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6 Reduce child mortality
Where we are?
- Notable improvement in child immunization under the Zimbabwe Expanded programme of Immunization coverage (ZEPI) since 1982.
- In the last three years, percentage of children aged 12-23 months who had received full vaccination had doubled since ZDHS 2005/06 to 80 percent.
- Diarrhoea is one of the top diseases affecting under 5-year olds and the other being acute respiratory infections, malaria and skin diseases.
- At national level, 11 percent of under 5- year olds had diarrhoea prior to the MIMS survey 2009 and comparable to the ZDHS 2005/06 prevalence of 12 percent.
- According to 1999 and 2005/06 ZDHS, the infant mortality rates for 5 years preceding the surveys declined from 65 deaths per 1000 live births to 60.
- The desired infant mortality rate of 22 per 1000 live births might only be achieved with decline of HIV/AIDS prevalence, increase in the provision of Mother-to-Child transmissions and ART, reduction in malnutrition and improvement of health delivery system.
Status and Trends
In Zimbabwe, infant and under-five mortality rates decreased substantially after Independence in 1980, but began to increase in 1996, possibly in response to the start of economic challenges and the introduction of cost-recovery policies.
The under-five mortality rate has risen from 77 per 1000 live births in 1994 to 82 per 1,000 live births in 2005. The infant mortality rate (IMR) followed the same trend. Neonatal mortality decreased from 29 per 1,000 live births in 1999 to 24 live births per 1000 in 2006.
According to the Zimbabwe Demographic and Health Survey Report of 2006, perinatal mortality was 25 per 1,000 live births. The Multiple Indicator Monitoring Survey (MIMS) of 2009 reported a small increase in the under-five mortality rate of 86 per 1,000 live births compared to 82 in 2005 while the 2009 estimates by the Inter-agency Group for Child Mortality Estimation, using a method adjusting for HIV and AIDS-related mortality for each data observation, showed an under-five mortality of 96 per 1,000 live births. This rise is mainly attributed to the direct and indirect impacts of the HIV and AIDS epidemic and the concomitant rise in poverty levels due to economic challenges.
HIV and AIDS
HIV and AIDS is one of the leading causes of under-five mortality in Zimbabwe, accounting for 21% of the deaths. Over 95% of the paediatric cases of HIV in children less than five years of age are vertically transmitted from mother to child during pregnancy, childbirth and/or breastfeeding.
At the end of 2009, of the 387,649 who needed ART, 53% (215,123) of all HIV-positive patients (public and private) were receiving it. Of these, about 21,000 (9.5%) were children below 15 years of age, with only about 700 of them younger than 18 months, thus implying that most of the children on treatment are long-term ‘survivors’, since it is known that over 50% of infants infected with HIV die before two years of age unless they receive medical treatment. Thus, preventing mother-to child transmission and screening infants for HIV after delivery and throughout breastfeeding are critical measures to reducing the numbers of children dying from HIV-related conditions.
Major challenges to achieving Goal 4
Challenges in Health systems and outbreaks Zimbabwe’s unprecedented economic decline saw spiralling inflation, deteriorating physical structures and, in 2008, the inability of the public sector to deliver basic social services. The country has been facing severe human resources capacity constraints in the public sector, and the health sector in particular. Drugs and medical supplies were largely unavailable for longer periods of time. The consequences of these challenges were further reflected in a major outbreak of cholera in 2008–2009, which saw 98,591 documented cases and 4288 deaths, and an outbreak of measles in 2009–2010.
Refusal of medical treatment or advice, whether on religious or traditional grounds, is an important factor with regards to the shaping of the population’s health-seeking behaviours. For example, both tradition and indigenous religions have a strong bearing on the child mortality rate in Zimbabwe. Some religious groups do not allow their children to be immunised or their sick to be treated using modern drugs.
The provision of a safe water supply and good sanitation is a major contributory factor to positive childcare. Of the total population, 33% still rely on the bush toilet for sanitation, and it is widely understood that diarrheal diseases can be exacerbated in environments where sanitation is poor.
Health services user fees
Although the government does have an existing user fee policy which should provide free of charge health services for pregnant and lactating mothers, children under five and the elderly (60 or more years of age), it has proved extremely difficult to implement. At present, user fees provide the main income for a very large number of facilities to provide at least the minimum service in the absence of substantial government support.
State budget for health
During the decade 2000–2010, state investment in health varied from 4.2% of the state budget in 2001 to 15.3% in 2009. An important commitment would be to keep to the Abuja Recommendation of 15% of the state budget for health. However, this proportion of the national budget falls significantly short of the per capita health cost allowance, which, according to the Ouagadougou Declaration, should be US$34-US$40. Currently, Zimbabwe’s annual budgetary allowance only stretches to US$9 per capita.
Requirements for Achieving Goal 4
- Focus on the most vulnerable age groups and young infants.
- Focus on filling health services gaps within the continuum of care.
- Implement interventions that address major newborn-related problems, such as prematurity, birth asphyxia, and infections.
- Address the major causes of mortality in the under-fives using the continuum of care principle that follows the life cycle approach, linking the facility with the community health services delivery system
- Strengthen the primary care approach including institutionalisation of the community health service delivery system.
- Follow a comprehensive approach to address both maternal and neonatal problems in an integrated fashion, with particular focus given to providing standard postnatal care.
- Address the issue of user fees.
- Enable a task-sharing policy to scale up child survival intervention.
The 8 Millennium Development Goals
- 1 Eradicate extreme hunger and poverty
- 2 Achieve universal primary education
- 3 Promote gender equality and empower women
- 4 Reduce child mortality
- 5 Improve maternal health
- 6 Combat HIV/AIDS, malaria and other diseases
- 7 Ensure environmental sustainability
- 8 Develop a global partnership for development
Targets for MDG4
- Reduce by two thirds the mortality rate among children under five
- Under-five mortality rate
- Infant mortality rate
- Proportion of 1 year-old children immunised against measles