Differentials in under-five mortality in Zambia: Persistent gaps in child survival interventions?

Abstract

Introduction:The millennium Development Goal (MDG) focused on child mortality aims at reducing the under-fire mortality rate (U5MR) by two thirds between 1990 and 2015. for Zambia ; this means reducing the 2007 U5MR of 119 to 64 deaths per thousand live infant mortality from 95 to 32 deaths per thousands live births . The question facing policy markers in Zambia is how can currend child survival interventions be realized and effectively contribute the attainment of the MDG on child mortality in the next decade. To answers this question; a secondary data analysis was done. Methodology: U5MR in Zambia was analyzed using secondary data from Zambia health and Demographic surveys 1992; 1996 ;2001 /2 and 2007( Preliminary data) other sources of data were health management information system (2004-2008) and censures 1960 ; 1970; 1980; 1990 ;and 2000 . Trends in U5MR were mapped for various parameters levels and patterns of U5MR; distribution by geographical areas and cause of death. Results : U5MR in Zambia has had periods of improvement and regression and is currently estimated at 119 deaths per thousand live births .thirty four percent (34) of all deaths among under-five children occur in the neonatal period (0-20 days );while 48occur in the post -neonatal period and more than a half (53) of neonate die with in the first week of their life . Marked disparities in the levels of under- five mortality and within provinces exist; raising issues of equiet in health services. Although strides have been made to roll out key child survival interventions; large proportions of children under five are still not reached and disparities are observed in coverage .The top five causes of health facility based mortality are due to preventable diseases while malnutrition and HIV/Aids are both the cause and contributor. Recommendation: Include need to (I) routinely review child survival interventions to identify elements that work to reduce child mortality (II) undertake operational research grounded in relevant theoretical framework which will specify causal pathways linking child mortality rate and its proximal and distal determinants in U5MR by age and in coverge of child survival interventions. Definitions 1-Under-five mortality: Probability of dying between bird and age 5 expressed per thousand live births ; 2-Neonatal mortality :deaths during the first 28 days of life ;3-Post -neonatal mortality :Deaths between the ages of 28 days and 12 months ; 4-Death rate under the age of 1 expressed per thousand live births; 5-Child mortality: the probability between 12 months and 59 months of age expressed per thousand live births ; 6-full vaccination: A child is considered fully vaccination if he or she receives a BCG vaccination against tuberculosis ; three doses of DPT vaccine to prevent diphtheria ; pertussis ; and tetanus(DPT) ; at least three doses of polio vaccine; and one doses of measles vaccine. These vaccinations should be received during the first year of life.7-MDG number 4: reduce by two thirds; between 1990 and 2015; the under-five mortality rate.