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 Reduce Child Mortality - Goal 4
One of the indicators of the health state of a nation relates to under-five mortality. However this indicator has been increasing since 1997. Under-five mortality between 1997 and 2000 deaths increased rom 106 per 1 000 live births to 122 per 1000 and stabilized at 120 per 1 000 in 2006.
Similarly, malnutrition amongst under-fives is estimated to be 39 percent, causing stuntedness and underweight prevalence estimated to be 10 percent. 47 percent of deaths are HIV and AIDS related. Infant mortality increased from 78 per 1000 live births in 1997, to 87.7 per 1000 in 2000 and stabilized at 85 per 1000 in 2006. Stabilization of infant and under-five mortality rates is expected to continue as the up-take on the Prevention of Mother to Child Transmission intervention increases. Nonetheless, the rate of increase between 2000 and 2006 was not so pronounced. On the other hand, malnutrition amongst under fives is estimated to be 39%, resulting in stuntedness and underweight prevalence estimated to be 10%.
The cause of deaths in 47% of cases is related to HIV/AIDS.
The refocus of government efforts towards the provision of safe drinking water and sanitation will also act as a contributing factor towards reducing child mortality. It is estimated that only 36% of households had access to clean safe water in the country during the dry season and as such the likelihood of children suffering from diarrhea increased by 32%. Prevalence of under weight children due to malnutrition has reduced between the period 2000 and 2006 from 10% to 7.4%. Prevention prograrmmes such as measles immunization coverage had been declining from 94% in 2003 to 60% in 2005. However an increase in immunization coverage was recorded in 2005 from 60% in 2006 to 82% in 2006.
There are promising signs in other areas. A national immunization campaign reached a signigicant coverage of children age between 9 - 59 months of 91.3%. The immunization programme has a high utilization rate on static facilities of over 80%. Despite the stable picture of infant mortality a further reduction of infant mortality will be achieved through significant gains in the national HIV/AIDS response, food security and improvement of access to safe water and sanitation.
The trend has increased confidence that Swaziland has potential in achieving MDG 4. However the recurrent incidence of drought and food shortages make under fives very vulnerable thus mortality likely to increase.
At another level, the quality of reproductive health care services is the major determinant for maternal and child health. Maternal mortality continues to be a major problem in Swaziland. The probability of life being at risk every time a Swazi woman becomes pregnant was estimated to be 1 in 69 in 2003. The maternal mortality ratio were estimated to be 229 deaths per 100 000 live births in 1997, rising steadily to 370 per 100 000 live births in 2005. The continuous increase in maternal mortality rate is associated with the rapid spread of the HIV and AIDS epidemic and limitations of the health system. Further, the health system faces several limitations which include shortage of adequately skilled nurse-midwives and doctors for maternal care, poorly equipped maternity units and the non-functionality of the referral system.
Lastly, there are several systemic challenges that contribute to the weak health system in Swaziland. Generally, the health workforce is inadequate in terms of both numbers and specialisations. There is also a high attrition rate of health personnel. Moreover, there is an urban bias in the distribution of health personnel, thus, rendering the more rural populations inadequately covered. The Doctor and nurse to population ratios are also too high. There are also weak regulatory structures for the health system, a phenomenon that compromises quality assurance and standards. Procurement and supply management system for the health sector also suffers from systemic challenges. There is also limited access to family planning and reproductive health. Major human development challenges have also been brought about by HIV and AIDS. These factors have resulted in serious shortfalls in the country’s health service delivery system and have, consequently, affected human welfare and development.
Government of Swaziland, Final Progress report on the achievement of the Millennium Development Goals, Ministry of economic planning and development, Swaziland government, Mbabane, September, 2007
Government of Swaziland, Final Progress report on the achievement of the Millennium Development Goals, Ministry of economic planning and development, Swaziland government, Mbabane, September, 2007
For latest news regarding this goal, visit WHO and UNICEF
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