Mortality rates have increased since the late 1990s, largely as the impact of HIV and AIDS rolled back earlier progress.
Botswana is one of the countries hardest hit by HIV in the world. By 2008 HIV prevalence was estimated at 17.6 % in the general population. The rollout of the government’s Prevention of Mother-to-Child Transmission (PMTCT) programme has reduced the chances of transmission from an HIV positive mother to her child from over 40% without PMTCT, to currently under 4%.
Besides, HIV, children born in Botswana today are more likely than ever to escape or overcome the preventable illnesses that threaten their health and survival. Over 90 per cent are being vaccinated against the most deadly diseases; a reported 97 per cent of mothers and babies are receiving essential care after delivery; 90 per cent of births are assisted by a trained attendant; and 89 per cent of HIV-positive mothers receive information and services to help prevent HIV transmission to their newborn.
There are numerous and tangible successes. However, important challenges remain to be addressed. While a high percentage of women and children are receiving services, the quality of those services is not consistent. As well, there are some services that are not fully utilised. For instance, only 14 per cent of children with pneumonia are taken to an appropriate health care provider and only 7 per cent of children receive fluids and continue feeding when having diarrhoea. In 2007, only 47 per cent of children aged 12-23 months received their first dose of Vitamin A and only 20 per cent received a second dose. In the same year, only 12 per cent of children under-five and 9 per cent of pregnant women in three malaria endemic districts used Insecticide Treated Nets (ITNs) to protect themselves against malaria.
Since 2009, with the implementation of the national Strategic Plan for Accelerated Child Survival and Development, we have seen significant progress. Through Vitamin A campaigns, coverage has now reached over 100% in 2010 and, in selected areas, new strategies to promote bed nets have achieved coverage rates of 91% and usage rates for children under-five of 39%.