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Available information shows that previous gains on the health status are being eroded by the advent of the double burden of communicable and non-communicable diseases. Such has resulted in high mortality rates in the country. The average life expectancy at birth has decreased from 58.8 years in 1997, to 43 years in 2007.
The Human Development Index (HDI) declined 0.523 in 1995 to 0.494 in 2005 and increased 0.498 in 2010. Increasing trends have been observed in the country's Crude Death Rate (CDR), Infant Mortality Rate (IMR), Under-Five Mortality Rate (U5MR) and Maternal Mortality Rate (MMR). Crude death rate per 1 000 population increased from 26.2 in 2005 to 31 in 2007(Population Census 2007). Infant Mortality (IMR) per 1 000 live births stabilised from 87 per 1000 in 2000 to 85 in 2007 (MDG Report 2010). The under-five mortality also stabilised from 122 in 2000 to 120 in 2007.
The stabilization can be explained by the focus of Government interventions on orphans and vulnerable children due to surging numbers of child-headed households. According to Black et. al. , the five major causes of child mortality in Swaziland are AIDS, which accounts for 49 per cent; pneumonia, 12 per cent; preterm birth complications, 9 per cent; diarrhoea, 8 per cent; and other infections, 7 per cent. Underlying these direct causes are a variety of complex and interrelated factors that contribute to ill health and mortality, including poverty, vulnerability, lack of education, and poor health care services.
There are no apparent differences in mortality rates between urban and rural areas. There are, however, significant regional differences as far as under-five mortality is concerned. Under-five mortality is very high in Lubombo followed by Shiselweni. It is much lower in Hhohho. Mortality rates due to vaccine preventable diseases have generally improved over the years. The mother's level of education was found to be inversely related to her child's risk of dying. Infant mortality rate was 96 per 1,000 live births to mothers with no education and 48 per 1,000 with others with tertiary education (SDHS 2007).
Malnutrition is associated with high morbidity and mortality among children under five, with almost 31% of children in the country found to be stunted (MICS 2010). Such a situation can be attributed to the high levels of poverty, income inequality, food insecurity, inadequate access to productive assets such as land; vulnerability to food shocks and dependency on food aid.
The maternal mortality ratio was estimated at 370 per 100,000 live births in 1995 (HDR, 2003), rising to 589 per 100,000 live births in 2007 (SDHS, 2007). The Maternal Death Review Audit 2001 indicated that out of 16 898 live births that occurred between January and December 2000, there were 43 maternal deaths in four regional hospitals. Direct causes of maternal deaths accounted for 48.8% of all the deaths.
There is evidence, however, that the effect of HIV/AIDS on pregnant women negatively affects the maternal mortality ratio. The overall level of HIV infection among pregnant women increased more than 10 times from 3.9 per cent in 1992 to 42 per cent in 2010 (MOH 2010). The HIV/AIDS epidemic has worsened the maternal health condition of women. Because of their low immune system, HIV-infected pregnant women are susceptible to opportunistic infections.
Communicable diseases continue to be a major challenge for the country. According to Health Statistics Reports, respiratory conditions account for about a quarter of all outpatient visits, from 26.6% in 2002 to 23.1% in 2010. The reasons for admission included pulmonary tuberculosis, HIV/AIDS, Other non-infective Gastro-enteritis and colitis, pneumonia and diabetes mellitus. Mortality was mostly caused by pulmonary tuberculosis, gastroenteritis, colitis, and pneumonia. The success of the immunization program has resulted in a dramatic decrease in the incidence of vaccine preventable diseases, namely tuberculosis, diphtheria pertussis, neonatal tetanus, poliomyelitis, measles and hepatitis B.
Tuberculosis has also become a very serious public health concern for the country, particularly given the high rates of HIV/TB co-infection. TB case notification rates has increased from 166 per 100,000 people in 2003 to 801 per 100,000 (MOH, 2010).
Malaria is endemic in selected parts of the country and is generally well managed. An analysis of the overall disease trend indicates that there has been a significant reduction in the burden of disease in the last 5 - 6 malaria transmission seasons. Between 2002 and 2007, Malaria incidence declined from 49.5 to 18 cases per 1000 of the population at risk. With this progress, Swaziland has already exceeded the MDG on malaria and Roll Back Malaria’s Abuja targets.
Table 2.1 below shows the top 20 out-patient department services rendered according to diagnosis among patients who visited any health facility in the country in 2010: