LAO PDR 4. Prevalence of underweight children (under five years of age) Ministry of Public Health. Women and children in the Lao People s Democratic Republic. Results from the LAO social indicator survey (LSIS). Vientiane: Mother and Child Diagnostic de la situation nutritionnel et consommation alimentaire au Laos. Rapport complet de l étude sur l état nutritionnel de la population Laotienne. ESNA :TCP/LAO/2354. Rome: Food and Agriculture Organization, 1995 Report on national health survey: Health status of the people in Lao PDR. Vientiane, Lao People s Democratic Republic, January 2001 Multiple Indicator Cluster Survey 2000 Acronym LSIS93 FAO94 NHS00 MICS00 50 LAO PDR - PREVALENCE OF UNDERWEIGHT CHILDREN (UNDER FIVE YEARS OF AGE) % of children under 5 40 30 20 10 0 1985 1990 1995 2000 LSIS93 FAO94 NHS00 MICS00 Observed Line MDG Line LSIS93, FAO95, NHS00, MICS00: Children 0-4 years old. 1
Percentage of children under five years who are classified as undernourished according to the anthropometric index of nutritional status: weight-for-age. The index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as malnourished if their z-scores are below minus two standard deviations (-2 SD) from the median of the reference population. To achieve MDGs (to halve the prevalence of underweight children), 2.8% of annual reduction is needed between 1990-2015, shown as MDG line in the graph. Lao PDR s progress, shown as observed line, is slower than MDG line, and it is about 0.8% of annual reduction. Additional indicators: Stunting, Breastfeeding, Vitamin A Prevalence of stunting (height for age <2 Z-scores) in children under 5 (%) % of infants under 6 months who are exclusively breastfed 0-3 months 4-6 months % of children 12-59 months who consumed vitamin A supplements 1993 48.0 1994 47.3 1999 80.0 2000 42.4 28.1 Note: Breastfeeding status refers to 24 hours preceding the survey. Stunting data refers children the same age as underweight. Source: For vitamin A, UNICEF/Nutrition Section survey 2000 For stunting and breastfeeding, the same as underweight 2
13. Under-five mortality rate Acronym 1994 Fertility and Birth Spacing Survey (direct) LFS94d 250 LAO PDR - UNDER-FIVE MORTALITY Under-five mortality rate (per 1000 births) 200 150 100 50 0 1960 1970 1980 1990 2000 LFB94d KH line WDI04 MDG Line Direct estimates: Infant and under-five mortality rates are calculated from the data from a sample survey that collects birth histories, with a mother being asked for information on the date of birth and, if relevant, the age at death of every live-born child she has had. However, the collection of such information by surveys is complex and requires high levels of interviewer quality and training. The surveys are therefore quite expensive and can only cover small samples. Indirect estimates: Indirectly, under-five mortality and infant mortality can be calculated by asking each woman surveyed for very simple information: her age, the total number of children she has borne, and the number of those children that have died. Indirect estimates adjust the proportions dead by age group of mother for an estimated exposure distribution in order to arrive at pure measures of under-five mortality and of reference dates for these measures. The information from the younger women gives under-five mortality of more recent years whereas the information from the older women gives under-five mortality of more distant years. The adjustment process assumes certain patterns of fertility and under-five mortality by age (East, North, South, West model life tables), and results can be quite sensitive to the choices made. 3
KH line: The line was estimated by fitting a regression line to the relationship between infant or under 5 mortality rates and their reference dates using weighted least squares. The method of estimation is adopted from the papers: 1) K. Hill, R. Pande and G. Jones, Trends in child mortality in the developing world: 1990 to 1995, UNICEF staff working papers, Evaluation, Policy and Planning Series, UNICEF, New York, 1997. 2) K. Hill et al, Trends in child mortality in the developing world: 1990 to 1996, unpublished report, UNICEF, New York, January 1998. The weights are listed in the table in the last section of this document. WDI04: Estimates used for World Development Indicators 2004. To achieve MDGs (to reduce under five mortality by 2/3), 4.4% of annual reduction is needed between 1990-2025. Lao PDR s progress, shown as WDI04 line, is slower than MDG line, and it is about 4.1% of annual reduction between 1990-2002. Additional indicators: Child (aged 1-4) mortality rate by gender Child (aged 1-4) mortality rate (per 1000 births) Survey year Male Female Note: Mortality rates are for the ten-year period preceding the survey Source: 4
14. Infant mortality rate Acronym 1994 Fertility and Birth Spacing Survey (direct) LFS94d 180 LAO PDR - INFANT MORTALITY Infant mortality rate (per 1000 births) 160 140 120 100 80 60 40 20 0 1960 1970 1980 1990 2000 LFB94d KH line WDI04 M DG Line Direct estimates: Infant and under-five mortality rates are calculated from the data from a sample survey that collects birth histories, with a mother being asked for information on the date of birth and, if relevant, the age at death of every live-born child she has had. However, the collection of such information by surveys is complex and requires high levels of interviewer quality and training. The surveys are therefore quite expensive and can only cover small samples. Indirect estimates: Indirectly, under-five mortality and infant mortality can be calculated by asking each woman surveyed for very simple information: her age, the total number of children she has borne, and the number of those children that have died. Indirect estimates adjust the proportions dead by age group of mother for an estimated exposure distribution in order to arrive at pure measures of under-five mortality and of reference dates for these measures. The information from the younger women gives under-five mortality of more recent years whereas the information from the older women gives under-five mortality of more distant years. The adjustment process assumes certain patterns of fertility and under-five mortality by age (East, North, South, West model life tables), and results can be quite sensitive to the choices made. 5
KH line: The line was estimated by fitting a regression line to the relationship between infant or under 5 mortality rates and their reference dates using weighted least squares. The method of estimation is adopted from the papers: 1) K. Hill, R. Pande and G. Jones, Trends in child mortality in the developing world: 1990 to 1995, UNICEF staff working papers, Evaluation, Policy and Planning Series, UNICEF, New York, 1997. 2) K. Hill et al, Trends in child mortality in the developing world: 1990 to 1996, unpublished report, UNICEF, New York, January 1998. The weights are listed in the table in the last section of this document. WDI04: Estimates used for World Development Indicators 2004. To achieve MDGs (to reduce under five mortality by 2/3), 4.4% of annual reduction is needed between 1990-2025. Lao PDR s progress, shown as WDI04 line, is slower than MDG line, and it is about 2.7% of annual reduction between 1990-2002. Additional indicators: Infant mortality rate by gender Infant mortality rate (per 1000 births) Survey year Male Female Note: Mortality rates are for the ten-year period preceding the survey Source: 6
15. Proportion of 1-year-old children immunized against measles Reported to WHO by country Reported to UNICEF by country Report on Multiple Indicator Cluster Survey (MICS 1996), 1997 1995 The graph is taken from WHO web site. http://www.who.int/vaccines-surveillance/whounicef_coverage_review/wucoveragecountrylist.htm Draft WHO/UNICEF estimate: WHO/UNICEF estimates of the most likely coverage for each year and antigen were made based on data from the WHO and UNICEF data bases and information from other sources. WHO and UNICEF consulted with Regional Offices and, where possible, national experts, to seek more in-depth knowledge regarding the functioning of the immunization system. 7
Additional indicators: WHO/UNICEF estimate of immunization coverage, BCG, DPT3, Pol3 Immunization coverage (%) WHO/UNICEF estimate BCG DPT3 Pol3 1985 8 4 4 1986 10 5 6 1987 15 10 10 1988 27 17 17 1989 29 21 22 1990 26 18 26 1991 34 22 22 1992 34 23 27 1993 42 25 26 1994 69 48 58 1995 62 54 64 1996 61 58 68 1997 58 60 69 1998 56 55 67 1999 63 56 64 2000 69 53 57 2001 60 40 55 2002 65 55 55 Source: WHO/UNICEF Review of National Immunization Coverage 1980-2002 http://www.who.int/vaccines-surveillance/whounicef_coverage_review/wucoveragecountrylist.htm 8
16. Maternal mortality ratio Estimate by WHO, UNICEF Estimate by WHO, UNICEF, UNFPA Estimate by WHO, UNICEF, UNFPA Acronym WHO90 WHO95 WHO00 1000 LAO PDR - MATERNAL MORTALITY Maternal Mortality Ratio (per 100,000 live births) 800 600 400 200 0 1985 1990 1995 2000 WHO90 WHO95 WHO00 WHO90: The WHO, UNICEF estimate. For a country with the Reproductive Age Mortality Survey (RAMOS) type estimates of maternal mortality. The maternal mortality ratio derived from the RAMOS study is used directly without any adjustments. Source: Revised 1990 estimates of maternal mortality: a new approach by WHO and UNICEF. WHO95: The WHO, UNICEF, UNFPA estimate. Maternal mortality estimates derived from Reproductive Age Mortality Studies (RAMOS). For countries with RAMOS-type surveys, the observed MMR is generally taken without adjustments. Source: Maternal mortality in 1995: Estimates developed by WHO, UNICEF, UNFPA WHO00: The WHO, UNICEF and UNFPA estimate. The method is used for countries with no national data on maternal mortality. The estimates are developed using the model. For each country, the regression model is used to predict PMDF, and the prediction then applied to WHO estimates of non-hiv deaths of women of reproductive age in 2000 to calculate maternal deaths. The MMR is then obtained by dividing the number of maternal deaths by an estimate of the number of live births in 2000 derived from the United Nations projections (2000 Revision). Source: Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA 9
17. Proportion of births attended by skilled health personnel Multiple Indicator Cluster Survey 2000 Acronym MICS00 100 LAO PDR - % of Births Attended by Skilled Health Personnel % of Births Attended by Skilled Health Personnel 80 60 40 20 0 1985 1990 1995 2000 MICS00 The year in the graph indicates the year of the survey. MICS00: Proportion of births in the one year before the survey attended by skilled health personnel. Doctor, nurse/midwife, auxiliary midwife is considered to be skilled health personnel. Additional reproductive health indicators: Fertility rate Adolescent fertility Total fertility rate (per woman) rate (per 1000 women aged 15-19) 1990 6.1 2000 5.1 2000-2005 91 Note: Total fertility rate is average lifetime total of live births per woman at the fertility rates of the year. Adolescent fertility rate is an annual number of live births to girls aged 15-19 per 1,000 girls aged 15-19. Source: UNICEF End-decade Databases 10
18. HIV prevalence among 15-to-24-year-old pregnant women HIV prevalence among 15-to-24-year-old pregnant women (No data) 11
HIV prevalence among pregnant women UNAIDS/WHO Epidemiological Fact Sheet 2002 Update (No graph) The graphs are taken from WHO web site. Trends in HIV prevalence among antenatal clinic attendees. The data reported are mainly based on the HIV database maintained by the United States Bureau of the Census where data from different sources, including national reports, scientific publications and international conferences are compiled. Studies conducted in the same year are aggregated and the median prevalence rates are given for each of the categories. The maximum and minimum prevalence rates observed are also provided. The differentiation between the two geographical areas Urban and Rural is not based on strict criteria, such as the number of inhabitants. For most countries, urban areas were considered to be the capital city and where applicable other metropolitan areas with similar socio-economic patterns. The term rural considers that most sentinel sites are not located in strictly rural areas, even if they are located in somewhat rural districts. 12
HIV prevalence among young people 15 to 24 years UNAIDS Report on the global HIV/AIDS epidemic June 2000 1999 UNAIDS Report on the global HIV/AIDS epidemic July 2002 2001 0.1 LAO PDR - HIV PREVALENCE AMONG YOUNG PEOPLE AGED 15-24 Prevalence rate (%) 0.08 0.06 0.04 0.02 0 1999 2001 Low estimate, female High estimate, female Low estimate, male High estimate, male Regarding the UNAIDS data, the estimated number of young people (15-24) living with HIV/AIDS at the end of the year divided by the population of young people (15-24) of the year. The estimates are expressed as a range generated by regional modeling. 13
19. Contraceptive prevalence rate Any method and modern method Acronym (No data) Percentage of women in union aged 15-49 who are using any contraception and modern contraception 14
Condom use rate of the contraceptive prevalence rate Acronym (No data) Percentage of women in union aged 15-49 who are using condoms for contraception among women in union aged 15-49 who are using any method. Simply calculated by: condom use divided by all methods. 15
20. Number of children orphaned by HIV/AIDS Number of orphans UNAIDS, Report on the global HIV/AIDS epidemic 2002 (No data) Number of children (aged 0-14) currently living whose mother, father or both parents have died due to AIDS (including those children who lost both parents and those who lost one parent to AIDS and the other parent due to another cause) 16
Ratio of proportion of orphans to non-orphans aged 10 to 14 years who are attending school (No data) The ratio of children (aged 10-14) who lost both parents and are attending school to non-orphaned children the same age who are attending school 17
21. Prevalence and death rates associated with malaria (No data) 18
22. Proportion of population in malaria risk areas using effective malaria prevention and treatment measures Bednet usage Multiple Indicator Cluster Survey 2000 Acronym MICS00 100 LAO PDR - USE OF BEDNETS AMONG CHILDREN UNDER FIVE % of children under five years old that slept under a (any) mosquito net during the night preceding the survey 80 60 40 20 0 1985 1990 1995 2000 MICS00 19
Bednet treatment Multiple Indicator Cluster Survey 2000 Acronym MICS00 100 LAO PDR - USE OF TREATED BEDNETS AMONG CHILDREN UNDER FIVE % of children under five years old that slept under an insecticide-treated mosquito net during the night preceding the survey 80 60 40 20 0 1985 1990 1995 2000 MICS00 20
Malaria treatment Multiple Indicator Cluster Survey 2000 Acronym MICS00 20 LAO PDR - MALARIA TREATMENT % of children who received appropriate malaria treatment 15 10 5 0 1985 1990 1995 2000 MICS00 Percentage of children who received antimalarial medicine, among children who had fever in the last 2 weeks before the survey. 21
23. Prevalence and death rates associated with tuberculosis Prevalence rates WHO TB data submitted to the UN in May 2002 Acronym WHO LAO PDR - TUBERCULOSIS PREVALENCE 500 Prevalence rate per 100,000 400 300 200 100 0 1985 1990 1995 2000 WHO Rates for tuberculosis prevalence excluding cases attributable to HIV/AIDS. Prevalence of smear-positive disease. 22
Death rates WHO TB data submitted to the UN in May 2002 Acronym WHO 100 LAO PDR - TUBERCULOSIS MORTALITY Death rate per 100,000 80 60 40 20 0 1985 1990 1995 2000 WHO Rates for tuberculosis mortality excluding cases attributable to HIV/AIDS. 23
24. Proportion of tuberculosis cases detected and cured under directly observed treatment short course (DOTS) Proportion of tuberculosis cases detected WHO Report 2004 Global Tuberculosis Control 100 LAO PDR - PROPORTION OF ESTIMATED NEW SMEAR-POSITIVE TB CASES DETECTED UNDER DOTS DOTS detection rate (%) 80 60 40 20 0 1985 1990 1995 2000 Proportion of estimated new smear-positive tuberculosis cases detected under DOTS (Directly Observed Treatment Short Course) 24
Proportion of tuberculosis cases cured WHO Report 2004 Global Tuberculosis Control LAO PDR - PROPORTION OF REGISTERED NEW SMEAR-POSITIVE TB CASES SUCCESSFULLY TREATED UNDER DOTS 100 DOTS treatment success (%) 80 60 40 20 0 1985 1990 1995 2000 Proportion of registered new smear positive tuberculosis cases successfully treated under DOTS (Directly Observed Treatment Short Course) 25
Data: Maternal mortality Proportion of Prevalence of ratio (per births attended underweight 100,000 live by skilled health children (%) Proportaion of 1-year-old children immunized against measles (%) births) personnel (%) HIV prevalence among 15-to-24-year-old pregnant women Reported by Reported by Government Reported Major urban Major urban Outside major Outside major WHO/UNICE country to country to official doses Survey 12- Survey <12 areas, age 15- areas, age 20- urban areas, urban areas, F estimate WHO UNICEF estimate administered 23 months months 19 24 age 15-19 age 20-24 HIV prevalence among pregnant women (%) Urban Rural Minimum Median Maximum Minimum Median Maximum 1985 6 6 33 1986 10 10 33 1987 11 11 33 1988 23 23 19 1989 20 20 20 1990 32 32 13 650 1991 47 47 20 1992 46 46 55 1993 46 46 46 44.0 1994 40.0 73 73 73 1995 68 68 68 62 650 1996 73 73 0.4 0.4 0.4 1997 67 67 67 1998 71 71 71 1999 71 71 71 71 71 2000 40.0 40.2 42 42 42 42 36 650 19.4 2001 50 50 50 50 73 2002 55 55 55 55 76 Ratio of proportion of Condom use Number of orphans to non- Proportion of Proportion of rate of the children orphans aged 10 Prevalence and tuberculosis tuberculosis contraceptive orphaned by to 14 years who death rates Treatment Tuberculosis Tuberculosis cases detected cases cured HIV prevalence among young people aged 15-24 (%) Contraceptive prevalence rate (%) prevalence rate (% ) HIV/AIDS currently living are attending school (%) associated with malaria Bednet usage (% ) bednet usage (% ) Malaria treatment (%) prevalence rate death rate (per (per 100,000) 100,000) under DOTS (% ) under DOTS (% ) Fem ale low Female high M ale low Male high Modern estimate estim ate estim ate estimate All mdthods methods 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 70 1996 25 55 1997 33 62 1998 39 75 1999 0.05 0.05 0.02 0.05 44 84 2000 38 82 82.3 17.7 8.7 148 27 2001 38 77 0.02 0.03 0.03 0.06 2002 43 26
Estimates of Under-five mortality and IMR, data and weights used for estimation: KH line Under-five mortality rate (per 1000 births) Data used LFB94 Direct Rate Reference year Rate Weight 1960-1980.5 181.6 2 1965-1985.5 182.4 1.8 1970-1990.5 142 1.2 1975 210 1980 188 1985 168 1990 151 1995 135 2000 121 2001 118 2002 115 KH line Infant mortality rate (per 1000 births) Data used LFB94 Direct Rate Reference year Rate Weight 1960-1980.5 121.6 2 1965-1985.5 122 1.8 1970-1990.5 113 1.2 1975 141 1980 127 1985 115 1990 104 1995 94 2000 85 2001 84 2002 82 27