EARLY CHILD HEALTH IN LAHORE, PAKISTAN .9. PERINATAL EVENTS

In Pakistan there are a number of acute problems related to maternal a nd infant health in the perinatal period. There is also lack of reliab le data needed for the formulation of action strategies. To provide a database 1490 women have been followed from the 5th month of pregnancy in four different areas at various levels of urbanization and socio-e conomic development. After adjusting for gestational age, the proporti on of newborns with weight for length < -2SDS in relation to the Swedi sh National Standard was 12-31 % for boys and 12-25 % for girls, the f igure being highest in the most deprived area. Preterm birth was infre quent compared with IUGR. The overall prevalence rate of birth defects was 21 % out of which 8 % were severe defects. The overall perinatal mortality rate was 56/1000 births, with rates of 60, 75, 36 and 33/100 0 births for the village, periurban slum, urban slum and the upper mid dle class. Two thirds of the deaths were related to either a continuat ion of intrauterine disturbances or severe congenital defects incompat ible with life. One third of the deaths were due to infection; mostly diarrhoea, clinical sepsis and ARI. Neonatal mortality was significant ly related to birth length ( < -2SDS, odds ratio 5.5) and length of ge station ( < 37 weeks, odds ratio 5.6) and was to a lesser extent relat ed to weight (< -2SDS, odds ratio 2.0) and weight for length (< -2SDS, odds ratio 1.3). Forty percent of the mothers had weight for height b elow -2SDS, 23-35 % had height < -2SDS. Forty percent of mothers from a subset within the cohort had a hemoglobin < 10 gm/dl and 20 % showed signs of pre-eclampsia. This presentation raises the issue of expandi ng the current Child Survival Programs into the perinatal period as we ll.