100,000 children
100,000 children
Updated 03:53am (Mla time) Nov 24, 2004
By Michael Tan
Inquirer News Service
Editor's Note: Published on page A15 of the November 24, 2004 issue of the Philippine Daily Inquirer
THINK of a fairly large nursery or day-care center with about 100 toddlers -- children below five years old -- in their care. Imagine a thousand of these day-care centers to visualize, however roughly, 100,000 of these toddlers.
You reach out for an imaginary dial to turn down the volume because the 100,000 toddlers can create quite a din. Turn down the volume on the squealing, giggling, laughing, babbling, until you get complete silence. Deathly silence.
Of the 2.5 million babies that will be born in the Philippines this year, 100,000 will not live to the age of five.
This figure is projected out of statistics from the 2003 National Demographic and Health Survey (NDHS), released two weeks ago. The NDHS asked 13,000 women a battery of questions, including several on the number of children they've had, and infant and child deaths. Based on this information, they were able to calculate infant mortality rate, which is the death rate of children below the age of one year, and the under-five child mortality rate.
The statistics are grim: For every 1,000 births, 29 will die during infancy, and 11 more will die before the age of five. The total under-five mortality rate is therefore 40 per 1,000 (or 4 percent of total births), which is how we derive the figure of 100,000 deaths.
Stalkers
What are these children dying of? I looked up the last Health Statistics yearbook of the Department of Health and wrote down the top 10 causes of death for infants, and then toddlers. The pattern reminds me of what I was looking at 20 years ago, when I first began to do public health research. Among infants, many of the deaths occur shortly after birth, caused by "birth injury and difficult labor" as well as congenital anomalies. Throughout infancy, the babies continue to ward off the Grim Reaper's many stalkers: respiratory diseases, diarrheas, measles, and malnutrition.
Among children aged one to five, the pattern is all too similar to that of infant deaths, with the addition of chronic obstructive pulmonary diseases (asthma, bronchitis, and emphysema), and accidents.
Some of these are not easy to deal with -- for example, the pollution that contributes to chronic respiratory ailments. But many of the other deaths can be prevented through provision of more and better quality health services, as well as improving access to these services. Note that access here isn't just a matter of physical facilities. For example, the government now provides free vaccines for children, including hepatitis B, yet the NDHS found that 30 percent of households had children with incomplete immunizations and seven percent had no vaccines at all.
Clearly, there's a failure here of health information and health education for parents. We grieved reading about the children who died from food poisoning because the father had fed them scraps obtained from garbage. I suspect there have been many similar cases that didn't make it to the press-those who died not just because of unsanitary preparation of food but due to severe under-nutrition caused by parents' poor understanding of nutritional needs, or chronic malnutrition which can kill a child slowly through starvation by making the child more vulnerable to all kinds of diseases.
Social barometer
Back in the 1970s, I listened to a lecture by Dr. David Morley, a renowned British pediatrician and public health worker, where he pointed out that child death rates are sensitive social barometers, its level, as well as its rate of decrease, telling us volumes about a country's priorities in development.
The NDHS, which is conducted every five years, has been chronicling the trends in these death rates. In the 1993 NDHS, the under-five mortality rate was reported at 54 per 1,000 births or 5.4 percent. This dropped to 48 in 1998 and to 40 in 2003. Progress has been made, but the rate of decrease has been slow, and the current figure of 40 is still high compared to those of many other countries.
The under-five mortality rates seem to parallel economic development. Among our neighbors, the most impressive rates are found in Singapore, with four per 1,000 live births and Malaysia with eight, figures that are even better than that of the United States. Thailand, which is more developed than we are, has a rate of 28. Indonesia, which is a bit poorer than we are, has a rate of 45.
But it isn't just economic development that brings down child death rates. The term "political will" has become such an over-used cliché but yes, government investments in health care do save children's lives in a dramatic way. Cuba, a country that is poorer than we are but with completely subsidized health care, has an under-five death rate of 9, about the same as that of the United States. Singapore and Malaysia's impressively low rates are products too of strong public health system supported by the state. Vietnam, which is poorer than the Philippines but has a socialized health care system, has a rate about the same as ours: 38 per 1,000 live births.
Our lackluster performance in bringing down child death rates also reflects serious economic and social inequities. It isn't surprising that the National Capital Region had an under-five death rate of 31 per 1,000 live births while the Autonomous Region in Muslim Mindanao had 72. Likewise, with the poorest 20 percent of households, the under-five death rate is 66, while among the richest 20 percent it is 21.
The NDHS figures also show how family planning can bring down the death rates. In households with only one child, the under-five death rate is 36. If there are four to six children, the death rate goes up to 45 and if there are seven or more, the rate is 83.
The most dramatic differences correlate with the education of mothers. In households where women had some college education, the under-five death rate was 18. In households where women had no formal education at all, the rate was an astounding 105. That last figure means that one out of every 10 babies born to these mothers will die before the age of five. There is a vicious cycle created in such households: Couples, aware of the high rates of child deaths in their family, will actually keep having more children to make sure they have enough surviving children.
The NDHS figures tell us it takes so little to save children's lives: more money and human resources for delivering basic services in communities and schools. Our unwillingness to invest in our children's health means many wasted lives, not just of the children who die but also of survivors who will continue to suffer from health problems later in life. They are the ones who queue up in government hospitals, or troop to radio and television stations, hoping for a dole-out. They, too, will bring the next generation of children into the world, as unprepared as their parents were. The lives of this next generation of Filipinos will again be all too short, flickering candles placed out in a storm.
Updated 03:53am (Mla time) Nov 24, 2004
By Michael Tan
Inquirer News Service
Editor's Note: Published on page A15 of the November 24, 2004 issue of the Philippine Daily Inquirer
THINK of a fairly large nursery or day-care center with about 100 toddlers -- children below five years old -- in their care. Imagine a thousand of these day-care centers to visualize, however roughly, 100,000 of these toddlers.
You reach out for an imaginary dial to turn down the volume because the 100,000 toddlers can create quite a din. Turn down the volume on the squealing, giggling, laughing, babbling, until you get complete silence. Deathly silence.
Of the 2.5 million babies that will be born in the Philippines this year, 100,000 will not live to the age of five.
This figure is projected out of statistics from the 2003 National Demographic and Health Survey (NDHS), released two weeks ago. The NDHS asked 13,000 women a battery of questions, including several on the number of children they've had, and infant and child deaths. Based on this information, they were able to calculate infant mortality rate, which is the death rate of children below the age of one year, and the under-five child mortality rate.
The statistics are grim: For every 1,000 births, 29 will die during infancy, and 11 more will die before the age of five. The total under-five mortality rate is therefore 40 per 1,000 (or 4 percent of total births), which is how we derive the figure of 100,000 deaths.
Stalkers
What are these children dying of? I looked up the last Health Statistics yearbook of the Department of Health and wrote down the top 10 causes of death for infants, and then toddlers. The pattern reminds me of what I was looking at 20 years ago, when I first began to do public health research. Among infants, many of the deaths occur shortly after birth, caused by "birth injury and difficult labor" as well as congenital anomalies. Throughout infancy, the babies continue to ward off the Grim Reaper's many stalkers: respiratory diseases, diarrheas, measles, and malnutrition.
Among children aged one to five, the pattern is all too similar to that of infant deaths, with the addition of chronic obstructive pulmonary diseases (asthma, bronchitis, and emphysema), and accidents.
Some of these are not easy to deal with -- for example, the pollution that contributes to chronic respiratory ailments. But many of the other deaths can be prevented through provision of more and better quality health services, as well as improving access to these services. Note that access here isn't just a matter of physical facilities. For example, the government now provides free vaccines for children, including hepatitis B, yet the NDHS found that 30 percent of households had children with incomplete immunizations and seven percent had no vaccines at all.
Clearly, there's a failure here of health information and health education for parents. We grieved reading about the children who died from food poisoning because the father had fed them scraps obtained from garbage. I suspect there have been many similar cases that didn't make it to the press-those who died not just because of unsanitary preparation of food but due to severe under-nutrition caused by parents' poor understanding of nutritional needs, or chronic malnutrition which can kill a child slowly through starvation by making the child more vulnerable to all kinds of diseases.
Social barometer
Back in the 1970s, I listened to a lecture by Dr. David Morley, a renowned British pediatrician and public health worker, where he pointed out that child death rates are sensitive social barometers, its level, as well as its rate of decrease, telling us volumes about a country's priorities in development.
The NDHS, which is conducted every five years, has been chronicling the trends in these death rates. In the 1993 NDHS, the under-five mortality rate was reported at 54 per 1,000 births or 5.4 percent. This dropped to 48 in 1998 and to 40 in 2003. Progress has been made, but the rate of decrease has been slow, and the current figure of 40 is still high compared to those of many other countries.
The under-five mortality rates seem to parallel economic development. Among our neighbors, the most impressive rates are found in Singapore, with four per 1,000 live births and Malaysia with eight, figures that are even better than that of the United States. Thailand, which is more developed than we are, has a rate of 28. Indonesia, which is a bit poorer than we are, has a rate of 45.
But it isn't just economic development that brings down child death rates. The term "political will" has become such an over-used cliché but yes, government investments in health care do save children's lives in a dramatic way. Cuba, a country that is poorer than we are but with completely subsidized health care, has an under-five death rate of 9, about the same as that of the United States. Singapore and Malaysia's impressively low rates are products too of strong public health system supported by the state. Vietnam, which is poorer than the Philippines but has a socialized health care system, has a rate about the same as ours: 38 per 1,000 live births.
Our lackluster performance in bringing down child death rates also reflects serious economic and social inequities. It isn't surprising that the National Capital Region had an under-five death rate of 31 per 1,000 live births while the Autonomous Region in Muslim Mindanao had 72. Likewise, with the poorest 20 percent of households, the under-five death rate is 66, while among the richest 20 percent it is 21.
The NDHS figures also show how family planning can bring down the death rates. In households with only one child, the under-five death rate is 36. If there are four to six children, the death rate goes up to 45 and if there are seven or more, the rate is 83.
The most dramatic differences correlate with the education of mothers. In households where women had some college education, the under-five death rate was 18. In households where women had no formal education at all, the rate was an astounding 105. That last figure means that one out of every 10 babies born to these mothers will die before the age of five. There is a vicious cycle created in such households: Couples, aware of the high rates of child deaths in their family, will actually keep having more children to make sure they have enough surviving children.
The NDHS figures tell us it takes so little to save children's lives: more money and human resources for delivering basic services in communities and schools. Our unwillingness to invest in our children's health means many wasted lives, not just of the children who die but also of survivors who will continue to suffer from health problems later in life. They are the ones who queue up in government hospitals, or troop to radio and television stations, hoping for a dole-out. They, too, will bring the next generation of children into the world, as unprepared as their parents were. The lives of this next generation of Filipinos will again be all too short, flickering candles placed out in a storm.
posted by Dante at 3:53 AM
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