The consultant paediatrican at Mater Dei Hospital and vice-president of the Malta Paediatric Association, Paul Soler has emphasised that the interpretation of data on child deaths must be done with caution due to the fact that there exists a complex interplay of factors influencing the rate of child deaths before the fifth birthday.

These include socio-economic factors, the standard of living, cultural factors, disease prevention, health education and surveillance, among other factors.

Dr Soler, who has been instrumental in the recovery of many children who faced difficulties at birth, insisted that in Malta’s case, it is the Infant Mortality Rate (deaths in the first year of life per 1,000 live births) which accounts for the relatively elevated child death rate from 0-4 years, outlining a number of reasons, including the high prevalence of obesity.

Dr Soler was replying to questions made by this newspaper following a report published in the internationally reputable medical journal The Lancet on 2 May.

On Sunday, the Malta Independent on Sunday reported the findings on Malta, which has one of the highest death rates in Western Europe among children under the age of five. This emerged from the Institute for Health Metrics and Evaluation (IHME) in Seattle.

The report is a systematic analysis of the Global Burden of Disease Study 2013.

This newspaper asked Dr Soler if the cause of the high death rate is linked to the blanket ban on abortion or if there are other underlying factors.

While the UK’s rate is 4.9, with nearly five children dying out of every 1,000 born, Malta’s rate is 7.0.

This means that, after Malta, the UK rates the worst in terms of child deaths.

As for early neo natal deaths (in the first six days), Malta also ranked the worst, with 3.2 deaths per 1,000. The UK follows once again with 2.1, while the rate of both Ireland and Switzerland is 2.0, according to the report in The Lancet.

“The reliability of data reporting is variable as not all countries strictly use the WHO definition of “live birth”,” Dr Soler said.

“Moreover, the figures in Malta are small and a slight increase/decrease in deaths can influence rates by several points either way, he added.

Comparing Malta’s death rate for children aged one to four years to other countries in the EU, Dr Soler said that Malta’s rate compared very favourably with other EU countries while pointing out that the rate is lower than in the Netherlands, Switzerland and the UK.

Dr Soler said that Malta’s figures tally closely with those of the US which are higher than those of central Europe, reportedly due to a higher proportion of preterm deliveries and a higher incidence of maternal obesity in the US.

In 2010 Malta, for instance, congenital malformations and chromosomal abnormalities accounted for 46% of deaths in the first year of life (12/26 months).

Dr Soler exlained that countries with legalised termination of pregnancy would obviously alter this figure.

On Malta’s Infant Mortality Rate (deaths in the first year of life per 1,000 live births) which accounts for the relatively elevated child death rate from 0-4 years, he said that possible explanations for this are that in other European countries, figures for babies with congenital malformations and chromosomal abnormalities do not feature because many of these babies are terminated during pregnancy.

In Malta, termination is not practised.

But there may be other factors which have an impact on the wellbeing of the baby before birth and in the first year of life, such as “maternal obesity and an unhealthy lifestyle”.

“It is known that Malta has a relatively high prevalence of obesity when compared to the rest of the world, and maternal obesity is associated with increased risk of complications for both mother and baby,” Dr Soler said.