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A decade of perinatal mortality in Pakistan: Systematic review of patterns and challenges (2013-2022)
N Shahid1, T Kazmi2, S Farhat2
1Department of Statistics, Lahore College for Women University, Lahore, Pakistan.
Insights
Perinatal mortality (PNM) remains high in Pakistan, with factors like hypertensive disorders and infections contributing significantly. Further research is needed to accurately assess PNM rates for effective policy development.
Area of Science:
- Public Health
- Neonatal Medicine
- Epidemiology
Background:
- Perinatal mortality (PNM) is a critical indicator of newborn care quality, reflecting prenatal, intrapartum, and postpartum healthcare.
- Globally, 2.3 million children died within their first 20 days of life in 2022, with approximately 6500 daily newborn deaths.
- PNM is a significant public health issue in low and middle-income countries, with Pakistan reporting a consistently high rate (75 per 1000 births).
Purpose of the Study:
- To determine the frequency of perinatal mortality (PNM) and early neonatal mortality (ENM) in Pakistan over the past decade.
- To identify additional risk factors associated with PNM and ENM in the Pakistani population.
Main Methods:
- A systematic review was conducted using databases like PubMed, SCOPUS, Science Direct, and Google Scholar.
- Keywords included PNM, ENM, stillbirths, risk rate, and perinatal period.
- Eighteen relevant articles were selected following PRISMA guidelines, focusing on studies reporting PNM, ENM, stillbirth, or live birth rates.
Main Results:
- The systematic review indicated a persistently high PNM rate in Pakistan between 2013 and 2022.
- Hypertensive disorders, antepartum hemorrhage, and neonatal infections were identified as key contributors to PNM and ENM.
- Other contributing factors included advanced maternal age, low birth weight, congenital abnormalities, multigravida status, poor socioeconomic conditions, and gestational diabetes.
Conclusions:
- The PNM rate in Pakistan is notably high, though discrepancies exist compared to WHO global figures.
- Further original research is recommended to accurately ascertain Pakistan's PNM rate.
- Accurate data is crucial for developing informed and effective public health policies to reduce perinatal mortality.
Background:
The World Health Organization (WHO) defines perinatal mortality (PNM) as the "death of a baby between 28 weeks of gestation onwards till the first 7 days of life." PNM is a key indicator of the quality of care for newborns and directly reflects the category of prenatal, intrapartum, and postpartum care given to a newborn. According to a report published by the WHO, 2.3 million children died within their first 20 days of life in 2022. Approximately 6500 newborn deaths occur every day, accounting for 47% of all child deaths under the age of five years. PNM is a public health concern in low and middle-income countries. According to the Pakistan Health and Demographic Survey 2017-18, the PNM rate has remained consistently high in Pakistan (75 per 1000 births) during the last decade.
Aims:
To observe the frequency of PNM and early neonatal mortality (ENM) among the Pakistani population within the last decade and to identify additional risk factors for PNM and ENM.
Methods:
Published studies were searched using keywords comprising PNM, ENM, stillbirths, risk rate, perinatal period, and their combinations with search engines such as Science Direct, SCOPUS, PubMed, and Google Scholar. We followed Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines to filter articles and selected 18 relevant articles for systematic review. All studies reported either the PNM, ENM, stillbirth, or live birth rate.
Results:
Systematic review showed that the PNM rate in Pakistan remained high from 2013 to 2022. Hypertensive disorders, antepartum hemorrhage, and neonatal infections increased the overall risk of PNM and ENM. Other factors that contributed to the high PNM rate were advanced maternal age, low birth weight, congenital abnormalities, multigravida, poor socioeconomic conditions, and other medical problems such as gestational diabetes.
Conclusion:
The PNM rate in Pakistan was found to be high according to the systematic review, but discrepancies were observed when compared with the WHO figures for PNM. We recommend conducting more original research to accurately assess the PNM rate in Pakistan, which is essential for informed and effective policy making.
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