Author: Malchinkhuu, D.
During the last decade, the government of Mongolia has developed and implemented a series of policies and actions to protect maternal and child health. As a result, the IMR (infant mortality rate) and U5MR (under-5 mortality rate) have been constantly decreasing and have reached a level that is similar to levels in countries with medium IMR and U5MR. Despite this progress, over 2,660 children under 5 years of age still die in a single year. There has not been a single nationwide survey or scientific study conducted to determine the causes as well as the biological, medical, and social factors influencing children's mortality. The need for this kind of study is the reason for doing this survey in Mongolia.
Purpose / Objective
In order to study all mortality cases of children under 1 and children under 5 from 1996 to 1998 in the country, and in order to prepare a technical basis of reviewing and reformulating national policies related to the reduction of childhood mortality, the following objectives were established for the survey:
- To develop a questionnaire, forms, and methodology using health statistics, records and reports at national, aimag, and soum levels
- To determine causes of mortality in children under 5 by their age group
- To conduct a comparative review of mortality in children under 5 by seasons
- To determine biological, medical, and social factors influencing the mortality of children under 5
- To determine the role of the implementation of public health projects like ARI, CDD, HIV/AIDS, breastfeeding, and others on the reduction of mortality in children under 5
- To prepare a technical basis for the improvement of preventive and curative services addressing the leading causes of mortality in children under 5
- To consolidate findings of the survey and to prepare a technical basis for the formulation of national policies aimed at further reduction of childhood mortality
Sample records were randomly selected from all records according to their dates of hospitalisation at aimag and soum levels (the sample covers 32.5% of all hospital mortality cases). Information from samples was recorded in questionnaires. Eighteen surveyors and seven supervisors were specially trained for data collection using this survey. The data was analysed with the EPI-Info computer program. In addition, all chief pediatricians from 21 aimags and Ulaanbaatar city have completed seven questionnaires using their health statistics records from 1996, 1997, and 1998, and these results were compared with results from the actual survey.
Key Findings and Conclusions
Within the surveyed period of 3 years, out of 149,090 live births, 7,601 died before reaching 5 years of age. The child mortality rate has decreased by 2.96% in 1997 and by 9.1% in 1998. The number of infant mortality cases per 1,000 live births has decreased every year of the survey period by 0.9 cases in 1997 and then by 4.2 cases in 1998, and the average for the three years is 36.3 cases; the number of mortality cases in children aged 1-4 per 1,000 live births has decreased by 1.8 cases in 1997 and by 6.3 cases in 1998, and the average for the three years is 51 cases.
Hospital deaths occurring within the first 24 hours of hospitalisation have increased since 1996 from 25.1% to 25.3%, but the average is 24.6% due to a notable decrease in 1997; thus, 1 out of 4 children died in a hospital. The rate of hospital deaths occurring within the first 24 hours is highest in Gobi-Sumber, Dornogobi, Khovd, Sukhbaatar, Dornod, and Bayan-Ulgii aimags.
Home deaths have increased steadily each year by 1.1% starting from 20.7% in 1996 up to 22.9% in 1998. This statistic suggests that 1 out of 5 children under 5 years of age has died at home without receiving medical assistance and service. The rate for deaths at home is highest in Bayan-Ulgii, Zavkhan, Gobi-Altai, Dundgobi, Tuv, and Bayankhongor aimags.
Of all the surveyed children, 752 (41.3%) had died due to respiratory diseases, and pneumonia accounted for 75.7% of these deaths. Pneumonia is also responsible for 31.2% of all deaths. 68.9% of the children died before one year of age, while 31.1% of deaths occurred between the ages of 1 to 4 years. Out of 569 children who died from pneumonia, 401 (30.4%) were infants, and 168 (29.5%) were 1-4 years of age.
The second major cause of under-5 mortality is diarrheal disease (with 352 cases of diarrhea without blood in stools and 13 cases with blood in stools). Of the 352 children who died from diarrhea without blood in stools, 63.3% were infants, and 36.7% were 1-4 years of age. Diarrheal disease is the third leading cause of under-1 mortality (16.9%) and is ranked second in 1-4 mortality (28.8%). Of all children who died from diarrheal diseases, 88% (310) were under 2 years of age.
The third leading cause of under-5 mortality (14.9%) and the second leading cause of under-1 mortality (20.1%) are four types of perinatal (neonatal) conditions. Among the four illnesses in this group, asphyxia and anomalies (defects) in development are the major components. In the 1-4 years age group, the third leading cause of mortality is a combination of six infectious diseases (10.4%). Cerebral and neurological diseases (5 to 7 types of diseases) rank fifth for under-5 (12.4%), under-1 (15.4%) and 1-4 (4.6%) mortality.
The growth of the child was monitored in 1,574 cases; 739 (47.0%) children had normal development, 809 (51.4%) children had low weight-for-age, 3 (0.2%) children had low height-for-age, and 24 (1.5%) children had high weight-for-age.
The mental development of children was reported in 1,239 cases; 318 (25.7%) children had mental development that was late for their age, and 24 (3.9%) children had neuropathy.
Data regarding the vaccinations of 1,555 children indicated that 1,080 (69.4%) children were satisfactorily vaccinated, 185 (11.9%) received only half of the necessary vaccinations, and 290 (18.6%) children were not vaccinated. Of the 290 unvaccinated children, 65.6% were not vaccinated because of illness, 19.8% were not vaccinated due to the fault of the parent, and 14.6% were not vaccinated due to the fault of the health worker.
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ECD - Health