Analytical summary - Child and adolescent health
Infant mortality declined from 71 deaths per 1,000 live births in 1980 to 45 in 2006. The same trend is observed in the under-five mortality rate, which is 61 deaths per 1,000 live births. (Inter-Agency Child Mortality Estimation Group (IACMEG), 2009; MoHSS and Macro, August 2008). Although acute respiratory infections are among the leading causes of morbidity and mortality in children under-five, not enough has been done to improve the management of acute respiratory infections.
The MOHSS essential indicators report of 2006/07 show that diarrhoea (29%), pneumonia (29%) and HIV/AIDS (8%) are the major causes of infant mortality. The same three conditions are the leading cause of child mortality (age 1 to under5 years) with diarrhoea causing 35% of reported deaths and pneumonia and HIV/AIDS causing 24% and 8% of reported deaths respectively. The high prevalence of diarrhoea is largely due to poor sanitation and hygiene practices especially in some regions such as Caprivi, Kavango and Ohangwena. Community based treatment for pneumonia has not yet been introduced in Namibia. (MoHSS, 2008)
Concerns around adolescent health focus on STIs (including HIV), alcohol and substance abuse, and mental health, but specific data is lacking.
The nutritional condition of children in Namibia is poor. Almost 30% of children are stunted. This is a marked increase from 2000, where the number of stunted children was just higher than 20%. Of children born during 2006/ 2007, 14% had a low birth weight. This indicates that a significant number of women suffer of insufficient calorie intake, or have pregnancy related complications that condition foetus development. (WHO, 2011)
Trends in coverage of health interventions for newborns and children under-five suggest that it has been on the increase since 1992, except for initiation of breastfeeding within one hour after birth; and the treatment with anti-malarial drugs amongst under-five year olds. For both interventions, coverage has gone down since 2000 (MoHSS and Macro, August 2008; MoHSS, 1992; MoHSS, 2000).6
During 2006, almost 70% of children received all required vaccinations, representing a marked improvement on 1992 (75.7%), and 2000 (80.4%). (MoHSS, 1992; MoHSS, 2000; MoHSS and Macro, August 2008) The coverage of measles vaccination was at 83.8%. Although this shows good immunisation coverage, there is a marked variance between regions. The lowest vaccination coverage is in Kunene and Caprivi regions, where only 35.3% and 47.7% respectively of children aged 12-23 months of age have been fully vaccinated. Omusati (81%), Erongo (76.3%) and Khomas (75.5%) on the other hand exhibit higher coverage. (MoHSS and Macro, August 2008)
During 2006/ 2007, 12% of under-fives slept under a mosquito net, of which 11% of nets were treated with insecticides. Use of bed nets vary according to the region. In the Caprivi Region where malaria is endemic, about 48% of children slept under a net, while in the Erongo Region less than 1% made use of a net. (MoHSS and Macro, August 2008) Infants and under-five year old children are particularly susceptible to this disease, with severe anaemia and even death as a consequence.
Every day more than 10,000 newborn die mostly because pregnant women do not have access to skilled emergency care. A 2005/06 survey of all hospitals found that only four out of 34 hospitals provided comprehensive EmOC. (MoHSS and Macro, August 2008)
During 2006, of an approximate 1,200 neonatal deaths it has been estimated that nearly three quarters of deaths were due to preterm births (39%), followed by birth asphyxia to which 25% of babies succumbed. Lastly, 9% of deaths can be related to congenital anomalies. A further 19% of neonatal deaths were caused by infections, especially pneumonia and sepsis, neonatal tetanus and diarrhoea. (WHO, 2008)
Child health is mainly based on immunization, micronutrient supplements, diagnosis and management of common diseases among infants and children such as diarrhoea, malaria and pneumonia. (MoHSS, July 2010)
Of children younger than five years, about 56% were taken to a hospital where 15% of children received treatment in the form of antibiotics, and 10% received anti-malarials. In cases of diarrhoea, 73% of under-five year old children received increased fluids or oral rehydration therapy. (MoHSS and Macro, August 2008) Growth monitoring is also an important part of child health. Infant and child care is organized and delivered through the package of Integrated Management of Newborn and Childhood Illness (IMNCI), which has achieved a high coverage. (MoHSS, July 2010)
Inequities exist between regions in the coverage of immunisation and EmOC services, as well as the distribution of newborn and infant mortality rates. The main policies governing child and adolescent health in Namibia are the National Policy on Infant and Young Child Feeding, 2007 and the National Policy for Reproductive Health, 2001.
Despite rising maternal and child mortality rates, reproductive health (RH) expenditures have gone down, from N$582.9 million or US$ 65 million (12.4 percent of THE) in 2007/08, to N$508 million or US$57 million (10.3 percent of THE) in 2008/09. To achieve the Millennium Development Goals for child and maternal mortality, Namibia has developed a Reproductive Health Roadmap, which is estimated to cost US$717.2 million or N$6.4 billion over five years (2009–2014). RH spending would need to rise sharply from its current level if Namibia is to follow this strategy. (MoHSS, December 2010)
A wide range of newborn and child health indicators are surveyed in regular NDHSs. In April 2010, Guidelines for Completing the Maternal & Peri/Neonatal Death Review Form was produced in order to facilitate the investigation of maternal, peri-natal and neonatal deaths within health facilities (MoHSS, April 2010).