Infant and child mortality in Zimbabwe : an analysis of levels, trends, differentials and determinants
Creators: name: Jhamba, Tapiwa
Publisher: name: The Australian National University
Year: 1995
Subjects: subject: Infants MortalityZimbabwe
subject: Children MortalityZimbabwe

description: This study examined levels, trends, differentials and determinants of infant and child mortality in Zimbabwe covering the period from the late 1960s to the early 1990s. The study was based on data collected in the 1982 Census, the 1992 Census and three nationally representative surveys: the 1984 Zimbabwe Reproductive and Health Survey (ZRHS), the 1987 Inter-Censal Demographic Survey (ICDS) and the 1988 Zimbabwe Demographic and Health Survey (ZDHS). Infant and child mortality differentials and determinants were examined, first at the provincial and district level using the 1992 Census, and second at the individual woman level using the 1984 ZRHS, 1987 ICDS and 1988 ZDHS, and lastly at the individual child level using the birth history data from the 1988 ZDHS. At the national level, infant and child mortality declined significantly through the 1970s and 1980s with signs of a stagnation or an upward trend around 1990. Results from the 1992 Census show that substantial district variations in infant and child mortality exist in Zimbabwe. A high mortality belt exists along the borders with Mozambique in the east and north-east and the border with Zambia in the north. The district variations are associated with levels of female education, fertility level and population density. It is argued that the district variations are generally related to broader characteristics which include natural environmental conditions, levels of socioeconomic development, and ethnic and cultural factors which may influence beliefs, practices and the diffusion of health related information. With respect to individual children, maternal age and birth order had significant independent effects on infant mortality but not child mortality, indicating that their effects were mainly biological and related to circumstances at birth. Short preceding birth intervals of 18 months or less were associated with significantly higher infant and child mortality and the effects were independent of the survival of the preceding sibling, indicating that sibling competition was not the main mechanism of influence. Also, shorter succeeding birth intervals were associated with higher probabilities of dying between ages one and five years, a likely effect of interruption of breastfeeding. The survival of successive siblings was correlated, which indicates the existence of common endogenous, environmental or family level factors affecting successive siblings. Differentials by sex of child did not show any evidence of the effects of sex preference on infant and child mortality. Characteristics of mothers that were significantly related to the mortality of their children include place of residence, education, age at marriage, ever-use of modem contraception, and whether or not the mother had pre-natal care for the last child. Place of residence and use of modem contraception were particularly important during infancy while maternal education and province of residence were important between ages one and five years. Higher maternal education, ever-use of modem contraception and residence in urban areas, the effects of which were largely independent of maternal reproductive characteristics, may indicate better maternal knowledge concerning nutrition, hygiene and curative and preventive medical care, and access to health services. This study found that the levels and factors affecting infant and child mortality vary according to the economic and social organisation of the place of residence. Child mortality was highest on commercial farms, lowest in urban areas and intermediate in communal areas. In communal areas, household possession of cattle and an ox-drawn cart, and paternal occupation were significantly associated with infant mortality, and the availability of a toilet facility had significant effects on child mortality. In the long term, the combination of higher educational attainment by women, increase in age at marriage, delay in age at first pregnancy, use of modem contraception, longer birth spacing, increase in utilisation of health services and promotion of public health awareness are expected to further reduce infant and child mortality in Zimbabwe. This would only be realised if the effects of the economic structural adjustment program (ES AP) on provision of health and other social services is minimal and that he spread of HIV and AIDS is controlled, otherwise infant and child mortality will indeed increase.