Infant mortality remains high

Despite an earlier infant mortality rate (IMR) in Turkmenistan of 34 per live 1,000 births, according to a recent joint government and USAID sponsored demographic and health survey, the figure now stands at 74, over double its original estimate. "This suggests an urgency to further investigate the reasons for the increase in IMR," Mahboob Shareef, the assistant representative of the United Nations Children's Fund (UNICEF) in the Turkmen capital, Ashgabat, told IRIN on Tuesday. The earlier estimate of infant mortality was based on data collected according to protocols established during the time of the former Soviet Union. Those protocols classify a pregnancy that ends at less than 28 weeks of gestation as a miscarriage unless the infant born survives for at least seven days. However, according to the Turkmenistan Demographic Health Survey (TDHS) released in September, infant mortality data was collected based on the international definition of a live birth, i.e. a birth that shows any sign of life, irrespective of the gestational age at the time of delivery (United Nations, 1999). Given the difference between the government data collection system and that of the TDHS in the definition of a live birth, the TDHS estimate of IMR exceeds the earlier estimate. According to Shareef, the original IMR estimate for the five-year period 1996 to 2000 was 32 per 1,000, but under the new survey, the IMR for the same period was 74 per 1,000. He added that the survey found significant differences in the IMR between urban areas (60 per 1,000) and rural areas (80 per 1,000). Compared with other Central Asian countries, for example, the IMR for Kazakhstan over approximately the same period was 62 per 1,000. According to TDHS, it is known that closely spaced births (i.e. births within 24 months of a previous birth) put infants at relatively high risk of dying. In Turkmenistan, 36 percent of second and higher order births occur within 24 months of a previous birth. Infant morality for those births (94 per 1,000) was almost twice as high as for births occurring after an interval of 48 or more months (49 per 1,000). This suggests that a programme promoting birth spacing and child survival interventions could reduce infant mortality. Regarding the positive health aspects for children in Turkmenistan, the UNICEF official maintained that the government was able to maintain 95 percent of vaccination coverage among children under one year of age. "This is an impressive achievement compared to many developing countries," Shareef said, adding that the Turkmen government had pledged to procure all vaccines for its regular immunisation programmes with its own resources. "Turkmenistan has been able to iodise 75 percent of all edible salt in the country, and is working vigorously with UNICEF to ensure 100 percent salt iodisation," he explained. Turkmenistan had great potential for becoming one of the first former Soviet republics to achieve the universal salt iodisation goal, he added. Commissioned by the Turkmen health ministry, in an effort to plan effective policies and programmes to promote the health and nutrition of women and their children, the TDHS was the first national-level population and health survey in the country since it achieved independence in 1991.