Poverty and Human Development Report 2009 - UNDP in Tanzania

CLUSTER II- GOAL 2
Ghana (Edmond et al., 2006) found a four-fold increase in neonatal death associated with nonexclusive
breastfeeding in the first month and a 2.4-fold increase in risk due to late initiation of
breastfeeding. The study concluded that 22% of neonatal deaths in Ghana could be averted if
all newborns commenced breastfeeding in the first hour. Another study on Zanzibar documents
the relationship between malaria infection, anaemia, stunting and cognitive development.
In Zanzibari children aged 5-19 months, higher malaria parasite density was associated with
anaemia and with stunting, while height-for-age significantly predicted better motor and language
development (Olney et al., 2009).
Tanzania will not achieve the MKUKUTA target for reduction in prevalence of stunting in underfives
to 20%, unless effective nutrition interventions are vigorously scaled up; a conclusion shared
by a recent national nutrition review (Tanzania Food and Nutrition Centre (TFNC) et al., 2007). The
key window for scaled-up interventions will be strengthening nutrition during the first two years
of life, and the health sector will need to play a leading role in delivering the interventions that
impact malnutrition in this age group – in particular, maternal nutrition, malaria prevention, and
promotion of breastfeeding/safe weaning practices.
Maternal Health
The TDHS 2004/05 survey estimated the maternal mortality ratio (MMR) at 578 per 100,000
live births which is equivalent to more than one maternal death in Tanzania every hour. 38 The
previous survey estimate of 529 per 100,000 live births in 1996 indicates that maternal mortality
has remained exceedingly high over the past decade with no improvement.
In the absence of frequent estimates of maternal mortality, MKUKUTA monitors a second
indicator – proportion of births attended by skilled health workers – to assess progress in the
provision of maternal health services. In 2004/05, skilled birth attendance was estimated at 46%,
up only slightly from 44% in 1999, indicating little improvement in the provision of maternal health
services. The level of skilled birth attendance in Tanzania corresponds closely to the proportion
of births taking place in a health facility. In 2004/05, 47% of births took place in a health facility.
Routine data from health facilities provide a slightly higher estimate of births occurring in health
facilities; 853,000 institutional births were recorded in 2007 representing 53% of the 1,600,000
births expected that year. However, given known weaknesses in routine data monitoring systems,
it would be premature to draw a conclusion without confirmation of this trend by survey data.
Access to institutional delivery/skilled birth attendance varies widely among population subgroups.
Rural women are much less likely than their urban counterparts to deliver at a health
facility. Disparities according to household wealth status or educational attainment of the mother
are even more pronounced (Table 14).
38 Given the need for large sample sizes to accurately estimate maternal mortality, the TDHS 2004/05 calculated
the MMR based on maternal deaths occurring in the ten-year period prior to the survey.
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