Overview of Perinatal and Neonatal Health in Nepal

Dr SR Manandhar (MBBS, MD)Pediatrician, KMCTH

Introduction• Perinatal and neonatal mortality rate in Nepal is

still very high

• Over the last 15 years, Nepal’s infant mortality rate has fallen from 82 to 48 per 1000 live births (NDHS 2006)

• May be due to programmes conducted through government and other organizations, including those for ARI and diarrhoeal diseases

• But, very few programmes to reduce perinatal and neonatal deaths in Nepal To reduce under 5 mortality rate

IMR and NMR should be reduced

• NMR and IMR constitutes 2/3rd of under 5 mortality

Trends of Infant Mortality

3432

79

64

48

1996 2001 2006 2011 20150

20

40

60

80

100

Infant Mortality Assume MDG Target Achieved Earlier MDG TargetMortality Trend Trend Assumed

• Nepal is on the track to achieve MDG Target.

• If the current trend remains, the country will achieve MDG 4 earlier….

Trends of Under 5 Mortality

54

31

118

91

61

1996 2001 2006 2011 20150

20

40

60

80

100

120

140

U5 Mortality Assume MDG Target Achieved Earlier MDG TargetU5 Mortality Trend Trend Assumed

• Nepal is on the track to achieve MDG Target.

• If the current trend remains, the country will achieve MDG 4 earlier….

Neonatal Mortality Trend

50

39

33

15

50

39

33

15

1996 2001 2006 20150

10

20

30

40

50

60NMR Trend

MDG Target to reduce Child Mortality for Nepal

T A R G E T - 5Reduce by two-thirds 1990 and 2015 the under-5 mortality rate

Indicators 1991 1996 2001 2006 2015 TARGET

IMR 108 79 64 48 34

U5MR 162 118 91 61 54

NMR 46 50 38.6 33 15

Nepal Millennium Development GoalsP R O G R E S S R E P O R T 2 0 0 5

NMR & IMR/1000 live birth (Trend)

Year IMR NMR NMR in % of IMR

1996 79 50 63%

2001 64 39 60%

2006 48 33 69%

9

Direct causes of neonatal deaths In Nepal

(Hospital based data)• Infection• Birth asphyxia/trauma• Prematurity• Hypothermia

Causes of stillbirths in Dhanusha

0

10

20

30

40

50

60

70

67

10 10 7 3 2 1

Obstetric complications

Prematurity

Unclassifiable

Maternal disease

Congenital malformations

Multiple pregnancy

Other

%

(Total = 601)

Reference: Manandhar SR et al. Causes of stillbirths and neonatal deaths in Dhanusha District, Nepal: A verbal autopsy study. Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 1-5

2 yrs (1st Sept ‘06 – 31st Aug’08)

0

5

10

15

20

25

30

35

4037

30

15

75 5

1

Birth asphyxia

Severe infection

Prematurity or Low birth weight

Hypothermia

Unclassifiable

Other

Congenital malformation

%

(Total = 671)

Causes of neonatal deaths in Dhanusha

Reference: Manandhar SR et al. Causes of stillbirths and neonatal deaths in Dhanusha District, Nepal: A verbal autopsy study. Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 1-5

2 yrs (1st Sept ‘06 – 31st Aug’08)

• 81% births at home• 50% births attended by relative or

other untrained persons• 19% each by trained person

»NDHS 2006

Delivery scenario of Nepal

THANK YOU