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Calverton, MD - The Ministry of Health of the Republic of Mali recently released the final report for the 2006 Mali Demographic and Health Survey (EDSM-IV) in Bamako. The EDSM-IV interviewed 14,000 women ages 15 to 49 and 4,000 men ages 15 to 59. More than 8,500 of these adults were also tested for HIV. The EDSM-IV was carried out by the Cellule de Planification et de Statistique du Ministère de la Santé (CPS/MS) and by the Direction Nationale de la Statistique et de l'Informatique du Ministère de l'Economie, de l'Industrie et du Commerce (DNSI/MEIC), with technical assistance provided by Macro International and funding from a variety of national and international sources.
On the whole, results reported in the EDSM-IV are promising; however, there remain areas of little or no progress. Significant gains were made in rural areas for both maternal and child health. Immunization coverage of children ages 12 to 23 months increased markedly since 2001 as did women's use of antenatal care during pregnancy. The survey results show important reductions in morbidity and mortality but other areas, such as fertility and malnutrition rates, saw little change.
Key Findings from the final report include the following.
Child Health
Almost half of all children (48 percent) ages 12 to 23 months received all their required vaccinations compared to only 29 percent in 2001. To be fully vaccinated, it is recommended a child receive one dose of BCG vaccine, three doses each of DPT and polio vaccines, and one dose of measles vaccine. Despite the improvement, Mali's coverage falls well below the desired full coverage.
In another positive development, more and more women are correctly breastfeeding their babies. In initial breastfeeding, nearly half of all infants (46 percent) are breastfed immediately after birth, a significant increase from 32 percent in 2001. Exclusive breastfeeding, recommended during the first six months of life, is also increasing. In 2001, 25 percent of children younger than six months were exclusively breastfed whereas in 2006, 38 percent were exclusively breastfed.
Despite these improvements, malnutrition among children under age five continues to need attention. Stunting, a sign of chronic malnutrition, changed only slightly from 38 percent in 2001 to 34 percent in 2006 while the percentage of children who are underweight remained essentially unchanged, from 33 percent in 2001 to 32 percent in 2006.
Maternal Health
More women are seeking professional health care during pregnancy, delivery, and the post-partum period. Between 2001 and 2006, the percentage of women seeking antenatal care increased from 57 percent to 70 percent. The greatest improvements were seen in rural areas, where 64 percent of women in 2006 sought health care compared to 47 percent in 2001. The percentage of women receiving two or more tetanus toxoid injections to prevent neonatal tetanus also increased substantially from 32 percent in 2001 to 48 percent in 2006.
More women also received skilled assistance during delivery, up from 41 percent in 2001 to 49 percent in 2006. The percentage of women who received postnatal care in the two days following delivery more than doubled from 10 percent in 2001 to 22 percent in 2006.
Mortality
Important decreases in infant, child, and maternal mortality were noted between 2001 and 2006. Overall, there was notable progress in reducing both infant and child mortality, with infant mortality decreasing by about 15 percent between the two surveys, from 113 deaths per 1,000 to 96 deaths per 1,000. Under-five child mortality also decreased by 17 percent from 229 per 1,000 in 2001 to 191 per 1,000 in 2006. A decrease was also noted for maternal mortality, with rates dropping from 582 deaths per 100,000 live births in 2001 to 464 deaths per 100,000 live births in 2006. It should be noted that despite this overall progress, infant, child and maternal mortality rates in Mali remain some of the highest in the world.
Fertility
Mali's total fertility rate (TFR) is 6.6, one of the highest in Africa. Fertility in Mali has not declined noticeably since 1996 when the TFR was 6.7 and the highest fertility rates continue to be seen in uneducated and rural women (7.0 and 7.2 respectively). Teenage motherhood declined from 42 percent in 1996 to 36 percent in 2006. However, the percentage of women who become mothers at a young age remained high with two in five young women age 15 to 19 (36 percent) pregnant or having already given birth.
Anemia
Malnutrition continues to be a significant problem for children and women in Mali. Among children, anemia decreased slightly since 2001, but remains unacceptably high: 81percent of all children under five are anemic. Anemia also increased among women in recent years: in 2001, 63 percent of women were anemic while in 2006, that percentage rose to 68 percent.
HIV prevalence and behavior
HIV prevalence in individuals ages 15 to 49 in Mali did not change significantly between 2001 (1.7 percent) and 2006 (1.3 percent). There was little difference between those infected with either HIV-1 or HIV-2 (1.3 percent) and those infected with only HIV-1 (1.2 percent). HIV prevalence among Malian women age 15-49 (1.5 percent) continues to outpace HIV prevalence in Malian men (1 percent).
HIV prevalence is higher in urban areas and is highest in Bamako (1.9 percent). Among men, those with a secondary or higher education are most likely to be HIV positive (1.8 percent) while among women, those with a primary level education (2 percent) or no education (1.4 percent) are more likely to be infected. In findings similar to many other African countries, both men and women from wealthier households are more likely to be HIV positive.
Although 20 percent of women and 35 percent of men know where to be tested for HIV, only 7 percent and 6 percent respectively have been tested and received the results. Testing during antenatal care in Mali is even lower: only 4 percent of women who gave birth in the previous two years were counseled and tested during an antenatal care visit and received their results.
Additional information about the survey may be obtained from the Cellule de Planification et de Statistique (CPS) : B.P. 232, Bamako, Mali, Telephone (223) 223 27 25, Fax (223) 223 27 26 E-mail : cpssante@cpssantemali.org, and the Direction Nationale de la Statistique et de l'Informatique (DNSI) : B.P. 12, Bamako, Mali, Telephone (223) 222 24 55, Fax (223) 222 71 45; e-mail cnpemali@afribone.ml
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