Abstract
A study was carried out to determine secular changes in all-cause mortality rates for children aged < 5 years in 1960-1989 and their association with measles and malnutrition mortality rates in the same age group in the same period in city of Gweru, Zimbabwe. The study utilized under-fives mortality data from births and deaths registration office and measles and malnutrition surveillance data obtained from Gweru city’s public health department. Data was analysed in SPSS version 20 for windows and linear regression analysis was used to determine whether measles and malnutrition mortality rates were independent predictors of all-cause underfives mortality rates. It was found that in 1960-1989 underfives mortality rates from all causes were 10.2-63.7/1000 live births (median: 28.7, Q1 = 16.2, Q3 = 42.6) and these rates significantly and linearly declined in this period (χ2 for linear trend=165.74, p < 0.001). Measles mortality rates among underfives significantly and linearly declined (χ2 for linear trend = 812.49, p<0.001) while malnutrition mortality rates in the same age group also significantly and linearly declined (X2 for linear trend = 2411.54, p<0.001) in underfives in 1960-1989. Linear regression analysis indicated that malnutrition mortality rates (Regression Coefficient = 0.072, 95% CI = 0.039 - 0.104, p < 0.001) and measles mortality rates (Regression Coefficient = 0.029, 95% CI = 0.006-0.052, p=0.02) were independent predictors of all-cause underfives mortality rates with an adjusted coefficient of determination of 70.5% (Adjusted R2 = 0.7048) with malnutrition mortality rates uniquely explaining 21% of the variance in all-cause mortality (semipartial correlation squared = 0.21) while measles mortality rates uniquely explained 7% of the variance in all-cause mortality rates (semipartial correlation squared =0.068). It was concluded that decline in malnutrition and measles mortality rates among underfives significantly contributed to decline in all-cause underfives mortality rates in 1960-89 in Gweru city, Zimbabwe. On account of these findings, it is critical that efforts directed at controlling malnutrition and measles be intensified in areas and populations of similar settings.
Highlights
Malnutrition and measles are known to contribute significantly to all-cause underfives mortality and, their control would contribute substantially to reduction in all-cause underfives mortality [1,2,3]
Measles and malnutrition mortality rates among underfives, and all-cause mortality rates for the same age group in the period 1960-1989 are indicated in table 1 and figure 1
A study that examined secular trends in mortality attributed to measles in Gweru in 1967-89 found that both measles and malnutrition mortality rates had declined among underfives in that period [12]
Summary
Malnutrition and measles are known to contribute significantly to all-cause underfives mortality and, their control would contribute substantially to reduction in all-cause underfives mortality [1,2,3]. Underfives mortality attributed to undernutrition has been estimated at 53-55% [2, 4] and on account of this it has been concluded that effort directed at reducing malnutrition should be a policy priority [1]. Measles control through improved vaccination efforts is estimated to have reduced all-cause child mortality by 23% in the period 1990-2008 [3]. On account of the importance of malnutrition and measles to child deaths, a retrospective study that examined secular changes in all-cause underfives mortality in the period 1960-89 in the city of Gweru in Zimbabwe explored the relationship between these secular changes and mortality attributed to measles and malnutrition in children of the same age group in the same period. Tawanda Marufu et al.: Impact of Malnutrition and Measles Mortality on Underfives All-Cause
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