MDG 4 -MALDIVES
MDG 4: REDUCE CHILD MORTALITIY RATE
Maldives has done a commendable job in reducing child mortality rate over the last ten years. The less than five mortality rate was 48 per 1000 live births in 1990. Thus, Maldives needs to bring the child mortality rate down to 16 per 1,000 live births by 2015. By the end of 2005, the reported child mortality rate decreased to the required target of 16 per 1000 live births. However, child mortality increased to 18 per 1000 live births in 2006 and it is not yet advisable to conclude that Maldives has fully achieved MDG 4.
In the last five years the child mortality rates have been fluctuating. In the year 2004 there was an increased child mortality compared to 2003, while 2006 again showed a slight increase from 2005. In 2004, 21 percent of the under five mortality that year was due to the tsunami.
It is also noted that there is almost no difference between the rural population and the urban (Malé) population as well as between the sexes. It is highly likely that goal will be met for both the urban and rural populations.
The main contributory factor for such achievement in reducing child mortality is the reduction in infant mortality. The infant mortality rate which stood at 34 per 1,000 live births in 1990 has been reduced to 16 per 1,000 live births by the year 2006. What is important is that, this trend has continued for both the rural and urban populations as well as the sexes. Though the figures do not indicate a vast difference. Infant mortality was reduced primarily through the reduction of neonatal mortality. the gap between child mortality and infant mortality as well as infant mortality and neonatal mortality is gradually decreasing .
CLOSE TO UNIVERSAL VACCINATION FOR Expanded Programme on Immumunization (EPI)
The Maldives have maintained close to universal vaccination for EPI vaccines over the years and has one of the highest vaccine coverage within the South Asia region. Interestingly and importantly, the country has attained self procurement of all EPI vaccines thus further strengthening the immunization programme.
According to the Multiple Indicator Cluster Survey conducted in year 2001, it was shown that the Maldives has achieved close to universal coverage for vaccines in the EPI programme. For measles, the total coverage stands at 92.4 percent with 91.7 percent coverage for males and 93.2 percent coverage for females. The full immunisation coverage stands at 85.4 percent for the country.
QUALITY OF DATA ON CHILD MORTALITY SHOWS
Independent estimates of infant mortality made from past censuses show a much higher rate than the vital registrations system (VRS). Though indirect estimations tend to over report whereas direct estimations usually have some under reporting. The VRS though is the only source of data available to show a time trend in mortality patterns.
Many interventions to improve the VRS system have been made in the last few years and a number of new control measures have been put in place. As can be seen from Census data, the estimations of Infant Mortality Rate are much higher during 1990 and 1995 than the routine reporting.
The strategies implemented by the health sector have worked efficiently within the last 15 years to bring the progress in reducing child mortality.
- Data discrepancies.
- An extensive independent assessment of the vital registrations system is needed to further improve and enhance the system. Maintenance of the current high rate of vaccination and introduction of new vaccines into the EPI programme is necessary to sustain the low rate of child mortality.
3. Monitoring and surveillance of Expanded Programme on Immumunization target diseases has to be maintained and strengthened further.
4. Furthermore, independent external reviews should be undertaken to assess the EPI programme.
5. Prevention and appropriate management of emerging diseases such as dengue is also critical to reduce child mortality.
6. Intervention to improve neonatal care at all levels of the health service is required to address the current challenge in reducing neonatal mortality. However, since such interventions require modern medical equipment and specialised nursing and other paramedic care, the challenge really lies in the feasibility of such interventions.
- TARGET FOR REDUCING MATERNAL MORTALITY IS ON TRACK
Maternal Mortality Ratio (MMR may have reduced significantly from around 500 per 100,000 live births in 1990 to 69 per 100,000 live births in 2006, reliable data are available starting year 1997 when maternal death audits were introduced in the Maldives. Hence, 1997 is taken as the baseline year for this target. Given that the reported MMR for 1997 is 258.73 per 100,000 live births, and by 2006 it has reduced to 69 per 100,000, the target for reducing maternal mortality is in process. Based on the 1997 baseline, the target for reduction in MMR is 64.5 per 100,000 live births. The Health Master Plan 2006 to 2015 sets targets to reduce the absolute number of maternal deaths per year. Proportion of births attended by skilled personnel is an indicator where the baseline data is not available. The Multiple Indicator Cluster Survey (MoH 2001) presents some reliable baseline statistics for this indicator. In 2001, 48 percent of the deliveries were conducted by doctors and 22 percent by nurses.