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Infant Mortality in Nepal and South East Asia Annotated Bibliography

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First Author, Name of journal, Year, Setting Cause of Under-five mortality Study Design, Sample Size Key Findings Interpretation of Findings
Shrestha, Burn injuries in pediatric population, 2002, Nepal Med Assoc.

Pandey, Reduction in total under-five mortality in western Nepal through community-based antimicrobial treatment of pneumonia, 1991, Lancet.

Qureshi, Road traffic injuries, 2005, lancet

Moriss, Predicting the distribution of under-five deaths by cause in countries without adequate vital registration system, 2003, Baltimore

Black, Where and why are 10 million children dying every year, 2003, London School of Hygiene and Tropical Medicine

Singh, Burden of pneumonia in children, Nepal Med Assoc.

Suwal, The main determinants of infant mortality in Nepal, 2002, southeast Asia

Klemm, Newborn vitamin A supplementation, 2006, Bangladesh

Bangladesh, Estimating child mortality due to diarrhea in developing countries, 2008, Georgetown University

Burn injuries among the pediatric population

Mortality as a result of pneumonia

Deaths due to road traffic injuries among children aged 5 years and below.

Predictions regarding the distribution of deaths among children aged 5 years and below in countries that do not have proper registration systems.

Other causes claiming 10 millions children aged 5 years and below annually.

Impact of pneumonia in young children based from an Asian perspective.

Other common determinants of infant mortality.

Mortality among infants as a result of a deficiency in vitamin A especially in rural areas.

Diarrhea as a cause of death among children aged 5 years and below

The study comprised 580 patients all of whom were children aged below 15 years. The children had been hospitalized in1999-2003 at a hospital at a burn center in Ostrava. Mechanisms of the injuries were analyzed and were related to the age of the patient and also the extent as well as the depth of the injury. Localization of the burn injury and the applied local treatment to the injured parts.

Compiled data were classified into three sets of age groups ranging from 2 to 5 years, another from 5 to 10 years, and finally one aged 10-15 years. Analysis was done on burn due to hot liquids, hot objects, and others due to electricity. The focus was also done on burns due to explosions and burning when the children came into contact with hot clothing.

Surveillance of death among children as a result of pneumonia was done on seven health centers and two sites that were community-based in 2004-2006 on 117 cases of pneumonia. The condition was tested through cerebrospinal fluid.

Co-trimoxazole and 9-valent conjugate vaccine was used to test on the resistance of the victims on the drugs. The fluids were tested in the local laboratories both for culture as well as antimicrobial susceptibility. Various related symptoms such as fever, cyanosis and convulsions were focused and sent to various clinics.

A study that was conducted in 2004 involved number of clashes along road traffic and the number of resulting deaths among children aged 5 years and below.

The number of children who were killed as pedestrians was also focused a long those that occurred among young cyclists or motorcyclists.

Data was also taken for the children who died among occupants of vehicles involved in road accidents. The mortality was converted per 100, 000 population and compiled among HIC= high-income countries as well as LMIC= low-income and middle-income countries.

A close review and analysis of all publications on death of children aged 5 years and below by cause since 1980 was done. Standardization of the cause of such deaths was carried out and information compiled regarding all characteristics in each study in a particular population.

The researcher used a meta-regression model and related the characteristics to various results in proportion to mortality. The researcher then predicted the overall distribution across the nation using the known characteristics.

The researcher used a prediction model to estimate death distribution among children aged 5 years and above involving 42 countries. The comparison of the results was done against the estimates of the world health organization.

The evidence of the research in this area was to provide evidence out of the recommendations regarding the use of antibiotics used to treat majority of infections of the respiratory systems especially when they are acute. Most of the data was gotten from publications of various international organizations. Terms such as sinusitis, acute respiratory infections and tonsillitis were used in their right definitions.

Panel data was collected from a survey based on population within a period of three years 1994 to 1999. The exercise involved 1,442 women to follow up changes in family planning among couples who were reproductive and find out what encouraged couples to communicate on the issue of family planning based on the exposure of the community programs.

The study involved 15, 937 infants from rural areas where over 90% of babies are delivered at home. 50% of the babies were randomly selected and administered with 50,000 IU vitamin A dose and the other half were put under placebo. The vitamin was administered orally a few hours after birth preferably 7 hours.

Sources of data included systems for vital registration and epidemiological studies. Search strategy was from earlier publications that involved 804 papers. The research also made use of a model for proportional mortality where proportions of death were observed from diarrhea as well as variables that were potential explanatory.

The highest of the burn cases in the children was caused by contact with hot clothing on which a hot liquid had poured. Majority of the cases involved deep burns touching most parts of body and requiring surgical intervention. Regarding the extent of the burns, scalding took the second position. Above 50% of the burn cases were found to be superficial and age largely determined the areas most affected by the burns. A very low percentage of the burns resulted from explosion of materials that were combustible and took a third position on the causes of burns. Areas that were most affected were the head and trunk as well as upper extremities on average.

72% of the tested cases of pneumonia among children aged 5 years and below were found to have developed resistant to co-trimoxazole. However, 48% still responded positively when they were administered with conjugate vaccine and survival of the child was greatly improved. Severe cases of pneumonia were diagnosed if the child was not able to drink and experienced lethargy. The victims also suffered malnutrition and very calm with symptoms of hypothermia.

There was also presence of fast breathing as well as severe chest pain. Research also proved it difficult to isolate and therefore most of the infections were indicated as having not been recognized at early stages.

The research indicated that, as children continue growing, they extend their experiences to discover the external world especially along the local traffic and become more exposed to the related risks and hazards.

The current roads in use are not designed with a consideration that, children are part of the pedestrians or cyclists who use the roads. Some children also prefer to play along roadsides where if the risks are not fatal, they become disabled whenever they are involved with the accidents though the accidents are not intentional.

The research indicated that, the resultant numbers of deaths were found to be closely linked to regions and the level of mortality as well as how the children were exposed to malaria. The outcome was also associated to great extent on safety on health care especially during delivery as well as supply of clean water. Another great influence was on the methods put in place of defining various causes of death.

Research revealed that, over 10 million children aged 5 years and below die annually as a result of cause that are otherwise preventable especially in developing and poor countries. There is a great variation on these causes of death in different countries and this indicated the importance of enhancing understanding of issues regarding mortality rates among the age bracket.

Bacteria’s that are resistant to the convectional antibiotics have now been given recognition as an international problem on global scale. Acute respiratory infections have also been termed as the most significant contributors in the use of antibiotics in any given community and these are caused by viral infections. It is therefore recommended that, use of antibiotics be rationalized so as to reduce their abuse which would consequently lead to resistance among children aged 5 years and below as well as latter on in their life.

Communication between the spouse elevated odds regarding use of family planning. There was increased communication between the couples who were initially not very much involved in discussion about family planning.

Those who were administered with vitamin A had a mortality rate of 38.5 per 1000 births while those who received no supplement had a mortality rate of 45.1. Vitamin A was found to reduce mortality rate caused by all factors by reducing chances of infections that usually claims infant’s lives.

Research has shown that, there is still high uncertainty regarding mortality rates caused by diarrhea among infants. This is because the data available is not sufficient for the study. Among the studies that were done, 68 of them met inclusion criteria and were forwarded for analysis as they had sufficient data to explain under-5 mortality rates.

The mechanism that caused burning was found to be mostly through scalding as a result of hot liquids as well as food and this was dependent on age. Children age below two years accounted for 9190 cases and the trend prevailed up to 80% to the age of 2-5.

It was however noted that, cases of burn due to hot objects increased with increase in age due to increased exposure to the objects. It was also observed that, more cases of boys than girls fell victims of burn cases but generally, majority of both sex were at the age of two.

91% of the burn cases were through scalding as a result of hot clothing. In most cases, it was necessary for the victims to undergo surgery. On the other hand, teens received burns from other sources like explosions and hot objects but less from scalding.
It is possible to prevent a vast majority of infant deaths that are caused by pneumonia through vaccination that is effective to more than 50% of the resistant strains.

Research also indicated that, the high resistance to co-trimoxazole was an indication that, the medicine was not among the first line agent that would be recommended in treating pneumococcal infections. The vaccine had a positive consequence as it reduced chances of pneumonia infections resulting from antimicrobial strains that were resistant. Studies revealed pneumonia as among the leading causes of death among children aged five years and below.

Infant futility among developed countries is far much higher compared to developing countries and when death occurs in poor countries as a result of road accidents is common in urban areas.

High traffic mix is highly associated with such deaths because the areas reserved for the pedestrians Areas not safe. It is therefore important that, interventions are made in the developed state to implement strategies for reducing high mortality rates due to road accidents.

If a country or a state lacks adequate and vital registrations, there is high likelihood of such a country to have proportion distribution of deaths among children 5 tears and below as an estimate based on the probable cause of death.

This method makes use of systematic associations existing between the distribution and the corresponding characteristics regarding the respective population in which the study was carried out.

Under nutrition was found to contribute significantly to children’s deaths because such children were at high risks of infectious diseases that occur in series and sometimes concurrently. Such diseases include diarrhea and pneumonia which research has shown to be claiming majority of deaths among children aged 5 years and below. Most deaths were found to be in sub-Saharan Africa and also in south Asia. However, research has shown that, in Asia, there has been a decline in infant mortality and only one in 10 cases of death occur prior to the age of 5. Other factors that pose threat to the children include unsafe drinking water which is also insufficient for adequate hygiene.

It is necessary to place distinction between the patients of acute respiratory infections and potential beneficiaries of antibiotics. Antibiotics should be sold only on prescription as a recommendation because this is one of the strategies which would significantly reduce the frequency of resistance by the bacteria’s. Currently, about 35% of hospital admissions and 40% of outpatients comprise of children aged five years and below. Research has also shown that, acute respiratory infections also arise in adults though they have been recorded as highest without the first five years and during adolescence.

It is important to have new indicators in order to capture the effect of campaign on predisposed couples regarding family planning. The outcome of the research encourages cooperation in decision making to enhance family planning. The autonomy of women should be promoted as a strategy to reinforce their capacity to negotiate with their partners on the implementation of family planning.
Vitamin A has capacity to reduce infant mortality especially if they are less than 6 months. If the vitamin is also given during birth, it enhances infant’s survival for the first 6 months.

Although several attempts have been made on contribution of diarrhea on infant’s mortality, it is still not clear on the impact diarrhea has on infant’s death and no reliable conclusion have been made. This is because the methods that have been in use in the studies have not been consistent.

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