Concerns about infant mortality

Jul 24, 2018 Letters

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DEAR EDITOR,
The editorial in the KN issue of July 18 does not really allow us to make comparisons in order to decide whether or not we have a serious problem at the hospital.
Readers can decide if a total of 119 neonatal deaths at the GPH is a problem only if we know: a) how many births there were in the same period at the GPH, and b) how many of those neonatal deaths were of babies born at the hospital, and how many were born elsewhere and were transferred to the GPH. (KN says that the GPH is the only institution where neonatal care with invasive breathing support is available – which suggests that a baby with serious problems born elsewhere will likely be transferred to the GPH.
In which case, in order to make meaningful comparisons, we really need to look at ALL neonatal deaths in Guyana in relation to ALL births in Guyana within a given time frame, or neonatal deaths of infants born at the GPH in relation to all infants born at the GPH within the given time frame).
Then there appears to be confusion between neonatal deaths and infant deaths/mortality. Neonatal death is usually defined as a death within the first 28 days after birth. Infant mortality usually means death within the first year after birth. But you skip from one term to the other.
The infant mortality rate could be falling, although the neonatal mortality rate remains the same or is increasing, and vice versa. And there can be different causes of neonatal mortality (prematurity or birth defects, for example) and infant mortality (e.g. diarrhea caused by drinking some impure liquid – not impossible for a neonatal infant, but I think we do tend to be more particular about what we give a baby in that first month).
In order to compare the incidence of any phenomenon in different places, one usually needs to convert the raw figures to a ratio of so many per 1,000 in the population.
For example, later in the editorial we read that the Ministry aims to reduce the incidence of neonatal mortality of 29 deaths per 1,000 live births. I assume that the Ministry is here referring to all neonatal deaths in Guyana, not only deaths at the GPH; because if there is a total of 6409 live births and the 119 neonatal deaths at the GPH are of babies born throughout the country, that is a 20 per thousand neonatal death rate (it is actually a fraction less than 20, but the figure has to be rounded up, since there is no such thing as a part of a child).
If Guyana currently has 29 neonatal deaths per 1,000 live births, then either our government gave inaccurate figures to UNICEF in 2016 or the neonatal death rate has increased instead of decreasing between 2016 and 2018. UNICEF statistics state that Guyana’s neonatal death rate was 20 per 1000 live births in 2016.
Then Freddie Kissoon in a subsequent column says that “Guyana per capita must have one of the highest, if not the highest rate of neonatal deaths among countries”. Well yes, we are among the higher rates, but we are not the highest. (Mr. Kissoon, thank you for explaining cogently the meaning of a rate per 1,000 so that I don’t have to go into that).
Most of the countries with rates of 20 per 1,000 and higher are in Africa or Asia according to the UNICEF statistics – for example (not an exhaustive list) Ethiopia 20, Senegal & Uganda 21, Zimbabwe & Zambia 23, Myanmar & India 25, Mozambique, Ghana & Yemen 27 (although I expect that Yemen’s rate may have increased recently with the war in that country), Gambia 28, Sudan 29, Sierra Leone 33, Nigeria 34, Guinea-Bissau 38, Somalia & Lesotho 39, Afghanistan 40, and Pakistan (the highest) 46.
What I find more troubling in Guyana’s situation is that a number of other countries, which in 1960 had much higher rates than 20 per thousand, have managed to bring their rates down to Guyana’s 2016 rate or lower (granted that was a 56-year interval), while Guyana is now talking about reducing our rate by only a further 3%.
Again, as examples, Senegal reduced their rate from 62 per 1,000 live births in 1960 to 17 in 2016, Rwanda reduced from 63 to 17, Jamaica went from 35 to 11, Panama 39 down to 10, Peru 55 down to 8. Even Bangladesh, which had 103 deaths per 1,000 in 1960 had reduced their rate to 20 in 2016.
Several other Latin American and Caribbean states have rates in 2016 that are much lower than Guyana’s – Trinidad & Tobago 13, Suriname and Jamaica 11, Belize and St. Vincent 10, Colombia 9, Barbados and Brazil 8, St. Lucia, St. Kitts and the Bahamas and Costa Rica 6, Antigua 4, and Cuba with a highly developed country rate of 2 per 1,000 live births.
The USA has 4 per 1,000, which is high for such a wealthy country – the same as Antigua, a far, far poorer country. Japan, Slovenia, Singapore all have 1 per 1,000 live births. Israel, South Korea, Latvia, Sweden, Spain, Portugal, Norway, Austria, Belgium and Australia have 2 per 1,000. New Zealand, Poland, Lithuania, the Netherlands, Switzerland, the Slovak Republic, Canada and the U.K. are 3 per 1,000 live births. The average rate for the world is 19 per 1,000 live births.
While Guyana’s rate is relatively high, it is by no means, the highest in the world, nor is it exceptionally high for a state with one of the lowest GDPs in the region. However, that is not a matter for complacency. We should perhaps be learning from our near neighbours how to reduce our rate further. It will be interesting to see if and how we improve as the oil money starts to flow.
//Source: UN Interagency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UN Dept of Economic & Social Affairs Population Division)
Pat Robinson Commissiong

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