Nepal: Grassroots efforts help reduce child deaths

News and Press Release
Originally published
DADELDHURA, 20 May 2007 (IRIN) - Carefully holding her two-month old daughter, Nanda Devi Bohara cries with joy as she sees her breathing normally again after a doctor held a nebuliser (medicinal inhalation device) over her mouth and nose in the government hospital of the remote Dadeldhura district, nearly 700 km northwest of the capital, Kathmandu.

"She's breathing again. She's alive now," Bohara told IRIN, recounting how a local female health care volunteer (FCHV) had helped her with some available medicine before accompanying her to the nearby hospital for more treatment.

Bohara said that her daughter would not have survived if there was no FCHV in her village, where local people mostly use traditional healers to cure their sick children as they have no other choice.

Her daughter was suffering from pneumonia, a disease that contributes significantly to the high rate of child mortality in Nepal. Pneumonia, diarrhoea, under-nutrition, measles and acute respiratory infections kill nearly 65,000 children under five every year, according to UNICEF.

However, community-based efforts such as the use of FCHVs are reducing child mortality rates, say public health experts.

A recent report published by Save the Children (US) said that innovative community-based approaches to health care in Nepal are giving health workers the knowledge and tools they need to take action.

"More than half of Nepal's children under-five can now be treated for diarrhoea and pneumonia close to home - often by a carefully selected and trained female health worker in their own community," said the report, entitled State of the World's Mothers 2007. It added that parents do not have to make long, costly and often dangerous journeys to medical facilities when their children are sick.

Under-five mortality rate halved

According to the report, despite the decade-long armed conflict between 1996 and 2006, Nepal has cut its under-five mortality rate by almost half in the past 15 years.

One of the key measures in doing this has been extensive anti-measles immunisation and vitamin A national campaigns in the country - with immunisation rates increasing from 43 to 83 percent. Over 95 percent of five-month-old to five-year-old children receive at least one annual vitamin A supplement, an essential human nutrient, according to UNICEF.

"Despite all the odds against saving lives, there has been progress and there is optimism to save more if such community-based efforts are sustained," said Abhinesh Dhital, medical officer at the government-run Dadeldhura District Hospital. He said that there is such a huge shortage of staff, hospitals and clinics that it is the community workers who treat the rural populace.

"Death among children under five years old is a common occurrence and it's a tragedy that we can't still control the mortality even today," said Kalpana Swar, a community health worker in Dadeldhura.

She added that child mortality rates could soon increase during the approaching monsoon season when many children typically die of diarrhoea and pneumonia.

"We are trying our best to save children's lives and hopefully with more government and mass support, we could do more," said Saraswati Shah, who has been a health care volunteer for the past 10 years and says she has saved the lives of hundreds of children in her village.

There has been strong political will in Nepal to cut child mortality rate. According to UNICEF, the country could be successful in reaching its millennium development goal (MDG) of cutting the current 65,000 annual child deaths by two thirds.

"Although there was political disruption due to the armed conflict, health among children has improved and there was not much disruption to health services [especially relating to children]," said Robin Houston, an independent international public health expert who has been working in the country since the early 1980s.