Mangochi-ICEIDA-Partnership-in-Public-Health-2012-2016-Part-II ...

MANGOCHI ICEIDA PARTNERSHIP IN PUBLIC HEALTH – PROGRAMME DOCUMENT 2012-2016
76.4% of children 12-23 months of age were fully immunised (national average 80.9%). The HMIS
reported 71% immunisation coverage in Mangochi (fully immunised at 1 year) for the financial year
2010/2011 (72% in 2009/2010). HSAs play a role in immunisation.
Integrated Management of Childhood Illnesses (IMCI) is another pillar of a child survival strategy. The
main causes of disease and death in young children are diarrhoea, acute respiratory infections (ARI)
and malaria. Reported scores for care seeking in childhood illnesses and for use of oral rehydration
therapy (ORS) for treatment of diarrhoea are low in Mangochi. Here again HSAs play a role, in
sensitisation and health education in the community and in early case management and referral.
Finally, child nutrition is an important component of a child survival strategy and malnutrition is both
a cause and a consequence of ill health. Mangochi scores below average in this field. The priorities
under this heading are firstly—in order to prevent malnutrition—to increase the effort in health
education within the communities. Here, HSAs and midwifes play a role. Second, the HSAs—when
they perform growth monitoring—are supposed to detect vulnerable children and refer. Early
referral to a health centre is encouraged. This activity needs to be strengthened. Not all HSAs have
received basic training in this field.
2.3.1.2. Reproductive health
Three quarters of maternal deaths occur during delivery or immediately post-partum. MICS/2006
reported a maternal mortality rate (MMR) of 807/100,000 live births but recent estimates show a
favourable trend in Malawi. According to HSSP maternal mortality rate decreased in the country by
31% from 984/100,000 live births in 2004 to 675 in 2010 with 25% increase in women delivering in
health facilities from 57.2% in 2004 to 71.5% in 2010. The main strategies in reproductive health are
family planning, antenatal care and delivery care.
2.3.1.3. Family planning
Birth spacing is an important strategy to combat high maternal and child mortality and improve the
health of both women and children. With higher prevalence of contraceptive use and lower fertility
rate there would also be less demand for MCH services and more space for improving the quality of
services which would further benefit maternal and child health.
According to MICS/2006, the education status of mothers is low: “primary education” 55% and
“none” 38%. Only 6.5% of mothers have secondary school education. Mangochi is one of the districts
in Malawi with highest experience of teenage pregnancies and motherhood, 41% of teenagers have
begun childbearing. This poses a risk for the mother (complications in childbirth are more common
resulting in higher maternal mortality), and for the child.
Close birth spacing is also a risk for child survival. Mangochi has the lowest contraceptive prevalence
rate in Malawi. MICS/2006 found that only 28% of women married or in union used contraception.
DHS/2010 found that 26.6% of women of childbearing age in Mangochi used any modern method of
contraception. HMIS reported 32% in the financial year 2010/2011. Injections are the most
commonly used method. On the ground, one of the reasons cited for the low contraceptive
prevalence rate is irregular supply of contraceptives. While a broken supply chain is undoubtedly part
of the problem, it may not be the only explanation. It is safe to say that the issue is insufficiently
explored.
2.3.1.4. Antenatal care
Minimum antenatal care is defined as four visits. Blood pressure measurement, urine testing for
bacteria and protein should be done. Blood testing for syphilis and severe anaemia and
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