The Maternova team is reposting this compelling four-part series by Dr. Harman Boparai with the persmission from [Global Pulse](http://www.globalpost.com/dispatches/globalpost-blogs/global-pulse/india-children-dying)
BOSTON — On the second day of clinical rotations during my medical training in India in 2008, I found myself in the pediatric intensive care unit. Four-month old Dhruv lay in his bed fighting for his life with severe pneumonia. His breaths came fast and in grunts, as his rib muscles stretched in gasps from the effort. He had been brought from a nearby village and needed emergency care. We started intravenous antibiotics, but with the only two mechanical ventilators at the hospital already in use, I had to put a hand-held self-inflating bag on his face to help him breathe. He opened his eyes a few times and closed them, but after a while he seemed to breathe easier.
I went home late that night after handing over his care, and when I returned the next morning I found that the pneumonia had taken Dhruv. But was it really the pneumonia? Or was it the fact that his parents, both migrant laborers, were uneducated, poor and could not afford to bring him to the city hospital in time? Or maybe the fact that we had only two ventilators, both unavailable? And this was Punjab, one of the more affluent states in India.
Despite being hailed as an economic miracle, India’s rapid growth has failed to bring about corresponding gains in controlling child mortality. India still accounts for one-fourth of the world’s child mortality. Of the 27 million children born in India each year, nearly 2 million never make it to their fifth birthdays.
Just like Dhruv, nearly half of these children die from easily preventable causes like pneumonia and diarrhea. The heaviest burden of these deaths is borne by the poorest in the population, with wide differences among socioeconomic groups in access to, and use of, essential health services.
In my final year of medical schooling, I found myself at Massachusetts General Hospital, passing through another ICU during a rotation with the department of anesthesiology and critical care. A respiratory therapist assisted a patient in a state of the art facility, complete with modern ventilators, cardiac monitors and a web of intravenous lines, feeding tubes, suction pumps and drains. But India and the United States are worlds apart, with the US under-five mortality rate at 8 deaths per 1000 births, in comparison to 61 in India. According to The World Bank, the United States spends more than $8,500 per capita on health care — more than any other country in the world. India spends $59.
India has managed to decrease its number of child deaths from 3 million in 1990 to 1.7 million in 2011, an annual reduction rate of almost 3 percent. But even at this rate, India is not on course to meet Millennium Development Goal 4, which aims to reduce child deaths by two-thirds from 1990 levels. Further, the numbers hide major inequities among the urban and rural populations and the fact that most of these deaths are concentrated in the lowest economic quintiles.
With this in mind, I travel from New York to India to report on what is being done on the ground to tackle the problem and to talk to the families who bear the real cost of losing these children. I will travel to the central state of Madhya Pradesh, to the district of Panna. Famous for its diamond mines and its tiger reserve, Panna also has the unenviable distinction of having among the highest child mortality rates in the country; out of every 1,000 live births, 140 children die. The fact remains that most of these lives can be saved with vaccines, adequate nutrition and basic medical and maternal care.
Please join me as I journey to the heartland of India, to get to the root of the issues that are deciding the fate of its children.
World Pulse Editor's Note: This is the first in a series of posts about child health in India, where, in 2011, 1.7 million children under the age of 5 died. Health reporting fellow Harman Boparai travels to India, where he once practiced as a physician, to take a deeper look at child health in his home country. "A Doctor's Notes" is part of a GlobalPost Special Report titled "The Seven Million," about the many challenges faced worldwide in an effort to reduce child mortality. http://www.globalpost.com/dispatches/globalpost-blogs/global-pulse/india-children-dying
Note that a later post in this four part series will follow the newborn twins, Pooja 1 and Pooja 2--this is their home!
Identification of anemia in pregnant women is important, since it is an important cause of multiple complications during pregnancy (preterm delivery, low birth weight and perinatal death), so it is recommended to all pregnant women, in the first prenatal visit and at 28 weeks of gestation, the measurement of serum concentrations of hemoglobin and hematocrit as a screening test for anemia.
Prenatal assessment seeks to identify, through clinical history, sociodemographic characteristics, mean blood pressure, Doppler of the uterine arteries and biochemical markers such as pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PlGF), those women who are at high risk of developing preeclampsia in order to take appropriate measures. that can help reduce that risk.