Academic journal article Central European Journal of Public Health

Changes and Determinants in Under-Five Mortality Rate in Turkey since 1988

Academic journal article Central European Journal of Public Health

Changes and Determinants in Under-Five Mortality Rate in Turkey since 1988

Article excerpt

SUMMARY

Child survival is the focus of the fourth Millenium Developmental Goal (MDG4). This paper describes levels, trends, and differentials in Under-Five Mortality Rate (U5MR) and also summarizes state programmes in Turkey between 1988 and 2010. Turkey is among only a few countries that have already surpassed MDG4 and have reduced their under-five mortality rate by more than two-thirds. In 2010, 13 out of every 1,000 children died before their fifth birthday. Low birth weight, high-birth order, short birth intervals, rural residence, low level of maternal education and lowest wealth quintile have affected negatively children's chances of survival. Expanding the scope of free vaccination programmes for children, improving screening and disease prevention schemes aimed at children, encouraging breastfeeding, implementing an emergency obstetric care programme, improving the services provided to newborns (a newborn intensive care programme) have brought about a significant decrease in the rate of infant and under-five mortality. The implementation of state and region specific action plans should be necessary to increase the chance of an access to the Continuum of Care for each mother and infant and to surpass MDG4.

Key words: children, mortality rates, millennium, developmental goals, Turkey

INTRODUCTION

Within the ten Millennium Development Goals (MDGs), child survival is the focus of the fourth MDG, that calls for a two-thirds reduction in under-five mortality rate (U5MR - the number of children dying before the age of 5 per 1,000 live births) between 1990 and 2015 (1). Turkey is among only a few countries that have already surpassed MDG4 and have reduced their U5MR by more than two-thirds (2-5). As many countries are undergoing rapid social and economic changes, Turkey provides an interesting case study for this decline.

To decrease U5MR, a continuum of care for mothers, newborns and children that integrate programmes for reproductive health, safe motherhood, newborn care, and child survival, growth and development should be provided appropriately. The concept of the continuum of care has arisen in recent years from the recognition that an integrated approach reaps more dividends than myriad of separate initiatives (6). Country profiles could be easily followed by elements of the continuum of care (7). The purpose of this report is to review the changes in U5MR, infant mortality rate (IMR) and neonatal mortality rate (NMR) in Turkey since 1988, with the current statistics and to summarize state interventions and status of the continuum of care in Turkey. Further, country status was compared with OECD (the Organisation for Economic Cooperation and Development) countries, WHO (the World Health Organisation) regions, UNPOP (the United Nations Population Division) region, and UNICEF (the United Nations Children's Fund) regions.

METHODS

The data is taken from the national cross-sectional demographic and health surveys (TDHS) conducted in Turkey between 1988 and 2008 (8-12). TDHS collects nationally representative data on women of child-bearing age (15-49 years) and their children. Changes in prevalence of mortality between surveys were given as percentages. These studies included variables of children born in the 5 years preceding the survey. Data of the Turkish Ministry of Health, the Turkish Statistical Institute (TURKSTAT), the Turkish Health Statistical Yearbook, OECD, UNICEF and WHO were taken and comparisons were made among countries and regions of WHO, UNICEF and the World Bank (3,5, 13-15). Some vital elements of the continuum of care in pre-pregnancy (contraceptive prevalence, unmet need for family planning, avoidable high-risk fertility behaviour), pregnancy (antenatal care coverage), birth (delivering in health facility, skilled attendant at birth, proportion of caesarean section), postnatal (initiation of breastfeeding, exclusive breastfeeding for 6 months, fully vaccinated, malnourished) periods (6) were selected and changes in frequency of the elements between 1993 and 2008 were calculated from TDHS (8-12). …

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