Academic journal article Journal of Health Population and Nutrition

Geographic Differentials in Mortality of Children in Mozambique: Their Implications for Achievement of Millennium Development Goal 4

Academic journal article Journal of Health Population and Nutrition

Geographic Differentials in Mortality of Children in Mozambique: Their Implications for Achievement of Millennium Development Goal 4

Article excerpt

INTRODUCTION

In September 2000, Mozambique joined other countries in signing the declaration which launched the United Nations Millennium Development Goals (MDGs), with 1990 scenario as baseline. Of the eight MDGs, Goal 4 aims at reducing mortality of children aged less than five years (under-five mortality) by two-thirds within 2015. However, as stated by the UN report on the progress of the MDGs in 2010, child deaths are falling but not quickly enough to reach the target (1). The report found that, overall, sub-Saharan Africa still experiences high levels of under-five mortality compared to other regions of the world, although a reduction has occurred from 184 per 1,000 livebirths in 1990 to 144 per 1,000 livebirths in 2008 (1). Further, the report found that some countries in the sub-Saharan Africa region have achieved absolute reductions in under-five mortality against the odds of poverty. These countries include Mozambique, Ethiopia, and Malawi (1).

Although the baseline figures for mortality in 1990 are not available for Mozambique, the most recent country report on the progress towards the achievements of MDGs shows that under-five mortality has declined from 219 per 1,000 livebirths in 1997 to 178 per 1,000 in 2003 (1,2). In addition, data from the most recent Multiple Indicator Cluster Survey (MICS) showed that a further reduction has taken place, and in 2008, under-five mortality reached 154 per 1,000 livebirths (3). However, despite this positive development in under-five mortality rates at the national level, there is a growing concern regarding the persisting geographical differences in under-five mortality (1) (Table 1).

The 2010 country report on the MDGs for Mozambique noted that there were great geographical differences in under-five mortality. A child in the North province of Cabo Delgado was three times more likely to die before the age of five years than a child born in Maputo city (1). According to the report, infant mortality was lower in the Southern region compared to the Central and Northern regions of the country, with the mortality rate of 147 per 1,000 livebirths in Zambezia and 131 per 1,000 livebirths in Cabo Delgado (1). The rates of child mortality were 180 per 1,000 livebirths and 205 per 1,000 livebirths in Cabo Delgado and Zambezia respectively (1). Maputo city had a child mortality rate of 108 per 1,000 livebirths, and Maputo province had a child mortality rate of 103 per 1,000 livebirths. The report noted that the country had a potential to achieve its overall 2015 targets for child mortality (67 per 1,000 livebirths) and under-five mortality (108 per 1,000 livebirths) (1). However, no breakdown for the child mortality and underfive mortality targets by province was given.

Geographically, the country exhibits substantial differences in welfare and economic development, with a high concentration of economic activities, infrastructure, and basic services (including healthcare facilities) in and around the capital Maputo city, situated in the very south of the country (4) (Table 2). This has resulted in differences in the development of regional welfare, which are important issues in Mozambican society and politics.

To understand the role of province (region) of residence in the differentials of under-five mortality in Mozambique, this study relies on the framework of the proximate determinants by Mosley and Chen (5). The model of the proximate determinants was developed to study the factors affecting child mortality and is based on the idea that all social and economic determinants of child mortality operate through a set of biological or proximate determinants to affect a child's probability of survival (5). The model combined social, economic, medical and biological explanations of child mortality. Mosley and Chen (5) grouped the proximate determinants into five categories: (i) maternal factors (age, parity, and birth interval); (ii) environmental contamination (air, food/water/fingers, skin/soil/ inanimate objects, and insect vectors); (iii) nutrient deficiency (calories, proteins, and micronutrients, such as vitamins and minerals; (iv) injury (accidental or intentional); and (v) personal illness control (personal preventive measures and medical treatment). …

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