Shahamah Ahmed ( Child Life Foundation, Karachi, Pakistan. )
Madam, neonatal mortality in Pakistan i.e. babies within first twenty-eight days of life, is 49 per 1000 live births. Moreover, Pakistan contributes to 7% of global neonatal deaths.1 Cause of mortality may be infection, intra-partum complications, prematurity or congenital birth defects but there is one thing common: most of them occur in rural populations due to lack of access to health care facilities.2
With recent advances tele-medicine has proved to be a milestone in medicine, especially in underdeveloped rural areas. According to World Health Organization (WHO), Telemedicine is defined as the affordable use of Information and Communication Technology (ICT) for provision of health facilities and care.3
A study done in Karachi in early 2020 by Ashfaq A et al. showed average knowledge of Telemedicine among clinicians and junior doctors, but we are still hopeful that since after the global pandemic of COVID-19, not just this knowledge has improved but also perceptions regarding Telemedicine should have changed.4 In another study done in China by Makkar A. et al. they demonstrated the role of Tele-medicine in tele-rounds of NICU and successful e-examinations of Retinopathy of prematurity, tele-echocardiography, tele-NPR guidance to healthcare providers and family support. Moreover, parents and attendants can be guided and trained to provide home based care to preterm and low birth weight babies including establishment of enteral feeding.5
With a global shortage of physicians worldwide, the lack of neonatologists is a major reason of neonatal referrals from rural areas, and Telemedicine can give promising results in this regard. It can not only prevent unnecessary ambulation of tiny patients but also improve survival and quality care. Though under the umbrella of private NGOs, Telemedicine is being started for satellite centres in few regions of the country but obviously it doesn't cover the majority of population. It is high time to realize the importance of Telemedicine in periphery care setups. Though the provision of equipment, instalments of high- quality ICT and infrastructure might seem a barrier in the establishment of Telemedicine but it can bring revolutionary improvement in neonatal care. It can help reduce over burdening to tertiary care hospitals avoid hazards and cost of patient transfer.
Disclaimer: None to declare.
Conflict of Interest: None to declare.
Founding Source: None to declare.
1. United Nations Inter-Agency Group for Child Mortality Estimation Levels and trends in child mortality: Report 2019. New York: UNICEF, 2019.
2. Duby J, Pell LG, Ariff S, Khan A, Bhutta A, Farrar DS, et al. Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan. Global Health Action. 2020; 13:1802952.
3. World Health Organization. Telemedicine: opportunities and developments in member states. Report on the second global survey on eHealth. Geneva: World Health Organization, 2010.
4. Ashfaq A, Memon SF, Zehra A, Barry S, Jawed H, Akhtar M, et al. Knowledge and Attitude Regarding Telemedicine Among Doctors in Karachi. Cureus. 2020; 12:e6927.
5. Makkar A, Siatkowski RM, Szyld E, Ganguly A, Sekar K. Scope of telemedicine in neonatology. Zhongguo Dang dai Er Ke Za Zhi. 2020; 22:396-408.