As you know, malnutrition is high in certain segments of the population e.g.children and pregnant mothers. Mortality rates in general as well as age-specific mortality rates reflect the incidence of malnutrition in a particular community. Let us learn about the various mortality rates which are computed for giving us an idea of incidence of malnutrition in a community.
Crude Death Rate (CDR)
Crude Death Rate is defined as the deaths per 1,000 population per year in a given community.
Number of deaths in a year
CDR = ------------------------------------------------ x 1000
Mid-Year Population
CDR serves as an indicator of the health status of people. Though it is not considered as a perfect measure of health status, a decline in death rate indicates improvement in health status of the population. A sharp decline in death due to control of certain communicable diseases by improved health services without a similar decline in birth rate in our country is leading to a high growth rate.
The present death rate in India is 11.0 when compared to 11 in Sweden, 11 in UK and 9 in USA (UN 1992). Death rate has declined in India from a figure of 21 in 1960 to the present figure of 11.0.
Infant Mortality Rate (IMR)
Infant Mortality Rate considered as a sensitive index of health status and living standard of people. When you compare the mortality figures, you will observe that deaths below one year will be the highest when compared with any other ge group. You will also see that the immediate causes of death among infants are different from that of adults. There are several other determinants of mortality which vary for different age groups, regions and communities. Major of mortality include povets, poor nutrition, illiteracy, poor sanitation, life style factors, pollution and adulteration, age at marriage, large family size and short spacing of births.
Diarrhoeal diseases, respiratory diseases and undernutrition are considered to be the main causes of high infant mortality. Any health programme specifically aimed at infants brings about a direct and quick reduction in infant mortality rate. The decline in infant mortality can be achieved, as has been seen in the developed countries, by
- improvement of standard of living;
- control of communicable diseases;
- availability of better medicines like various antibiotics and their utilization;
- availability of better health care facilities including safe deliveries and
- balanced diet and safe drinking water.
These are certain high priority interventions to control infant and child mortality. But many more are needed.
Infant mortality rate in India is 92 per 1000 live births (1991). It is higher in rural areas (98) when compared to urban areas (58). When you compare these figures with infant mortality rate in developed countries (around 15 per 1000 live births), it is very high. But one encouraging factor in infant mortality is its trend of gradual decline, say from 204 in 1911 to 92 in 1991. The decline is seen in both urban as well as in rural areas.
Neonatal Mortality Rate
Infant deaths occurring within 4 weeks or 28 days of birth are called neonatal deaths. Neonatal mortality rate is defined as neonatal deaths per 1000 live births in a given population.
Number of deaths under 28 days of age
Neonatal Mortality Rate = ----------------------------------------------------------- x 1000
Total live births
It may be interesting to you to know that nearly half of total infant deaths occur during the first 28 days of life. Most of these deaths are considered to be caused by injuries occurring during delivery besides unscientific procedures following conducting delivery. Other causes of neonatal deaths are congenital disorders, prematurity, certain blood disorders, condition of placenta and cord, diarrhoea1 diseases and acute respiratory infections. The neonatal mortality rate in India is 57.7 (1987) which is very high.
Perinatal Mortality Rate
Perinatal Mortality Rate is defined as the deaths (still births) occurring in late foetal life, i.e., 28 weeks of gestation or more and deaths under one week after birth in infants weighing over 1000 g. at birth.
Late foetal deaths (still births) + deaths under
Perinatal one week in infants weighing over 1000g. at birth
Mortality = --------------------------------------------------------------------------------
Rate Total live + still births weighing over 1000 g. at birth
Perinatal Mortality may be due to :
- complications in mothers during pregnancy or delivery
- complications in placenta
- disorders in the infant
You may however remember the following main causes:
- Low birth weight
- Injuries during birth
- Congenital malformations
- Infections after birth
Several factors have been identified to influence these main causes. They are :
- mother's age (early pregnancy, i.e., less than 19 years or late pregnancy, more than 35 years).
- space between pregnancies (less spacing).
- unsatisfactory progress of the pregnancy.
- poor nutritional status of the mother.
- low socio-economic status of the mother.
- lack of availability and non-utilization of health services.
- improper delivery by non-qualified birth attendants.
Perinatal mortality is considered as a sensitive indicator for antenatal care (care during pregnancy), natal care (care during delivery) and post-natal care (care after birth).
Even in developed countries, the perinatal mortality is high and attempts are being made to control this mortality. In developing countries like our country, the infant mortality (mortality during the first year of life) is very high and masks the perinatal mortality rate. The perinatal mortality rate in India is reported to be 56 when compared to figures of 10 to 20 in the developed countries like Sweden and U.K.
Post-Neonatal Mortality Rate
Post-neonatal mortality rate refers to the deaths of infants during 1 to below 12 months of their life per 1000 live births.
Deaths of infants 28 days to under one year
Post-Neonatal = --------------------------------------------------------------------- x 1000
Mortality Rate Total live births
Nearly 60% of all infant deaths occur between one month to below one year of the infant's life. These deaths can be prevented. This will become clear to you if you know what are the causes of deaths during this period of life. The causes are: diarrhoeal diseases; acute respiratory infections; communicable diseases for which immunization is available like whooping cough, diphtheria, tuberculosis, malnutrition and accidents. You will now realise that deaths during this period are mainly due to the vicious cycle set up by malnutrition and infection, one leading to the other and so on and so forth.
Post-neonatal mortality rate in India is around 60 per 1000 live births when compared to 20 in Sweden and 33 in Y.K.
Toddler Mortality Rate (TMR)
Children between 1 and 4 years are known as toddlers or pre-school age children.
The number of deaths in the 1 to 4 years age group children per 1000 such children is known as Toddler Mortality Rate.
The infant mortality rate has long been used as an indicator of the health status of a population. However, now it is being realized that 1-4 years mortality rate is much more sensitive. As you know pre-school age (1-4 years) is a time of combined nutritional and emotional stress. These children are much more prone to infection and malnutrition than infants. It has been estimated (according to the recent projections) that IMR in India as compared to developed countries was 10 times higher while the 1-4 mortality rate was 30 to 50 times higher.
The second year of life runs the highest risk of dying. Toddler mortality rate reflects the economic, educational, cultural and nutritional status of the community. So toddler mortality rate is taken as an indicator for several developmental programmes including nutrition programmes. It is now considered as the most sensitive indicator of the health status of the population.
In India, toddler mortality is 24 per 1000 children of the 1-4 years age group and it is observed that the decline in child mortality is very slow reflecting that there is a need to strengthen the developmental and nutrition programmes in the population.
Maternal Mortality Rate
Maternal mortality rate is defined as number of deaths of mothers while pregnant or within 42 days of termination of pregnancy excluding accidental causes in every 100000 pregnant women.
Number of deaths from puerperal causes
Maternal Mortality Rate = ---------------------------------------------------------------- x 100000
Number of pregnant women in the area
The maternal mortality rate reflects the quality of maternal services available to the population. It also indicates the proportion of morbidity among pregnant mothers usually at the rate of 1:20 i.e., for every death of one mother in pregnancy there can be 20 such women who are ill. The major causes of maternal mortality are toxaemias, haemorrhage and sepsis. In addition, anaemia, associated heart and lung diseases, illegal abortions, are the other causes.
The key factors governing maternal mortality are :
- The mother's age: The ideal child bearing age is between 20 and 30 years. Conception at ages below 20 or above 30 years of the mother poses higher risk for the mother as well as the new born.
- Birth interval: Short birth intervals or lack of spacing has higher risk for both the mother and the child.
- Parity: High parity, i.e. more number of births in the case of the mother poses risk to her life.
- Undernutrition: The prenatal nutritional status of the mother and low dietary intake during pregnancy causes a severe risk to the mother. Undernutrition leads to high maternal mortality.
All these four factors are also interrelated and play a greater role than medical causes in high maternal mortality in India and other developing countries. Maternal mortality rate in India in 1988 was around 340 per 100000 pregnant women. In developed countries, the figure is around fraction of one (i.e., in UK it is 0.13).
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