Department of Microbiology, Aga Khan University Hospital, Karachi, Pakistan.
PLoS One. 2010 Nov 1;5(11):e13783. doi: 10.1371/journal.pone.0013783.
During the past two decades there has been a sustained decline in child and infant mortality, however neonatal mortality has remained relatively unchanged. Almost all neonatal deaths (99%) occur in developing countries, where the majority are delivered at homes. Evidence suggests that these deaths could be prevented by simple, inexpensive practices and interventions during the pregnancy, delivery and postnatal period. In Pakistan over the last decade extensive efforts have been made by the international donors and government to implement these practices. However, limited attempts have been made to explore if these efforts have made a difference at the grass root level. This study assessed the burden of neonatal mortality and prevalence of practices for newborn care in a squatter settlement of Karachi, Pakistan.
METHODOLOGY/PRINCIPAL FINDINGS: A community based cross-sectional study was performed. A pre-tested structured questionnaire was administered to 565 women who had recently delivered. Information was collected on neonatal morbidity, mortality and practices of women regarding care during pregnancy, child birth and for newborn, till 28th day of birth. Although 70% of women mentioned receiving antenatal care by a skilled provider, only 54.5% had four or more visits. Tetanus toxoid was received by 79% of women while only 56% delivered at a health care facility by a skilled attendant. Newborn care practices like bathing the baby immediately after birth (56%), giving pre-lacteals (79.5%), late initiation of breast feeding (80.3%), application of substances on umbilical cord (58%) and body massage (89%) were common. Most neonates (81.1%) received BCG injection and polio drops after birth. Neonatal mortality rate was 27/1000 live births with the majority of deaths occurring during the first three days of life.
Even after years of efforts by government and nongovernmental sector to reduce newborn morbidity and mortality, inadequate antenatal care, home deliveries and unhealthy newborn care practices are highly prevalent. This leads us to important questions of why practices and behaviors have not changed. Who is responsible and what strategies are needed to bring this change?
在过去的二十年中，儿童和婴儿死亡率持续下降，但新生儿死亡率保持相对不变。几乎所有新生儿死亡（99%）都发生在发展中国家，其中大部分是在家里分娩的。有证据表明，通过在怀孕、分娩和产后期间实施简单、廉价的做法和干预措施，可以预防这些死亡。在过去十年中，巴基斯坦的国际捐助者和政府做出了广泛努力来实施这些做法。然而，对于这些努力是否在基层产生了影响，尚未进行过有限的探索。本研究评估了新生儿死亡率的负担以及在巴基斯坦卡拉奇一个棚户区中新生儿护理做法的流行情况。
方法/主要发现：进行了一项基于社区的横断面研究。向最近分娩的 565 名妇女发放了一份经过预测试的结构化问卷。收集了有关新生儿发病率、死亡率以及妇女在怀孕期间、分娩期间和新生儿出生后 28 天内的护理做法的信息。尽管 70%的妇女提到接受了熟练提供者的产前护理，但只有 54.5%的妇女进行了四次或更多次产前检查。79%的妇女接受了破伤风类毒素，而只有 56%的妇女在有熟练医护人员的医疗保健机构分娩。新生儿护理做法如新生儿出生后立即洗澡（56%）、给予开奶前食物（79.5%）、延迟开始母乳喂养（80.3%）、在脐带和身体上涂抹物质（58%）和进行身体按摩（89%）很常见。大多数新生儿（81.1%）在出生后接受了卡介苗接种和脊髓灰质炎滴剂。新生儿死亡率为每 1000 例活产 27 例，大多数死亡发生在生命的头三天。
尽管政府和非政府部门多年来一直努力降低新生儿发病率和死亡率，但产前护理不足、家庭分娩和不健康的新生儿护理做法仍然非常普遍。这让我们产生了重要的疑问，即为什么做法和行为没有改变。谁应该对此负责，需要采取什么策略来带来这种改变？
