Infant mortality is one of the most important indicators that reflect population health in general and evaluates access and quality of resources of infant and maternal health in particular. The target of Millennium Development Goal (MDG) 4 is the reduction of the under-five mortality rate by two-thirds between 1990 and 2015. Based on the knowledge that approximately 80% of the deaths of children under five years old in the Region of the Americas occur among children under one year old, infant mortality will be used for the analysis presented here.
Currently, to a greater or lesser extent, problems with infant birth and mortality registration data still exist. Also, various sources for both the infant mortality rate (IMR) numerator and denominator are being used; for example, registered or estimated live births or survey results, which impact on the consistency of the time series data available to PAHO.
To contribute to a critical discussion of MDG 4, we decided to carry out this comparison exercise with the aim to enrich the process of improving health information and reports in our countries. IMR time series estimates will be used based on statistical models as published by Rajaratnam JK et al in The Lancet in 2010. The authors evaluated the IMR decline during the 1990–2010 period. In the analysis presented here, the countries’ progress over the 2004–2009 period will be evaluated, as well as the annual rate of reduction that will be required over the next five years in order to achieve the MDG 4 target by 2015. Comparisons of and differences between the IMR reported by the countries and the estimates presented by Rajaratnam JK et al, are shown in Table 1.
When comparing IMR reported to PAHO and the estimates by Rajaratnam JK et al, it can be observed that 30% of countries report IMRs close to estimates. On the other hand, Dominica’s reported rate is 49% higher than its estimated rate, while Jamaica’s is 40%, Bolivia’s is 30%, and Nicaragua’s is 25%. Four countries report IMR lower than the estimated rates: Saint Vincent and the Grenadines, Guyana, Suriname, and Trinidad and Tobago which present differences that range between 34% and 50%. According to The Lancet article, countries which had the lowest IMR reduction during 1990–2010 were Saint Vincent and the Grenadines (6.7%), Trinidad and Tobago (15.4%), Antigua and Barbuda (23.2%), Suriname (23.3%), Dominica (31.0%), Panama (33.6%), and Guyana (37.4%). Countries that presented the highest percentage of decline were Chile (64.7%), El Salvador (64.6%), Cuba (63.5%), Peru (62.1%), Brazil (59.8%), and Barbados (59.1%). Cuba and Chile are among the countries with the lowest IMR in 1990 and also presented a strong reduction during the evaluation period.
Figure 1 depicts the percentage decline of IMR over the 2004–2009 period. A slow decline is observed in some countries (Brazil, Chile, Cuba, El Salvador, Guatemala, Nicaragua, and Peru), especially those which had presented an important decline since 1990. One of the possible explanations is that neonatal mortality has diminished at a slower pace when compared to postneonatal mortality. Seven countries (Brazil, Barbados, Chile, Costa Rica, Cuba, El Salvador, and Peru) had a substantial IMR decline and in order to reach the target, their progress over the next five years can be less than in the previous quinquennium. A large number of countries of the Americas will have to duplicate the amount of their decline over the 2004–2009 period in order to achieve the MDG 4 target by 2015.
According to published estimates of infant mortality trends for the Region of the Americas (Rajaratnam JK et al, 2010; United Nations and Regional Agencies–report coordinated by ECLAC, 2008) there is a significant reduction of IMR in the Region, regardless of the differences among the values of the rates estimated for every country. The Americas is on track to achieve the reduction of the infant mortality rate by two-thirds by 2015.
Map 1 depicts the percentage of IMR required to reach the target of MDG 4 by country.
- Estimated IMR: Rajaratnam JK, Marcus JR, Flaxman AD, Wang H, Levin-Rector A, Dwyer L, et al. Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4. The Lancet 2010;375(9730):1988–2008.
- Reported IMR: Ministry of health data provided through corresponding PAHO/WHO country offices, latest year available. ECLAC: Millenium Development Goals. New York: United Nations; 2008.
The analysis includes 33 countries for which data are available.
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