Nepal on track in reducing infant mortality

Achham,Nepal – Mathura Shahi, 30, presses the timer button and counts the breath intake of Sajjana, a month-old baby snuggling in her grandfather's arms.

Shahi assures 79-year-old Setu Shahi that he’s doing a fine job babysitting. “Tell your daughter-in-law that she does not need to worry about the baby. Her breathing is normal,” she says. “But do remind her to see that the little one is to be breastfed on time.”

Gathering up the folds of the shawl around little Sajjana's face, she adds: “And make sure that the baby is snuggled up properly and protected from the cold."

‘On track to achieve MDG 4’

Mathura is a Female Community Health Volunteer in Birpath village, Achham District, in far west Nepal. She is one of nearly 50,000 women in the country who have been working as the most reliable primary health care extension workers at the community level, trained to provide key services and interventions for pregnant women and children.

"In the last 15 years, we have managed to reduce child mortality by two-thirds in the country," says Dr. Yashovardhan Pradhan, Chief of the Child Health Division under the Ministry of Health in Nepal. "The fact that we are well on track to achieve MDG-4 can be credited to the expansion of health facilities across the country and the role played by the Female Community Health Volunteers in reducing child mortality and morbidity."

Millennium Development Goal 4 calls for a two-thirds reduction in child mortality worldwide by 2015.

Dr. Pradhan calls health volunteers like Mathura the “main actors” in the success of public health interventions such as supplementation of Vitamin A, distribution of de-worming tablets, management of diarrhoea and pneumonia, and polio and measles immunization campaigns.

Replicating success at the earliest age

Nepal has shown exemplary reduction in mortality rates for infants and children under five – which have come down from 79 to 48 deaths per 1,000 live births, and from 118 to 61 deaths per 1,000 births, respectively, in the past decade, according to the 2006 Nepal Demographic and Health Survey.

And yet this success has not been replicated in neonatal mortality. Over 50 per cent of the babies who are still dying in Nepal are less than one month old.

"Newborns across the country are dying due to hypothermia, asphyxia, complications due to low birth weight, and infection in the first week of life," says Dr. Pradhan. "We estimate that by addressing these four conditions, we would be able to save 67% of newborn lives."

Interventions for newborn care

Since the majority of births in Nepal (81%) continue to take place in homes, the earliest interventions must also take place there. Accordingly, the Government of Nepal, in close consultation and collaboration with UNICEF and other partners, recently approved a Community-Based Newborn Care Package.

Under this package of interventions, volunteers like Mathura will spend as much time tending to the newborns as they have traditionally spent on the delivering mothers. Their presence during home delivery will provide simple services like proper wiping and wrapping of the babies, and skin-to-skin contact to prevent hypothermia and after-birth asphyxia, as well as monitoring for severe infections.

The newborn care package will be piloted in a few districts this year, with support from various partner organizations, including UNICEF. With the package’s expansion after the piloting phase, female health volunteers can expect to play a crucial role in saving the lives of thousands of newborns across this Himalayan country.