Abstract

BackgroundUnder-five mortality, which is the probability of a child dying before their fifth birthday, is of concern in Zambia as infant and child mortality rates are important social indicators. Displaced population in camps provide a basis for under-five mortality surveillance because detailed registration databases have been developed. Additionally, health data routinely collected on mortality allowed for a review of mortality trends and identification of correlating factors to under-five mortality. Literature suggests a number of factors that influence child mortality including biological, socio-econimic and environmental factors. However, while progress in reducing mortality is evident disparities in under-five mortality trends have been observed.MethodsThe study examined differential levels and trends of under-five mortality with correlating factors in Meheba refugee camp in Zambia which is presently in its post emergency phase. The retrospective cross-sectional study reviewed the ProGres and Health Information System (HIS) databases under-five mortality data for a seven (7) year period (2008–2014) and included all children aged less than five years in each year of review. STATA 12 (including Ordinary Least Squares Regression) and Microsoft Excel 2010 where used for data analysis and computation of findings.ResultsMalaria and respiratory infections accounted for 81 % of under-five deaths while cases of Diarrhoea were responsible for 10 % of reported mortalities. Seventy five percent (75 %) of all mortalities were reported in children aged less than 1 year (<1 year). While no significant variations in mortality were noted as a result of time, increased frequency of visits to health centre significantly (P < 0.05) reduced mortalities in children by 3/1000 in each year.ConclusionIn addition to improving health infrastructure and reducing distances to health facilities, the study also recommends sensitization programmes targeted at ensuring accessibility to health care services for children under-5 years. The study found that increased health centre visitations were associated with reduction in under-five mortality and encourages initiatives targeted at sensitizing communities to seek health care. Furthermore, collaboration between the health systems, community and Non Governmental Organisations (NGOs) is key in addressing higher infant mortality observed. It is envisaged that this will contribute to the reduction in mortality cases and will compliment already existing strategies.

Highlights

  • Under-five mortality, which is the probability of a child dying before their fifth birthday, is of concern in Zambia as infant and child mortality rates are important social indicators

  • This study focused on all under-five mortality cases reported during the period 2008–2014 through the camp based Health Information System (HIS) database as well as number of children under the age of five resident in the camp who were assigned refugee status at Meheba

  • Findings from this study explored interventions by the United Nations High Commission for Refugees (UNHCR) and the MoH in reducing under-five deaths and revealed that years with higher mortality levels were met with responses around malaria control and notable increases in facility attendance by residents

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Summary

Introduction

Under-five mortality, which is the probability of a child dying before their fifth birthday, is of concern in Zambia as infant and child mortality rates are important social indicators. Under-five mortality is of concern in Zambia as infant and child mortality rates are important social indicators associated with wellbeing or quality of life. Demographic health survey (DHS) data collected between 1992 and 2013 suggests that Zambia has made some progress towards attainment of Millennium Development Goals (MDGs) evidenced, in part, by the reduction of child mortality. A United Nations International Children’s Emergency Fund (UNICEF) report (2013) highlights that if current trends of under-five mortality continue; the world will not meet Millennium Development Goal 4 – to cut the rate of under-five mortality by two-thirds by 2015. Studies conducted among displaced populations globally suggest that following transition to host country, refugee under five mortality rate (U5MR) reaches rates that are much lower than those of the host nation and community [8]. Mortality data collected consistently and routinely provides information relevant for decision making regarding the health of the population. Refugees are usually at the highest risk of mortality during the period immediately after their arrival in the country [9]

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