M ATERNAL M ORTALITY

Estimates of maternal mortality for the period 0-6 years before the survey are shown in Table 11.4. This period of time was chosen to reduce possible heaping of reported years since death on five-year intervals. Age-specific mortality rates are calculated by dividing the number of maternal deaths by years of exposure. To remove the effect of truncation bias (the upper boundary for eligibility in the 2014 CDHS is 49 years), the overall rate for women age 15-49 is standardized by the age distribution of the survey respondents. Maternal deaths are defined as any death that occurred during pregnancy, childbirth, or within six weeks after the birth or termination of a pregnancy. This time-specific definition includes all deaths occurring during the specified period even if the death is due to causes that are not pregnancy related.

However, this definition is unlikely to result in overreporting of maternal deaths because most deaths to women in the specified period are due to maternal causes, and maternal deaths in general are more likely to

2 The time period is not exact because, as with all DHS calculations of exposure time, exposure is calculated separately for each respondent, counting back in time from the date of the interview, and dates of interview in the 2014 CDHS spanned a period of six months.

Table 11.3 Adult mortality rates

Direct estimates of female and male mortality rates for the period 0-6 years preceding the survey, by five-year age groups, Cambodia 2014 Note: Exposure years are calculated using a life table technique; here, they represent the number of person-years that men or women are exposed to the probability of dying.

1 Expressed per 1,000 population

a Age-adjusted rate

124 • Adult and Maternal Mortality

be underreported than overreported. For any given age group, maternal deaths are a relatively rare occurrence, and as such the age-specific pattern should be interpreted with caution.

There were 32 maternal deaths reported by survey respondents in the period 0-6 years preceding the survey. During the period 2008-2014, the maternal mortality rate, which is the annual number of maternal deaths per 1,000 women age 15-49, was 0.15. Maternal deaths accounted for 9 percent of all deaths to women age 15-49; in other words, about 1 in 11 Cambodian women who died in the period 0-6 years preceding the survey died as a result of pregnancy or pregnancy-related causes. Maternal deaths accounted for a similar proportion of overall female deaths as they had in the 2010 CDHS.

The maternal mortality ratio, obtained by dividing the age-standardized maternal mortality rate by the age-standardized general fertility rate, is often considered a more useful measure of maternal mortality because it measures the obstetric risk associated with each live birth. Table 11.4 shows that the maternal mortality ratio for Cambodia for the period 2008-2014 was 170 deaths per 100,000 live births (or, alternatively, 1.70 deaths per 1,000 live births). The 95 percent confidence interval of this estimate ranges from 95 to 246 deaths per 100,000 live births. The maternal mortality ratio can be converted to an estimate of the lifetime risk of dying from maternal causes: 0.005 or, in other words, a risk of dying of 1 in 200.

Table 11.4 Maternal mortality

Direct estimates of maternal mortality rates for the period 0-6 years preceding the survey, by five-year age groups, Cambodia 2014

Age

Percentage of female deaths

that are maternal Maternal deaths Exposure years Maternal mortality rate¹

15-19 0.0 0 33,159 0.00

20-24 13.2 4 40,909 0.10

25-29 27.1 11 40,901 0.27

30-34 10.5 5 30,606 0.16

35-39 16.1 8 23,590 0.32

40-44 2.8 2 19,321 0.11

45-49 3.0 2 14,071 0.16

15-49 9.1 32 202,557 0.15^a

General fertility rate (GFR)² 89 Maternal mortality ratio (MMR)³ 170 (±2 SE; CI = 95, 246) Lifetime risk of maternal death⁴ 0.005 CI = Confidence interval

1 Expressed per 1,000 woman-years of exposure

2 Expressed per 1,000 women age 15-49

3 Expressed per 100,000 live births; calculated as the age-adjusted maternal mortality rate times 100 divided by the age-adjusted general fertility rate

4 Calculated as 1-(1-MMR)^TFR, where TFR represents the total fertility rate for the seven years preceding the survey

a Age-adjusted rate

A comparison of the maternal mortality ratios from the 2005, 2010, and 2014 CDHS shows a large decline between 2005 and 2010 but a small decline from 2010 to 2014. Although the decline between 2010 and 2014 is far too slight to be significant because of the overlapping confidence intervals of these two data points (Figure 11.1), the results provide confirmation that the maternal mortality ratio has declined over the past decade.

Figure 11.1 Confidence intervals for maternal mortality rates, Cambodia 2005, 2010, and 2014

338

124 95

605

288

246

0 100 200 300 400 500 600 700

CDHS 2005 CDHS 2010 CDHS 2014

Deaths per 100,000 live births

472

206 170

INFANT AND CHILD MORTALITY 12

Key Findings

• One in every 36 Cambodian children die before their first birthday, and one in every 29 do not survive to their fifth birthday.

• Infant mortality declined from 45 deaths to 28 deaths per 1,000 live births between the 2010 CDHS and the 2014 CDHS.

• Under-5 mortality declined from 54 deaths per 1,000 live births to 35 deaths per 1,000 live births between the two survey periods.

• Childhood mortality is higher in rural areas than in urban areas. Mortality rates are lowest among children living in the richest households.

• Neonatal and postneonatal mortality rates are 18 deaths per 1,000 live births and 10 deaths per 1,000 live births, respectively. The perinatal mortality rate is 20 deaths per 1,000 pregnancies.

his chapter describes levels of and trends in neonatal, postneonatal, infant, and child mortality in Cambodia. Infant and child mortality rates reflect a country’s socioeconomic situation as well as the quality of life of the population under study. Childhood mortality is affected by socioeconomic conditions and can vary according to the demographic characteristics of children and their mothers.

Therefore, differentials in infant and child mortality by socioeconomic and demographic characteristics are also presented in this chapter.

Disaggregation of mortality indicators by economic, social, and demographic categories helps to identify groups of the population at risk. Preparation, implementation, monitoring, and evaluation of population, health, and other socioeconomic programs and policies depend to a large extent on identification of a target population. The data presented here can help identify at-risk populations and provide an indication of the current mortality situation, which can be compared with previously collected data to determine whether improvements in health and quality of life have occurred over time.

The data used to compute the childhood mortality rates presented in this chapter were derived from the birth history section of the Woman’s Questionnaire. Each woman age 15-49 was asked whether she had ever given birth, and, if she had, she was asked to report the number of sons and daughters who live with her, the number who live elsewhere, and the number who have died. In addition, she was asked to provide a detailed birth history of her children in chronological order starting with the first child. Women were asked whether a birth was single or multiple, the sex of the child, the date of birth (month and year, according to either the Gregorian or the Khmer calendar system), survival status, age of the child on the date of the interview if alive, and, if not alive, the age at death of each live birth. Childhood mortality rates, expressed as deaths per 1,000 live births, are defined as follows:

Neonatal mortality: the probability of dying within the first month of life

Postneonatal mortality: the probability of dying between the first month of life and first birthday (computed as the difference between infant and neonatal mortality)

Infant mortality: the probability of dying between birth and the first birthday Child mortality: the probability of dying between the first and the fifth birthday Under-5 mortality: the probability of dying between birth and the fifth birthday

T

128 • Infant and Child Mortality