• 90% of preterm babies in LIC die within the first few days;• Less than 10% in high-income settings.

• Causes :– 45–50% are idiopathic. – Multiple pregnancies– Infections – Chronic conditions, such as diabetes and high blood

pressure; – Maternal factors (Young or advanced maternal age, short

inter-pregnancy intervals and low maternal BMI)

How many child deaths can we prevent this year. Child Survival Series. The Lancet.2003;362.

Interventions Reduction in NMR

Full antenatal care 10–20%

Detection and treatment of

asymptomatic bacteriuria

Incidence of prematurity or

low birth weight: 20–55%

Antenatal corticosteroids for

preterm labour 25 – 50%

Extra care for LBW infants: extra

warmth, 20 – 40%

Emergency neonatal care:

management of serious illness15-50%

Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet Neonatal Survival series 2005

HUMAN MILK BANK

Bharadva K, Tiwari S, Mishra S, Mukhopadhyay K, Yadav B, Agarwal RK, Kumar V. Human milk banking guidelines. Indian pediatrics. 2014 Jun 1;51(6):469-74.

2.Congenital anomalies

Interventions

• Primary prevention :

– Periconceptional Folate

– Availability of genetic services for couples with a family history

• Secondary prevention :

– prenatal screening and diagnosis

– followed by the offer of termination of pregnancies affected

by major anomalies

Czeizel, A. E. (2005). Birth Defects Are Preventable. International Journal of Medical Sciences, 2(3), 91–92.

3.Sepsis and 4.Birth asphyxia

• Despite the fact that all deliveries are at hospitals (99.9%)

– Neonatal sepsis contributed to around 12% of infant

deaths.

• Despite a very high LSCS rate (43%),

– deaths are still happening due to birth asphyxias.

Infant Death audit to review current care against

standard of care

Dream or Reality ?Dream or Reality !

TOTAL RURAL URBAN

Total Male Female Total Male Female Total Male Female

12 10 13 14 12 15 10 8 11

Conclusion

1. So far, So good.

2. Why are the infants dying ? – Data gap

3. Focus on the neonates

4. Public health Clinical

5. Strengthen facilities

References1. Park’s Textbook of Preventive and Social medicine , 23 rd Edition2. United Nations Inter-agency Group for Child Mortality Estimation. 2015. Levels & Trends in Child Mortality. Report 2015.

[http://childmortality.org/]. New York3. World Health Organization, 2015, Health in 2015: From MDGs Millennium Development Goals to SDGs Sustainable

Development Goals, Geneva. [www .who.int/gho/publications/mdgs-sdgs/]4. You D, Hug L, Ejdemyr S, Idele P, Hogan D, Mathers C, Gerland P, New JR, Alkema L. Global, regional, and national levels and

trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. The Lancet. 2015 Dec 11;386(10010):2275-86.

5. SRS 2011, 2012, 2013, 20146. Census 20117. An Analysis of Levels and Trends in Infant and Child Mortality Rates in India, National Institute of Public Cooperation and Child

Development 8. UN Inter-agency Group for Child Mortality Estimates 9. IAP report on ‘Why infants continue to die in the state of Kerala?” 10. How many child deaths can we prevent this year. Child Survival Series. The Lancet.2003;36211. CBHI Health Profile 201512. Census India report on Causes of death 2010-201313. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet Neonatal Survival series 2005 14. Bharadva K, Tiwari S, Mishra S, Mukhopadhyay K, Yadav B, Agarwal RK, Kumar V. Human milk banking guidelines. Indian

pediatrics. 2014 Jun 1;51(6):469-74.15. Czeizel, A. E. (2005). Birth Defects Are Preventable. International Journal of Medical Sciences, 2(3), 91–92.

THANK

YOU !