Home » General » Child Mortality – All Is Not Lost [analysis]

“Imagine, when you think your child has mastered the art of crawling and you are looking forward to seeing him or her stand without leaning on anything and subsequently walk, he or she succumbs to one of the child killer diseases. “It’s like you were given a light and it is suddenly snatched away, plunging you into total darkness.”

These were the words of Mrs Rosario Makoni of Chitungwiza, who lost her first child when she was 18 years old.

The baby succumbed to pneumonia.

Pneumonia is a serious lung infection characterised by coughing, high temperature, sweats, shivers and headaches.

One may also become breathless or breathe fast and develop a tight chest.

“He was only four months and we were just teaching him how to sit.

“They said I exposed him to the cold and he developed pneumonia. I didn’t know it was pneumonia until I went to the clinic ,

“But it was already too late. Little Tawana failed to make it, he died,” Mrs Makoni, now 28, recalled in a low voice.

She said all parents look forward to seeing their new-born babies grow through all stages of life, particularly between the ages of zero and five years when the baby develops fast from one stage to another.

“This is the stage when motherhood is exciting as you witness the baby learn to sit, crawl, walk and talk.

This is the stage where you make frequent visits to the clinic for monitoring of the baby’s growth and vaccinations against child killer diseases.

“While losing a child at any stage is disheartening, losing it before its fifth birthday is an unimaginable nightmare,” she said.

Statistics from the Family Health Department in the Ministry of Health and Child Care show that pneumonia is one of the commonest causes of death among children below the age of five years – also known as under five mortality – accounting for 12 percent of all deaths.

Other causes of under five mortality are HIV and Aids, which accounts for 21 percent of all deaths, birth asphyxia (deprivation of oxygen) and low birth weight 30 percent, diarrhoea 9 percent and measles 8 percent.

Malaria and injuries account for three and 2 percent respectively. All the other causes of deaths account for a combined 15 percent.

According to the Multiple Indicator Cluster Survey (MICS) 2014, an estimated 75 children in every 1 000 die before celebrating their fifth birthday.

“While still high, the MICS 2014 showed improvements in the provision of services and this has impacted positively on the under-five mortality, which has come down to 75 deaths per 1 000 live births,” said family health director Dr Bernard Madzima.

In 2000, the number of children dying before reaching the age of five years stood at 102 per every 1 000 before dropping to 91 per 1 000 in 2009 and 75 per 1 000 in 2012.

Zimbabwe had targeted to reduce the number of children who die before reaching the age of five years by at least 75 percent from 102 deaths per 1000 live births by end of 2015.

The target translates to about 27 deaths per 1 000 live births by the end of this year.

This is in line with the Millennium Development Goal Number 4.

Dr Madzima attributed the country’s failure to meet this target to a number of factors chief among them HIV.

“The economic downturn of the past 15 years also had an effect on general health service delivery including service to children,” he said.

Dr Madzima, however, said hopes were high that the country’s under-five mortality will continue to decrease from the current 75 deaths per 1 000 live births (MICS 2014) because of new interventions introduced in recent years.

“There has been introduction of the pneumonia gonococcal vaccine to curb pneumonia and the rota-virus to curb diarrhoea. Government is also scaling up high impact health interventions such as immunisation, elimination of mother to child transmission (EMTCT) and improving nutrition of children among other interventions,” said Dr Madzima.

Government has also scrapped maternal user fees in its facilities mainly in rural areas to enable those who cannot afford user fees to deliver under supervision from a skilled birth attendant to reduce the number of women or their new-born babies who die during child birth.

A skilled birth attendant is a health professional specifically trained to assist pregnant women to deliver.

Statistics from Government show that of late, the number of women who deliver under supervision from a skilled birth attendant has improved from 60 percent in 2009 to 80 percent in 2014.

Exclusive breastfeeding has also improved from 25,9 percent to 41 percent while measles vaccination improved from 68 percent to 82,2 percent.

According to medical research an estimated 22 percent of deaths could be avoided if every baby were breastfed within the first hour of life and by 16 percent if breastfeeding is started within the first 24 hours.

Full immunisation rose from 36,8 percent to 69,2 percent.

“All these interventions are expected to reduce the number of children who die before reaching five years,” said Dr Madzima.

According to a recent UNICEF report titled, “Levels and Trends in Child Mortality” (2014), in the past two decades, an estimated 223 million children died before their fifth birthday throughout the world.

A third of these children were in Sub- Saharan Africa where 12 countries have an under-five mortality of 100 deaths or more in every 1 000 live births.

These countries include Angola, Democratic Republic of Congo and Zambia among others.

Community Working Group on Health executive director Mr Itai Rusike said there was need to enforce the free health care policy rigorously particularly in impoverished communities to ensure universal health coverage.

He said this is where majority of families were struggling to meet costs of health thereby contributing to high cases of under-five mortality.

“Health care costs are becoming a larger share of household spending on health in Zimbabwe.

“Protecting people from impoverishing effects of health care in poor communities calls for the current policy on free health care for primary care level to be more rigorously enforced,” he said.

UNICEF Country Representative Mr Reza Hossaini said while the country missed its MDG target, there were notable improvements in interventions that can reduce numbers of children dying before the age of five years.

These interventions include introduction of new vaccines, increased immunisation coverage, adoption and scaling up of the EMTCT programme and scrapping of maternal user fees among others.

Mr Hossaini attributed some of these improvements to the Health Transition Fund (HTF) – a five-year programme implemented by Government and its development partners since 2011.

“Before 2011 when the HTF was launched, Zimbabwe’s health sector was haemorrhaging, doctors and nurses were leaving the country in their hundreds, the few that remained were overworked and morale was very low, there were widespread shortages of medicines and equipment and maternal and child mortality were among the highest in Africa,” said Mr Hossaini.

He said by 2009, around 37 600 under- five children were dying every year. By 2014, this figure had come down to 30 000.

“Of course, these results cannot be attributed to the HTF alone, but the HTF has been instrumental in catalysing the overall effort to resuscitate the health sector by investing in selected critical areas of the health system where huge funding gaps were identified,” he said.

Reducing under-five mortality rate, infant mortality rate and increasing the proportion of one-year-old children immunised against measles were some of the targets under MDG Goal No. 4 on reducing child mortality.

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