2.1 MATERNAL, NEONATAL AND CHILD HEALTH
2.1.1 Vaccine preventable conditions
Malawi has a robust and enviable immunization programme over many years (Figure 1) and recent high coverage is confirmed in the preliminary 2010 DHS report which shows that 81% of children aged 12-23 months were fully immunized. This is an increase in coverage of 26% since the 2004 DHS. However, in 2010 the country experienced an outbreak of measles with an estimated 43,000 children requiring treatment.
Figure 1 Immunisation coverage in Malawi
High coverage, particularly of measles is required to maintain herd immunity and additional resources will therefore be required to sustain a vaccine coverage of 90 per cent and above for all antigens.
Maternity and Neonatal Care
Maternal mortality rate has decreased from 984/100,000 in 2004 to 675 /100,000 live births in 2010 with an increase in women delivering at health centres from 57.2% in 2004 to 71.5% in 2010.
Data from maternal death audits from districts has shown that sepsis and post partum Haemorrage were probably the most likely causes of death in the majority of health facility based mortality.
Unlike Child Health MDGs, Maternity MDG targets are unlikely to be met without significant additional investment to increase Emergency Obstetric Care (EmOC) access to many more pregnant women (Figure 2) and investment in family planning to reduce Total Fertility rates. Using data from the 2010 EmOC survey it is estimated that only half of the births requiring emergency care are receiving such care. Plans are in place to increase this access from 8% to 15% of births by 2016 by staffing and upgrading existing maternity units. The HSSP intends to increase operative deliveries from 4% now to 10% by 2016.
Figure 2 Trends in maternal mortality in Malawi
Currently, the neonatal mortality rate (NMR) is estimated at 33 deaths per 1,000 live births and it is higher in rural areas (34/1,000) compared to urban areas (30/1,000). It is also higher among male children (38/1,000) compared to female children (30/1,000). About 88 per cent of pregnant women are protected against tetanus.
The HSSP has included strategies to increase skilled attendant deliveries to reach the MDG target by 2015 and crucial to this is increasing the availability of trained midwives in all maternity units (Figure 3).
Figure 3 Births Attended by Skilled attendants
2.2 Family planning
The population projections using the 2008 census data reinforce the importance of scaling up interventions to meet the family planning MDG targets. The TFR is expected to remain high and only slowly fall in the next 5 years with substantial investment in additional family planning services (Figure 4).
Figure 4 Total Fertility Rate
The 2010 preliminary DHS Report confirms the slow increase in contraceptive use and the projected percentage of women aged 15-49 who use any form of contraceptive and in 2015 it is anticipated to be 55%, while the MDG target for 2015 is 65% (Figure 5). The reproductive health strategy has an ambitious target of 65% of women aged 15-49 using modern methods by 2015.
Figure 5 Contraceptive Prevalence Rate
There is significant unmet need of contraception as indicated in the preliminary 2010 DHS Report which found that 73% of women wanted to delay pregnancy or have no more children. Therefore there is need to increase the availability of family planning services to reach the 65% modern methods target using the MoH, Christian Health Association in Malawi (CHAM) and Banja La Mtsogolo (BLM) services.
