2013年-世界发展银行全球_Maternal_Health_Child_Health_and_Nutrition_in_Lao_PDR___Evidence_from_a_Household_Survey_in_Six_Central_and_Southern_Provinces_32页_753kb

Summary of MATERIAL HEALTH, CHILD HEALTH, AND NUTRITION IN LAO PDR: EVIDENCE FROM A SURVEY IN SIX CENTRAL AND SOUTHERN PROVINCES

Core Content

This report presents findings from a survey conducted in 2010 in six central and southern provinces of Lao PDR, focusing on maternal and child health (MCH) and nutrition outcomes in largely rural communities. The survey aimed to inform and evaluate pilot interventions designed to improve health-related Millennium Development Goals (MDGs) and nutrition indicators.

Main Findings

Health Indicators

• Life Expectancy: Increased from 46 years in 1970 to 67 years in 2011.
• Under-five Mortality Rate: 42 per 1,000 live births in 2011, which is relatively high compared to regional averages.
• Maternal Mortality Rate: 470 per 100,000 live births in 2010, among the highest globally and nearly double that of Cambodia and eight times that of Vietnam.
• Key MCH Utilization Indicators:
  • Only 35% of women had at least one antenatal care (ANC) visit.
  • 14% of births occurred at health facilities.
  • 2% of women received postnatal care.
  • 64% of children aged 12-23 months received the first dose of DPT and Polio vaccines, but only 26% received all Expanded Program on Immunizations (EPI) vaccines.
  • A sharp decline in immunization rates is noted between the first and second doses, indicating poor follow-up.

Nutrition Indicators

• Undernutrition: 32% of under-five children are underweight, and 48% are stunted.
• Breastfeeding: Only 40% of children under two received timely initiation of breastfeeding (within one hour of birth).
• Dietary Diversity: Most families consume grains and vegetables, but less than half consume meat or fish. Iron and Vitamin A-rich foods are largely absent.
• Diarrhea Prevalence: 15% of children under two had an episode of diarrhea in the two weeks prior to the survey.

Access to Health Services

• Physical Access: The mean distance to the nearest health center is 6 km, and to the nearest hospital is 34 km.
• Financial Barriers: 45% of respondents cited financial constraints as the main barrier to health service utilization, due to low health insurance coverage (less than 4% of households).
• Utilization Inequality: Institutional delivery rates are significantly higher in urban areas (30%) compared to rural areas without road access (6%). Similarly, education level correlates with higher utilization, with 30% of mothers with secondary education having institutional deliveries, versus 7% of those with no education.

Sanitation and Hygiene

• Sanitation Facilities: Only 23% of households had access to sanitation facilities, and 77% lacked toilets.
• Hygiene Practices: 50% of respondents washed hands before cooking, 9.3% before feeding the baby, and 20% after using the toilet. Soap use was less common, with 45% of respondents using it.
• Environmental Contamination: The high prevalence of open defecation and lack of toilets suggests widespread environmental contamination, contributing to malnutrition through fecal-oral transmission and environmental enteropathy.

Economic and Social Context

• Household Characteristics:
  • 80.4% of households were rural, with 19.6% urban.
  • 95% of households were headed by men.
  • 51% of household heads were Lao-Tai, 44% were Mon-Khmer, and 3% were Hmong-Mien.
  • 87% of individuals aged 14 and above were self-employed in agriculture.
  • 41% of households had access to electricity, while 36% used kerosene lamps.
• Education Levels:
  • 36% of households had heads with no formal education.
  • 51% of respondent mothers had no schooling.
  • Educational attainment is strongly correlated with economic status, with the poorest quintile having 58.3% of household heads with no education, while only 19.6% of the richest quintile had uneducated heads.

Government Interventions

• The Lao PDR government has implemented the "Free MCH Policy" to reduce financial barriers and improve service utilization.
• The Community Nutrition Project (CNP) has been piloted, combining conditional cash transfers and behavior change communication to promote MCH and nutrition practices.
• The 7th National Socioeconomic Development Plan emphasizes sustainable health financing, aiming to increase health budget allocation to 9% of GDP.

Policy Implications

• Demand-side Barriers: Physical access, financial constraints, and cultural/educational factors significantly hinder MCH and nutrition service utilization.
• Supply-side Challenges: Health facilities often lack essential commodities like iron and folic acid supplements, and staff training and service readiness remain inadequate.
• Cross-sectoral Approach: To address undernutrition, interventions must go beyond the health sector, including improved water and sanitation, agricultural support, and nutrition-specific and sensitive programs.
• Community-Level Interventions: Given the widespread lack of sanitation, community-wide efforts are necessary to reduce environmental contamination and its impact on child nutrition.

Conclusion

The survey underscores the persistent challenges in maternal and child health and nutrition in Lao PDR, despite some progress. The findings highlight the need for comprehensive, multi-sectoral interventions that address both demand and supply-side issues, improve access to and quality of health services, and promote better hygiene and sanitation practices.