Maternal and Child Health Are Improving, According to a Recent Demographic and Health Survey

On Wednesday, April 6, 2005, the Minister of Economy, Finance and Budget, Mr. Benjamin Andriamparany Radavidson, Minister of Health and Family Planning of Madagascar, Dr. Robinson JEAN-LOUIS, and the Managing Director of the National Statistical Institute, Jean Razafindravonona, joined the Director General of the United States Agency for International Development (USAID), Mr. Stephen Haykin, and the donors representatives including UNICEF, World Bank, UNFPA, at the launch and dissemination of the 2003-2004 Madagascar Demographic and Health Survey (DHS) report.

The DHS project is a global data collection effort initiated by USAID. It is a survey of households that collect data on demographic patterns, fertility, health, and nutrition to be used for policy and program planning. The 2003-2004 survey is the third DHS to be implemented in Madagascar, the first one took place in 1992 and the second in 1997, thus allowing for a useful trends analysis of the data.

According to today's newly released findings, the health of mothers and children in Madagascar has greatly improved since the last survey, in particular on issues related to family planning, vaccination rates, breast-feeding, and vitamin A supplementation. Data also show that Madagascar has been performing particularly well when compared to a number of other countries in the region.

Women have on average 5.2 children, down from 6 in 1997. This is in good part due to an increase in knowledge and use of modern methods of contraception, particularly in rural areas where current modern use rose from 7 percent in 1997 to 16 percent in 2003-2004. Together, 18 percent of women in union now use a modern method, roughly the same as in Tanzania (1999), Uganda (2001) and Ghana (2003). Injectables (10 percent) and the pill (3 percent) are the most popular methods. Periodic abstinence is practiced by 8 percent of women.

Another area showing significant improvements is child health. Full vaccination coverage increased from 36 percent of children 12-23 months in 1997 to 53 percent in 2003-2004. Treatment of diarrhea through the use of oral rehydration salts or of a homemade rehydration solution has almost doubled since the 1997 survey and now reaches 43 percent of children under 5.

Data on nutrition show net gains since 1997. Sixty-seven percent of women now start breastfeeding within one hour of birth, almost twice the proportion found in 1997. As for exclusive breastfeeding for children under 6 months, it has increased from 48 percent in 1997 to 67 percent in 2003-2004. Supplementation of Vitamin A reaches 76 percent of children, compared to only 4 percent of women who said, in 1997, that their children had received a Vitamin A supplement.

Undernutrition still represents a major challenge for Madagascar authorities as almost half the children under 3 are stunted (too short for their age) and 14 percent are wasted (too thin for their height), a sign of acute malnutrition.

Biological testing ( biomarkers ) was implemented for four health conditions: to measure the prevalence of anemia and syphilis and to assess the immunity level of women and children against tetanus and the immunity level of children against measles. Results show that 7 in 10 children 6-59 months suffer from some level of anemia and nearly half the women age 15-49. Four percent of men and women have active syphilis. Three women in five are completely immunized (for a period of at least 10 years) against tetanus, compared to 53 percent of children. Sixty-three percent of children are immunized against measles.

It was the first time that men were interviewed in a DHS survey carried out in Madagascar. As the Minister of Economy, Finances and Budget wrote in the introduction of the final report:

“Despite the burden of the operation made even more difficult with the passage of the cyclones Elita and Gafilo, this survey has been completed within just a week of the planned completion date”

The 2003-2004 Madagascar DHS is based on interviews with 7,949 women, age 15 to 49, and 2,432 men, age 15 to 59, from the six provinces of the country. The Direction de la Démographie et des Statistiques Sociales (DDSS) [Directorate of Demography and Social Statistics] of the Institut National de la Statistique (INSTAT) [National Statistical Institute] carried out the survey with technical support from ORC Macro through the MEASURE DHS + project. Funding was provided by the World Bank through its projects: the Programme Multisectoriel pour la Prévention du Sida (PMPS) [Multisectoral Program for the Prevention of AIDS], CRESAN 2, and SEECALINE; the United Nations Children's Fund (UNICEF); the United Nations Fund for Population Activities (UNFPA); and the U.S. Agency for International Development (USAID).