Nepal's childhood mortality falls by half as vaccinations rise tenfold



Nepal, one of Asia's poorest countries, has been taking hard knocks in recent years, struggling with a Maoist rebellion since 1996, and facing the appalling slaughter of many of its royal family by one of its own members in June 2001. But a delighted Sarat Singh Bhandari, Nepalese Minister for Health, recently reported significant health improvements in the country.

From 1980 to 2000 mortality in under five-year-olds fell by 55% (to 110 deaths of children 0–4 years old per 1000 births), said Bhandari; infant mortality has dropped by 33% (to 76 deaths per 1000 births) and fertility by 26% (to 4.7 children per woman).

The population still managed to more than double — from 15 million in 1980 to 37 million in 2000 — but it would have risen further if it had not been for a steady rise in the use of modern contraceptives by married women, from just 7% of such women in 1981 to 35% in 2001. The drop in child mortality is linked to the massive increase in the proportion of 12–23 month-old Nepalese children fully immunized against diphtheria, pertussis and tetanus: a rise to 80% in the year 2000, from just 8% 20 years ago.

These were some of the encouraging conclusions of Nepal's new Demographic and Health Survey, said the minister, speaking at the launching ce- remony for the Survey in Kathmandhu. Rebecca Rohrer, Director of the Health and Family Planning Unit of USAID, which funded the survey, said that Nepal has led the way in South Asia in improving demographic and health indicators in the last five years.

Some professionals working in the health sector, however, are not so confident, at a time when all growth indicators in Nepal are pointing downward. "The system could have improved further with better public–private partnership," claims Badri Raj Pandey, a senior health professional who has worked as Director of Bir Hospital, the largest hospital in Nepal, and Vice-President of Family Planning Association of Nepal (FPAN).

There is certainly still a great deal to do. Pandey points out that most Nepalese women deliver their babies at home without any medical aid or birth attendant. And cultural taboos are so strongly rooted in the rural areas of far western Nepal that menstruating women and those delivering babies still have to live outside the home in a shed, and fend for themselves. The maternal mortality rate in Nepal was 539 per 100 000 live births in 1996, according to USAID figures.

However Ms Pancha Kumari Manandhar, a consultant at Health and Family Planning Unit of USAID, is confident that the trends shown by the Demographic and Health Survey are correct, that Nepal has really achieved a lot in the health and family planning sector over the years despite all the problems that the country has been facing, and that the trends are in the right direction.

Credit is due in part, she says, to the massive public awareness of health issues created by information and communication campaigns, launched by the government and other health-related agencies, through the national radio network, regional community broadcasting and local FM stations, television as well as traditional and non-traditional channels of communication. Nepal is considered a leader in community broadcasting and FM networks in South Asia, she said.

"But there are still strong cultural taboos. The results would have been better if all those women and children who wanted to take advantage of the health services could really travel freely from their homes to the health centres," added Ms Manandhar.

Prakash Khanal, Kathmandu



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