Interpreting Recent Mortality Trends Paul Smithson 20th June 2005

Overview Is the change “real”? What might have caused it? What more do we need to know?

Infant Mortality Infant mortality 68 per 1,000 live births 31% lower than estimate from TRCHS 1999 (1995-1999) New data relates to period 2000-2004

Under-5 Mortality

Interpreting the Data New estimates well outside confidence limits for TRCHS 1999. And DHS 2004/5 has much bigger sample size 10,300 hh vs 3,800 Late 1990s estimate substantiated by Census 2002, DHS 2004/5 Quality control measures instituted immediately 2004/5 Statistically, every reason to believe that a recent, steep decline in mortality has occured Note: situation might be even better for more recent period.

But is it plausible? Other data sets also show steep decline since around mid-late 1990s Dar U5MR –23% (M), -36% (F) from 1994-1996 to 2001/02 Morogoro rural –34% (M), -25% (F) Hai –23% (M), -26% (F) Up to 2003, Rufiji, Morogoro now >50% decline since 1998 Ulanga also better (but not Kilombero)

What might have caused it? New front line malaria Rx Mosquito nets / ITNs Vitamin A Breastfeeding, nutrition District health resources, planning, management Given the size of these improvements, would be surprising if impact on mortality rates was not observed!

What else do we need to know? Better understanding of what has changed and when Decompose indirect estimates from 2002 census Calculate IMR/U5MR for 0-3 years before survey – or even annual? (expect around 2000 births per year in this sample) Obtain “best fit” trend line for all this data Decompose IMR/U5MR for male,female; urban,rural; poverty quintiles etc Look at DSS data for cause-specific mortality trends

Model impact of health intervention changes How big an impact would be expected from the key changes which have taken place? How much more scope is there for improvement? What coverage rates are needed to deliver the MDGs?

Conclusion Very good news story for Tanzania. Very few countries have ever achieved mortality reductions of this size We must be doing something right! Continuous improvement needed to continue the trend Renewed attention needed for the areas showing no improvement, especially maternal health