UN Conclusions on Child Mortality Questioned

By Michael Cowden
The Cambodia Daily      

Government, World Health Organization and UN Children's Fund officials on Monday cast doubt on the latest UN Development Program report pointing to an increasing child mortality rate in Cambodia, arguing that anecdotal evidence suggests that the rate is likely decreasing.

Minister of Health Nuth Sokhom provided figures indicating that the child mortality rate is in fact sharply lower now than in years past, and WHO and Unicef officials said the UNDP numbers are perhaps based on old data.

"Lies, damn lies and statistics," joked Rodney Hatfield, country representative for Unicef, warning that one must be extremely careful when comparing data compiled from different surveys and in different years.

A map featured prominently in the UNDP's recently issued Human Development Report 2005 shows Cambodia as being one of the few countries in the world-along with several nations in sub-Saharan Africa-where child mortality rates are increasing.

According to figures published in Human Development Report 2005, 140 of every 1,000 Cambodian children die before age five, up slightly from 138 per 1,000 in HDR 2004.

Figures from the Cambodian government paint a starkly different picture.

According to documents obtained Monday from the Ministry of Health, 124 of every 1,000 children in Cambodia died before age five in 1998.

But by 2003 the number had dropped to 83 per 1,000, a 33-percent decrease.

"It should be stable or a decrease, but I hope for a decrease," Nuth Sokhom said.

He declined to comment on the difference between his data and the UNDP's.

Explaining his optimism, Nuth Sokhom cited improved immunization programs, better roads and generally positive reports from village health volunteers across the country.

"The situation for the children in the village is better than before," he said the volunteers told him. "Some die, but less."

But both Hatfield and Severin von Xylander, a child health expert at WHO, warned against easy comparisons.

The data from 1998 and 2003 cited by the Ministry of Health, for example, came from two different surveys, each employing different methods, and thus are not necessarily easily comparable.

They also suggested that the sharp difference between the UNDP and government numbers was likely the result of data coming from different years and being compiled according to different surveying and statistical methods.

The dire UNDP figure of 140 per 1,000, they said, may have been based on a 2000 survey that was then used by UNDP statisticians as a basis for predicting future trends.

"In 2000 what was indeed striking was that there was a rising trend," von Xylander said.
"I think that it is perfectly valid data, but it is probably rather old," Hatfield said.

Both said a more complete picture of the child mortality situation in Cambodia would have to wait until early 2006, when the results of the 2005 Cambodia Demographic Health Survey will be released.

"In the meantime, it's just various interpretations of data," Hatfield said.

Both also agreed that the world map in HDR 2005-with Cambodia colored black to indicate an increase in child mortality, contrasting starkly with the lighter shades of the rest of the region-was not "helpful."

"I do not think it is extremely helpful to have the release of a report in New York which is based on results that are several years old," von Xylander said.

"It's unfortunate, I was hoping this had gone away," Hatfield said, lamenting that there may be yet another chapter in the already contentious and contorted history of child mortality in Cambodia.

"I sincerely believe that it is actually better than it appears to be from that data," Hatfield said, citing, among other things, improved health services, government immunization programs and Cambodia's declining fertility rate.

"This normally does not happen unless there is a reduction in infant mortality," he said, referring to declining fertility.

"I presume, I expect...that there will be a decrease in child mortality," von Xylander said, referring to the 2005 survey, which is still in progress.

But both said that Cambodia still had a long way to go, even if child mortality is ultimately shown to be on the wane.

"Even if it decreases, it would remain the highest in the region," von Xylander cautioned. "I don't want to paint an entirely rosy picture."

"There are still many, many problems," Hatfield said.

The UNDP had no official comment Monday.