Mortality

Mortality Rates

Many factors contribute to high child mortality. These factors include poverty, malnutrition among children and mothers, food insecurity, lack of access to safe water and improved sanitation, poor housing, low coverage of immunization programmes, limited access to preventive and curative healthcare services and lack of awareness of good childcare and hygiene practices at the family level.

Estimates from the UNDP, World Bank and the recent WFP surveys all indicate significant reductions in both under-five and infant mortality rates. The children under-five mortality rate is estimated at 86 per 1,000 live births in 2005, compared with 124 per 1,000 in 1998 (WB, 2007). The UNDP Millennium Development Goal (MDG) target for 2005 was 105. Similarly, the infant mortality rate is estimated at 68 per 1,000 live births in 2005, better than the target of 75 and the 1998 rate of 80 (WB, 2007).

The below tables (based on data from the CDHS surveys of 2000 and 2005) depict the rapid progress achieved in improving mortality rates for 2000 – 2005 in Cambodia. It should be noted that figures for mortality from the CDHS, UNDP and World Bank all differ albeit only slightly. Owing to this, these figures should be treated with caution due to different survey methods and questions used, nevertheless they are indicative of considerable improvement.

Figure 5.6: Trends in infant mortality

Source: CDHS 2000, 2005

Figure 5.7: Trends in Under five Mortality

Source: CDHS 2000, 2005

The rapid improvement in under-five and infant mortality, in the absence of considerable improvement in the living standards of the majority of the population, presents a paradox. One possible explanation is the rapid fertility decline in recent years. According to the UNDP evidence from other countries with high child mortality and low socio-economic development show similar rapid declines in child mortality with decline in fertility. However it is usually found that the initial positive impact of fertility decline is not enough to sustain continued improvement in child mortality.

The decline in child mortality rates is almost certainly liked to the increase in immunization coverage for the same period. The proportion of children under one year old immunized against DPT3 rapidly increased from 43 percent in 2000 to 83 percent in 2005, surpassing its target of 80 percent while the target for immunization against measles was also achieved, increasing from 41 percent in 2000 to 80 percent in 2005 (UNDP, 2005). Further, the period 1998 – 2000 also saw an increase in child-care and breastfeeding practices (with more mothers opting to feed their child). Because mother’s milk is the best way to protect babies from later infection by giving them solid immunity, infants are much more likely to remain in good health and mortality is reduced if exclusive breastfeeding is sustained. The proportion of mothers who start breastfeeding a newborn child within one hour of birth increased from 11 percent in 2000 to more than 29 percent in 2005 surpassing the MDG target of 28 percent (UNDP, 2005).

As mentioned above the present successes gained in combating mortality is liked to a decline in fertility. According to a 2005 National Institute of Statistics report, fertility rates in Cambodia will continue to gradually decline for the next decade before stabilizing.  Nevertheless in spite of a rapid and substantial initial fall in under-five mortality, further declines will be possible only through efficient disease control programs, the development of an efficient and accessible health infrastructure and most pertinently by improving the living standards of large proportions of the population, who live in an environment in which the major diseases, such as diarrhea and infections of the respiratory system, flourish.

Figure 5.8 Projection of TFR, 1950 - 2050