Faculty Research Summaries Under 5 Mortality in Trinidad and Tobago

Overview:

Under-five mortality rate is defined as probability of dying between birth and exactly five years of age expressed per 1,000 live births (UNICEF, n.d.). It is a valuable tool in assessing the overall health care system of any country. Under-five mortality shows a country’s commitment to its vulnerable population and is associated with economic development. According to the World Health Organization (2013), there were 6.6 million children in the world who died before their fifth birthday in 2012. The risk of dying is highest during the first 28 days of a child’s life also called the neonatal period.

Purpose:

The study looked at under-five mortality rates in Trinidad and Tobago. It was a collaboration between UNICEF and the Ministry of Health (MOH) in an effort to improve vital statistics and the overall quality of perinatal health by evaluating current policies and practices. Trinidad and Tobago - is one of the wealthiest country in the Caribbean with a gross domestic product (GDP) of 23.3 billion (USD) (2012), yet their infant and child mortality rates are significantly higher than their counterparts. With an under-five mortality rate of 28 deaths per 1,000 live births in 2011, and 34 deaths per 1,000 live births in infant mortality in 2009. In comparison, Jamaica has a GDP of 14.8 billion (USD) and an under-five mortality rate of 18 per 1,000 live births, and Barbados has a GDP of 4.2 billion (USD) with an under- five mortality rate of 20. In addition, Trinidad and Tobago is disproportionately affected by deaths especially during the neonatal period through the first year. Of all child mortality deaths, 89 percent occur in the first year and of those 64 percent occur in the first 28 days.

Methods:

Determinant Frameworks (UNICEF) were used and classified under 4 categories: Enabling environment; Supply; Demand; and Quality. (This frame work is part of the Marginal Budgeting of Bottlenecks (MBB) methodology preferred by UNICEF). Qualitative and quantitative data were obtained. 589 cases were used from medical records and death certificates from 6 hospitals and 9 health facilities. 90 interview and focus groups were conducted from government staff, health care providers (private and public), and parents who have lost their children after hospital birth.

Findings:

· Perinatal deaths (infants who died in the first week of life) mostly died during birth. 50% died from prematurity, 19% from congenital anomalies, 9% from neonatal diseases, and 5% from birth asphyxia. · Neonatal deaths (deaths between 7-27 days) were from prematurity (58%), congenital anomalies (19%), and neonatal diseases (8%). · Deaths of infants between 2-11 months were related to congenital anomalies (31%), infections (15%), injuries (2%), and prematurity (23%). 24.5 % of the cases were missing diagnosis recorders. st th · For the 10% of children who died between their 1 -4 year of life, 32% were from congenital anomalies, 22% were due to infections, 17% were caused by cancer, and 10% were from injuries. 43% of the cases were missing causes of death in the recorders. · Of the 589 cases reviewed, 393 had data on birth weights. Of those 207 (53%) were very low birth weight (less than 1500 grams) and 75 were moderately low birth weight (less than 2500 grams).

Qualitative Findings (examples):

Enabling Environment:

¨ Social Norms: “We need to get training for young physicians and ways to keep them in the country.”

¨ Budget/Expenditure: “We are told we are using too many (paper towels) and may be stealing.”

Supply:

¨ Availability of Equipment & Supplies: “Doctors spend a lot of time discussing who can use what monitor and who can’t because this baby needs it more than the other one. Some babies don’t get optimal care because there is not enough equipment.”

¨ Staffing: “The ratio of nurses to baby in NICU is 1:8. That’s way too many.”

Demand:

¨ Social and Cultural Practices and Beliefs: “Poorer people may not come in for care; they may go to herbal types for medication”

¨ Financial Access: “Our population has social problems, like being able to feed and clothe children”

Quality:

¨ Quality of Care: “We don’t have the capacity to handle ALL the social cases, we sometimes deliberately turn an eye, and it’s too long of a process.” Family Interviews:

¨ “Nurses need some kind of sympathy and grieving training. Three hours after my son died a nurse decided to me all the ways that it could have been my fault he died, and she ended with ‘just in case you want to blame the hospital’.” Recommendations:

· Create an electronic country wide health information system. · Establish a national Maternal and Child Health Coalition to increase partnership and collaboration, and standardize care. · Increase patient and health care provider’s education through modern communication and social marketing. · Increase access and maintenance of equipment. More neonatal beds & a transferring system are needed. · A national human resources plan to fill the human resources gap including pediatric medical specialists.

Summary: Child mortality is an important public health issue that needs immediate attention. As part of the Millennium Development Goal, child mortality needs to be reduced by two thirds between the years 1900 to 2015. It is essential to reduce child mortality rates and invest in the health of mothers and children as they play an important role in the overall health of the community.

Reference:

Nelson R. M., Kirby, R. S., Chee, V. A., & Kynes, R. E. (2013). Under 5 mortality in Trinidad and Tobago. Ministry of Health, Trinidad and Tobago and UNICEF

UNICEF. (n.d.). Basic indicators. Retrieved from http://www.unicef.org/infobycountry/stats_popup1.html

World Health Organization (WHO). (2013). Children: Reducing mortality. Retrieved fromhttp://www.who.int/mediacentre/factsheets/fs178/en/