Academic journal article Bulletin of the World Health Organization

Child Mortality in a Collapsing African Society

Academic journal article Bulletin of the World Health Organization

Child Mortality in a Collapsing African Society

Article excerpt

Introduction

A number of African countries have experienced socioeconomic difficulties and civil war over the past few decades, including Somalia, Ethiopia, Sudan, Chad, Liberia, Uganda, Angola, and Mozambique. The consequences of such disasters for the health of infants and under-5-year-olds are well known (1, 2). Reports from some of these countries mention high mortality rates during infancy and childhood in times of war (3, 4). However, there have been few studies that have reported longitudinal data on child mortality for a society that is undergoing social and economic collapse, and have analysed the social stratification of such mortality trends (5).

Epidemiological studies offer good possibilities for examining the impact on health of socioeconomic and political changes in society. Various characteristics can be used to identify communities at high risk. However, population-based data on mortality are not readily available in countries where health services do not cover all segments of the population and where information about vital events is incomplete (6). Thus, active epidemiological surveillance of infant and undet-5-year-old mortality remains a valuable and sensitive indicator of socioeconomic changes and is particularly useful for distinguishing between subgroups of the population (6).

In Somalia, the political and social situation deteriorated during the 1980s prior to the onset of the civil war in 1990. In two villages situated 40km from the capital, Mogadishu, a demographic surveillance study was carried out over the period 1987-89. The results provided us with an opportunity to study child health development prior to the onset of the civil war.

The present article assesses infant and under-5-year-old mortality in this rural Somali community, analyses the relative importance of socioeconomic characteristics on mortality, discusses the preventability of mortality, and analyses the mortality trends against a background of deteriorating socioeconomic conditions.

Materials and methods

Study area

The study was performed in two Somali villages, Lama-Doonka and Buulalow, situated approximately 10 km from the Shabeelle river and 40km from Mogadishu. In these villages, chosen as representative of the semi-arid agricultural area between the Somali rivers, a Somali-swedish collaborative research project had been in progress aimed at using epidemiological methods in the planning of public health activities. A field study base was established, where socioanthropological data constituted the background for a series of specific studies mainly focusing on women's and child health (7, 8)(a,b) The inhabitants were subsistence farmers, and did not represent a wealthy segment of Somali society. A small proportion of the population practised nomadic pastoralism part of the year and a large number bred cattle and earned a surplus from milk production.

In these two vinages, community health workers were trained, traditional midwives were given additional training, simple health centres were built by the villagers, and basic health care was provided. The primary health care activities at the regional and district level were gradually breaking down over the period 1987-89, with an accompanying lack of essential drugs and collapse of preventive activities, including immunization programmes. Reports of the political and social unrest in the central and northern regions of the country occurred on a daily basis. Commodities such as fuel and food, if available, were sold at high prices, and were hardly affordable for the ordinary villager. Internal refugees moved south from the northern part of Somalia, where the fighting intensified in 1988.

Study methods

A demographic surveillance system was in place from January 1987 to December 1989 in the two study villages. After an inital census (2456 inhabitants), all births, deaths, and in- and out-migrations were registered through intensive collaboration with village leaders, village health workers, and traditional birth attendants. …

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