Infant and Child Mortality

Introduction
Infant and child mortality rates (IMR and CMR) can be interpreted as measures of the well-being of children in any country. Usually, the values of these rates reflect the levels of health and socio-economic status of the population they are used to describe. These two measures of mortality are watched closely world-wide by policy-makers and national program managers. As indicators of general health status, health and children organizations such as WHO and UNICEF have introduced programmes in different countries to reduce these rates at various points in time.

Since 1967, nationwide health surveys have rarely been conducted in the occupied territories. The Israeli-controlled Palestinian health sector suffers from lack of estimates of important health indicators. Infant mortality estimates vary greatly depending on the source providing these estimates. While some Palestinian professionals claim that IMR exceeds 70 deaths in 1000 live births, the Israeli authorities claim that this rate is in the lower twenties.

The Israeli Ministry of Health (IMOH) publishes annual figures for registered infant deaths per registered live births. However, the rate of non-reporting of infant deaths and births is not known. UNRWA similarly publishes registered infant births and deaths. Table 2.2²¹ shows the official reported infant mortality rates (IMR) (1970-1990), indicating a steady decline since 1970. The rates for the West Bank exclude Arab Jerusalem.

Table 2.2 Official Israeli reported infant mortality rates for the occupied territories, selected years

	Reported Infant Mortality Rates23
	West Bank	Gaza Strip
1970	--	86.0
1975	38.1	69.3
1980	28.3	43.0
1985	25.1	33.4
1990	22.0	26.1

Indirect demographic methods have been used by different researchers to estimate IMR in small non-representative localities of the occupied territories (table 2.3). In addition, Vermund et al. (1985) have analyzed official records of infant deaths to estimate under-reporting and produced a further estimate of infant mortality rates. Using official records and applying a demographic model, Vermund et al. (1985) have estimated an IMR for 1982 of 53-63 for the West Bank and 53-56 for the Gaza Strip.

Table 2.3 Results of some local studies of infant mortality using indirect methods

	Sample Size of Ever Married Women	IMR	Year	Reference
3 villages in Ramallah area	272	91	1981	Giacaman (1989)
Biddu village, Ramallah area	311	49	1986	UPMRC/BZUCHU (1987)
20 villages in Hebron area	380	97	1988	Shahin et al. (1989)
Khan Younis	--	70	1982	Dahlan (1987)
Beach Camp and Ash-Shajaiyeh	--	32	1982	Scott (1989)

At the national level, the only recent estimate of IMR for the total population in the occupied territories is the one obtained through a multi-stage clustered sample survey carried out by UNICEF and the Jerusalem Family Planning and Protection Association (JFPPA) in the winter of 1991 and 1992 (Abu-Libdeh et al. 1992). Estimates of the probability of dying before exact age 1, between ages 1 and 4 and before exact age 5 for the total population, West Bank, Gaza Strip, Urban, Rural, Refugee Camps, North West Bank, Middle West Bank, and South West Bank were provided for both sexes combined and for each sex alone. According to the results of this survey, IMR for 1988 is estimated at 41 and U5MR is estimated at 55 deaths per one thousand live births.

FALCOT 92 has included a standard module questionnaire for indirect estimation of IMR and U5MR using the Brass (1964) methods and their variants (1983). In this section, we derive an estimate of IMR and U5MR using two approaches. In the first approach, we use data on children ever born (CEB) and children surviving (CS) classified by 5-year age groups of their mothers (15-19 years through 45-49 years). In the second approach, we use data on children ever born (CEB) and children surviving (CS), classified by 5-year duration of marriage groups of their mothers (0-4 years through 30-34 years). Due to the sensitivity of estimators to sampling and non-sampling errors, we start subsection 2 by pointing out some limitations of the data set. In subsection 3 we investigate the quality of data used for estimation. Data quality assessment is necessary to make sure that our estimates are seen in the proper context. We then proceed in subsection 4 to estimate q(1) and q(5) and highlight their trends during the last decade. In subsection 5, we compare the results obtained with those of UNICEF and JFPPA (Abu-libdeh et. al. 1992) and of neighbouring countries.

al@mashriq                       960715