Zero infant mortality targets in almost all dzongkhags stand at risk

Health: Although Bhutan has achieved the Millennium Development Goal (MDG) target for infant and under-five mortality rate, the number of babies dying within their first 28 days after birth still remains a concern in most dzongkhags.

The issue was highlighted during the mid-term reviews in many dzongkhags especially in the east. The target was to have zero deaths. However, the zero infant mortality targets in almost all the dzongkhags stand at risk.

Each dzongkhag reported about two to 15 infant mortality deaths last year.

For instance, Sarpang reported 15 infant deaths, Punakha reported three and Trongsa four.

Similarly, Tsirang and Pemagatshel also reported seven infant deaths each.

The infant deaths were attributed to reasons such as late reporting to hospital,  mothers being too young, socio-cultural factors, birth complications, infections, congenital deformities and difficult terrain, among others.

Lack of paediatricians was also cited as one of the reasons in some dzongkhags.

While requesting that the target be reviewed, as zero death was not achievable, some dzongkhags emphasised reinforcing and providing intensive awareness programmes.

However, Prime Minister Tshering Tobgay said that the numbers were a concern and urged the dzongkhags to put in their best efforts to minimise it while the government and health ministry would also assist the dzongkhags.

However, Lyonchoen insisted that the zero death target remain as it is and also urged local leaders to inform people that hospitals and health facilities are the safest places for child delivery.

Existing scenario

Infant deaths occurring today, when medical facilities and delivery services are said to have drastically improved, is definitely of concern.

However, health officials clarified that the reality was different.

Health minister Tandin Wangchuk said Bhutan has come a long way in reducing the infant and under-five mortality rate and it will further improve along with health services.

The high incidence of infant deaths in the dzongkhags, lyonpo said was because the target was set to zero, which is near impossible. An enquiry by the health ministry on why the target was set as zero revealed that it was to do with strong cultural beliefs.

“I was told that it was not right to set a certain target for death as if waiting for infants to die,” lyonpo said. “Such mentality among health workers is not right.”

Lyonpo said that in the past, there were no such targets set which is why it sounds alarming. “We’ll try our best but we need cooperation of mothers as well,” lyonpo said, emphasising that eight antenatal visits for pregnant women are a must but that most mothers don’t follow the requirement, which is an issue.

“Along with that institutional delivery should also improve,” lyonpo said.

Public health department’s director general Dr Pandup Tshering said that the strong political commitment, extended maternity leave, chopper services, road connectivity and communication facilities would have an impact on reducing the infant mortality rate.

“Infant mortality rate is also associated with various factors such as literacy rate and socio-economic development, among others,” he said. “The focus on strengthening institutional delivery, antenatal care visits and advocacy programmes would continue

In 2010, Bhutan’s infant mortality rate per 1,000 live births stood at 47 while it dropped to 30 in 2012, which according to health officials is a good indication. Besides, Bhutan has achieved the MDG 4 target with infant and under-five deaths.

The Annual Health Bulletin 2015 also shows a slight decrease in neonatal deaths. In 2012, there were 91 neonatal deaths according to the bulletin. The number dropped to 72 in 2013 and further declined to 62 last year.

“Although we’ve progressed comparatively, this doesn’t mean that we can sit back and relax,” Dr Pandup Tshering said.

Dr Pandup Tshering added that the ministry continues to strengthen its human resources and infrastructure in improving neonatal care. He acknowledged the issue of shortage of paediatricians in the country. There are about seven paediatricians today with four in the Thimphu referral hospital.

“But we are training our health workers in neonatal care to improve their competency,” he said.

Health officials said that baby warmers for preterm babies were distributed in all health facilities including basic health units (BHUs). But incubators are available only in a few hospitals.

Challenges

Last year, a UNICEF policy brief for Bhutan also highlighted that the number of babies dying within the first 28 days of birth is still high.

According to health officials, preterm birth is the main cause for newborn deaths. One in every 10 children born in Bhutan is premature and the number of premature births across the country is said to be increasing.

Paediatrician Dr Kinley Tshering said Bhutan is on track having achieved the MDG target of infant and under-five mortality. “We have made significant progress but we are still not up to mark,” he said.

Despite the progress, Dr Kinley Tshering said children in Bhutan were still dying from pneumonia and diarrhoea, which indicates there are issues with water and sanitation and child-care practices, among other issues.

“Globally, deaths among children under five occur before they attain one year and among children under one, it occurs in less than a month,” he said. “Essential newborn care in all health centres would help reduce infant mortality rate.”

Dr Kinley Tshering attributed infant deaths to primary causes such as birth asphyxia, preterm births and infections.

Emphasising on antenatal care and visits, health officials said that health of a baby is determined right from conception until they are born.

The national health survey 2015 states that about 85 percent of the mothers make more than four antenatal care visits, but only 52 percent made the first visit during three months of pregnancy.

Dr Pandup Tshering said all women should avail health services during pregnancy. “Make use of the available health facilities,” he said. “We provide standard services at the outreach clinics and BHUs.”

The World Health Organisation (WHO) states that in 2015, 4.5 million (75 percent of all under-five deaths) occurred within the first year of life. The risk of a child dying before completing the first year of age was highest in the the WHO African region at 55 per 1,000 live births, over five times higher than that in the WHO European region at 10 per 1,000 live births.

Globally, infant mortality rate has decreased from an estimated rate of 63 deaths per 1,000 live births in 1990 to 32 deaths per 1,000 live births in 2015, states WHO. Annual infant deaths have declined from 8.9 million in 1990 to 4.5M in 2015.

Kinga Dema