Journal of tropical pediatrics
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To describe the perspectives of pediatricians from a tertiary care center from India on end-of-life (EOL) care issues, a standardized anonymous questionnaire was administered, which included questions regarding attitudes towards withdrawal/withholding of life-sustaining treatment in children and neonates at the EOL, and responses to an EOL case scenario. The questionnaire was administered to 40 pediatricians, of whom 31 (22 males, mean age 34.5 +/- 7.7 years) responded. ⋯ The most common modes of life-support limitation practiced were withholding new treatments (17/31; 54.8%) and 'do-not-resuscitate orders' (14/31; 45.2%). 51.6% respondents believed that withholding treatment and withdrawal of support were ethically the same. There is wide variation in responses and there were significant differences from findings of similar studies from the developed countries, the most important being the complete lack of use of withdrawal of support.
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Demographic and Health Surveys conducted quinquennially in 1996, 2001 and 2006 show that infant, child and under-five mortality in Nepal have declined steadily at least over the past 25 years. Estimates based on exponential-decline regression curves fitted to the 15-year data immediately preceding each survey, aggregated by 5-year period, show the infant, child and under-five mortality rates for the period 1986-1990 to be 106, 58 and 158 per 1000 live births and 52, 17 and 67 per 1000 live births for 2001-2005, respectively. The projected rates, assuming that the policy and program efforts are sustained, for the period 2011-2015 are 32, 7 and 38 per 1000 live births. Nepal is most likely to achieve the Millennium Development Goals (MDG) target of a two-thirds reduction in child mortality by 2015, the end of the MDG countdown.