1. Interpreting Recent Mortality Trends
Paul Smithson
20th June 2005

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

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

4. Under-5 Mortality

5. Interpreting the Data
New estimates well outside confidence limits for TRCHS 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.

6. But is it plausible?
Other data sets also show steep decline since around mid-late 1990s
Dar U5MR –23% (M), -36% (F) from 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)

7. 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!

8. 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

9. 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?

10. 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