Amna Khan, Arslan Mazhar.
Neonatal deaths in Pakistan: managing the challenge.
Pak J Public Health Jan ;1(1):42-7.

Background: Every hour 450 neonatal deaths occur worldwide and approximately 4 million babies die during first week of their life. The middle and low income countries bear most of the neonatal mortality where more than half of these deaths occur in households. Pakistan is among six countries which account for 50% of all child deaths worldwide. Most of these deaths occurring in households are preventable. This review attempts to determine gaps either in our health system and practices for neonatal care to present a roadmap for the effective neonatal health programming in resource limited settings. Methods: The review methodology used three pronged approach. Firstly, we searched data bases such as PubMed, Cochrane, WHO regional database to catalogue international experiences. Secondly, a detailed document review for sorting the local evidence regarding neonatal health was performed. The third step of the review methodology used open search for indexing the neonatal care specific programmes both in the public and the private health sector. Discussion: Neonatal death entails a multitude of socio-economic and health system related factors. Health system related factors are substandard care, inadequate training, low staff competence and inefficient resources including equipment & medication while illiteracy, cultural practices and low socio-economic status also contribute to soaring neonatal deaths. The success of community based programmes specific to neonatal health is primarily dependent on socio-economic and political factors, health infrastructure and health system factors. Devising short, medium and long term strategies to bring down high neonatal mortality rates are critically needed at this point in time. Conclusion: Improvements in service delivery of neonatal health specific programmes and capacity development of community health workforce are short and medium term strategies in order to augment home based care. Long term strategies include empowerment of communities and relocation of health budgets towards betterment of primary health care services.

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