Common Country Assessment - Swaziland, 1997

Contents | Introduction | Poverty Reduction and Sustainable Livelihoods | Advancement/Empowerment of Women | Child Rights/Child Development/Child Protection | Education | Population | Environment | Health | STD/HIV/AIDS | Food Security/Nutrition | Governance and Participation | Institution Building | Summary and Conclusion

Chapter Eight - Health

"Most killer diseases in Swaziland are due to poor environmental sanitation in and around human settlements. The diseases are mainly diarrhoeal in nature, e.g. typhoid, hepatitis and cholera. About 80 percent of all sicknesses and diseases in Swaziland can be traced to unsafe water that either effects people directly, or serves as breeding ground for diseases and insect vectors. In an analysis of the leading causes of total inpatient deaths for two sentinel years (1989 and 1994), the top four leading causes were: environmentally-related, bacterial, non-vaccine preventable and cardiovascular. There was a 12 percent increase in environmentally related deaths between the two sentinel years. Deaths from oral/gastrointestinal causes also increased significantly (54 percent) during that period."¹ "Environmental related communicable diseases are the major causes of illness and death among the Swazis and account for more than 50 percent of all outpatient visits in the country and more than 20 percent of all the admissions into inpatient health care facilities."²

The disease of malaria has made a strong recovery in recent years, and over a quarter of Swaziland's children are estimated to have bilharzia (schistosomiasis).³ An estimated 35 percent of the total population are at risk from this infection.

The major cause of death in Swaziland, however, is accidents and injuries: the leading causes of overall mortality can be tabulated as follows:

Source: WHO: 1996 National Health Profile (Draft) p.42

Almost ninety percent of the inpatient infectious intestinal figure is caused by gastroenteritis.

As mentioned above, many of Swaziland's indicators are inconsistent with what could be expected on an international comparison. For example, despite having a maternal mortality rate reasonably consistent with its position on the HDI, Swaziland's under-five mortality rate is almost twice the average of countries with a similar GDP per capita (according to the 1997 HDR) - similar to Bolivia’s, which has an MMR of 650/100,000). The major causes of hospital deaths among children under five years in 1994 reveals why:

Source: MOHSW, 1994

Malnutrition is also considered to be the main underlying cause of under five mortality, weakening resistance to the other diseases. However, it is "non-exclusive breast feeding. . early supplementary feeding, together with poor water and sanitation, [that is the] major cause of illness and death in children... [Even with] access to clean tapped water, . . . this is rarely available inside the house, with a strong likelihood of contamination during collection and handling... Relatively low use is made of modern health services, partly because of the preferred traditional alternatives (some of which are positively harmful), partly because of inaccessibility and poor quality of modern services in some communities."⁴

The immunization programme is one positive factor in the fight against infant mortality, which would have been even higher without the progress described in this table:

Source: UNICEF, 1994. Summary Situational Analysis: Children and Women in Swaziland

The immunization programme is one of the major activities of the Ministry of Health and Social Welfare. The achievements entabulated above are still being improved through the Expanded Programme on Immunization, with the goals including Swaziland being declared a polio-free country, the elimination of measles by 2000, and by the same date an increase the overall immunization rate to 95 percent, and the TT2+ vaccination for women of child-bearing age to 80 percent.

Apart from such relatively easily quantifiable indicators, it should be noted that the indicators available for vital events have been described as ‘grossly inadequate’⁵, causing a reliance on hospital records - a function they cannot perform adequately, especially considering the trust placed by many in traditional healers.

Traditional healers are far more accessible to rural communities, even though about 85 percent of the population lives within an 8 kilometre radius of a modem health facility. There are about 8,000 traditional healers, compared to about 150 medical doctors, 1,400 nurses and 2,500 rural health motivators. 54 percent of rural dwellers lack access to potable water, and 64 percent lack adequate sanitation.⁶

It is worth recalling the point made at the end of chapter five in this context: that "in Swaziland, the urban and rural sectors are neither isolated nor discrete... Almost all urban workers have a rural homestead as their permanent residence... The interpenetration of wage employment and the rural economy, and rural-urban commonalities, are central features of the Swazi way of life."⁷ Although many with dwellings in both rural and urban areas may have improper sanitation in both, a larger than apparent proportion of the population could be exposed to unsanitary conditions because of this practice.

8.1 REPRODUCTIVE HEALTH

The estimated maternal mortality rate among women under 50 years in Swaziland is 229 per 100,000 live births, with a higher rate applying in the rural areas (266/100,000).⁸ About 44 percent of births occur at home, about half by choice and half by default due to access problems. About 100 mothers and 900 new-borns die each year from pregnancy and birth complications, and about 3,700 and 4,600 respectively develop long-lasting disabilities. Apart from the normal complications, unsafe abortions are also a major cause of maternal deaths. Women at the highest risk of complications from pregnancy and birth are adolescents, the over-35s, those with five or more previous children, those with short intervals between births, and those with pre-existing health defects.

About 97 percent of all pregnant women now make ante-natal visits and 67 percent make at least five visits per pregnancy. There also appears to have been a significant improvement in the numbers of women of childbearing age using methods of contraception - up from only 16.6 percent in 1988 to an estimated 28-30 percent in 1992.⁹

The above figures on reproductive health contain some encouraging trends, but the recent maternal mortality rate estimates are over twice as high as estimates around 1990 of 100/110 per 100,000. Those earlier estimates, however, were provided with the caution that they were not completely reliable.

1. MTEC, 1997, Vol 1, p.40.
2. WHO, 1996, p.xi
3. GOS/UNICEF, 1994, p.107.
4. C/- MHUD, 1990. Children and Women in Swaziland: a Draft Situational Analysis. Mbabane. p.vi.
5. WHO, 1996, pp. xi and 35.
6. GOS, 1997(2), p.43.
7. C/- MHUD, 1990, p.30.
8. WHO, 1996, pp.37-39.
9. This section relies heavily, but not exclusively, upon the consolidated information in MEPD, 1996, pp. 169-170.

Health Indicators

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