Problem Analysis Report
MEMORANDUM
To: Dr. Kesla
From: Akeddi
Date: October 8 2012
Subject: Problem Analysis Report
It is quite concerning the findings of recent reports concerning the childhood death rates in the world. A 2012 United Nations Children’s Fund (UNICEF) report puts the figure of children who die each day at a whooping 19000. Out of these deaths, India led the way in 2011 with 1,655,000 deaths. In fact, the report finds that 50% of the total number of global under five deaths, result from five countries: India, Pakistan, China, Nigeria and DRC (The Democratic Republic of Congo) of which India’s toll is actually higher than that of the DRC, Nigeria and Pakistan put together; suggesting that indeed India is the leading country when it comes to childhood mortality.
The leading causes of mortality include Pneumonia, pre-term birth complications, malaria, diarrhea as well as complications that at times arise intrapartum. Further, immunization records suggest that the success rate of immunization is only at 60%, a worrying figure considering the levels of mortality (Chakrabarty, 2013). The attached report delves deeper into the problem and raises questions of concern, as well as plausible recommendations to help remedy the problem. It is my sincere hope that reading the report will encourage you to take a serious interest in the matter and help develop as well as implement helpful and sustainable solutions to the problem of childhood mortality in India.
Thank you in advance for your support and consideration.
PROBLEM ANALYSIS REPORT
Childhood Mortality in India
Problem Definition
Childhood mortality continues to be a public health concern across the globe, despite the numerous progress that has been made through the introduction of vaccines and immunization schedules to combat concerns such as polio, tuberculosis and measles among others. According to Unicef, India contributes approximately 25% of the global infant deaths each year, and considering that childhood mortality is an important indicator of a country’s socio-economic status when it comes to medical and public health conditions, these figures are quite alarming. Findings by Suresh (2008) highlight the fact that 2.1 million Indian children die before their fifth birthday, while a half of these deaths occur before the children even reach 4 weeks old. Of the 9.7 million neonatal deaths worldwide, India contributes one third. Reasons that have been cited include: Poor maternal and child healthcare, poor neonatal care, communicable diseases, malnutrition and generally poor feeding practices. Specifically, Unicef reports that pneumonia is the biggest cause of infant deaths at 18% followed by premature birth complications at 14%, diarrhea at 11%, complications during intrapartum at 9% and malaria at 7%. Other causes of death also include complications arising due to HIV and AIDS.
The Issue
Despite the reduction of childhood mortality being one of the millennium development goals, India seems to be lagging behind countries that are even poorer when it comes to dealing with maternal and child healthcare. This is also despite the expanded immunization program, which is not only robust and quite beneficial when it comes to dealing certain previously problematic conditions such as pneumonia. Although poverty has contributed to the problem of childhood mortality significantly and served to further fuel the problem, the main challenge is no doubt policy related. Although other countries may possess less than India when it comes to wealth, these countries display a greater sense of organization and effectiveness when it comes to dealing with infant mortality. The main difference is the focus of healthcare. Whereas a majority of other countries have fully embraced World Health Organization recommendations and adopted an approach that is mostly preventative rather than curative, India is still lagging behind, as primary care institutions still seem to be underutilized. Disregarding the question of resources and considering the resources at hand to be the only available resources would therefore, not only serve to simplify the solution in terms of the need to identify solutions available that are cost effective, as well as practical. This would no doubt lead to invention and creativity, as well as the development of cost effective solutions that primarily aim at preventing disease rather than curing it. For instance, numerous research by NFHS (National Family Health Survey) indicates that illiterate women are more likely to lose a child due to illness than literate mothers; perhaps testament to how ignorance can actually affect our health seeking behavior, as well as our ability to follow instructions.
Impact
The high rates of childhood mortality, mean that the country will be unable to meet the millennium development goal of 2015, of reducing childhood mortality, unless it is able to bring down the levels of infant deaths to 39 per 1000 births. Further, the figures above, mean that a child’s chances of surviving beyond being a neonate are slashed by almost one third. Furthermore, India seemingly loses about 20% of its under fives population every year.
Conclusion and Recommendations
The list of the five leading causes of death seemingly suggest that indeed with hard work and dedication, childhood mortality in India can be brought down significantly. The recommendations that have been repeatedly made regarding the Integrated Management of Childhood Illnesses would no doubt be a good place to start (WHO), considering the fact that the economy is unlikely to change and advance as first as one would wish. Poverty is and continues to be one of the biggest challenges to accessing quality healthcare. The integrated management of childhood illnesses would no doubt offer a plausible solution to the problem that plagues India today, as it would not only represent a simple and cost effective solution to the problem, but it would also translate to a solution that can be evaluated.
The approach would advocate for the adoption of a three pronged approach involving the improvement of case management skills of the healthcare staff in order to ensure prompt and accurate diagnosis and management, the improvement of overall health facilities as well as the improvement of community and family health practices. The latter approach in particular could be very useful, more so when it comes to improving aspects such as immunization, as well as ensuring exclusive breastfeeding. Further, the use of health education drives to teach potential and current mothers on how to handle their children, the importance of hand washing, as well as the use of oral rehydration salts, could go a long way towards preventing infant deaths. Finally, a restructuring of the health system, could also lead to greater utilization of primary health care facilities, hence leading to improved diagnoses, which can then be dealt with in a timely manner. The problem can therefore be addressed through a simple policy change, to ensure that care is timely, and appropriate.
References
Chakrabarty, A. (2013). At 40% immunisation deficit level, child mortality in India under severe threat!. Retrieved from http://zeenews.india.com/exclusive/at-40-immunisation-deficit-level-child-mortality-in-india-under-severe-threat_6240.html
Suresh, S. (2008). Childhood Mortality and Health in India. Working Paper Series E 292. Retrieved from http://www.iegindia.org/workpap/wp292.pdf
United Nations Children’s Fund (2012). Child Mortality Estimates Report 2012.
World Health Organization (n.d). Integrated Management of Childhood Illnesses. Retrieved from http://www.who.int/maternal_child_adolescent/topics/child/imci/en/
