National Child Mortality Study 2009: Summary report
© UNICEF Mozambique
Mozambique, 30 September 2009 – The Ministry of Health, with support from UNICEF and the London School of Hygiene and Tropical Medicine, conducted a national child mortality study in 2008 to measure neonatal, infant and under-five mortality rates in Mozambique for all programme-relevant causes using data collected at community level.
The study used verbal autopsy (VA) as the main method for data collection. Verbal autopsy refers to the interviewing of family members or caregivers about the circumstances of the death of a child.
The study encompassed all under-five deaths identified through the INCAM (National Study on the Causes of Death), which itself captured deaths of all ages in a representative sample of 388 clusters of about 2000 inhabitants from all 11 provinces of Mozambique, in the one-year period from 1 August 2006 to 31 July 2007.
In addition to these, the study made use of nearly 500 children under five years of age who died in rural and urban hospitals as reference cases. These cases were reviewed by physicians who used all available information not only from the VA but also from the medical records of the child to attribute the cause of death.
Summary of results
- For the neonatal period (bellow one month), research indicates the three major causes of death are: prematurity (35%), birth asphyxia (24%) and sepsis of the newborn (17%), accounting in total for 76% of the mortality in this age group. The remaining deaths are caused by infectious diseases (12%) and other non-infectious causes (12%).
- In the post-neonatal period (1-12 months), the main cause of death is malaria (33%), followed by acute lower respiratory infection (ALRI) (19%), AIDS (11%), diarrhoeal diseases (10%), meningitis (3%) and other infectious diseases (10%). Non-infectious diseases account for 14% of deaths.
- For one to four-year-old children, malaria accounts for nearly half (46%) of the deaths. Other causes are AIDS (13%), diarrhoeal diseases (8%), ALRI and malnutrition (6% each), other infectious diseases (4%, including meningitis) and 16% for other non-infectious diseases.
- At the area level, the highest proportions of deaths from diarrhoeal diseases are found in Inhambane (12%) and Cabo Delgado (11%).
- AIDS deaths are in somehow higher proportions in urban (11%) than in rural (9%) areas, with Maputo Province (18%) and Gaza (16%) showing the highest mortality fractions.
- With respect to malaria, the rural areas indicate the highest proportions of death (34%). Malaria accounts for over a quarter of under-five deaths in all provinces except for Maputo Province and Maputo City (both 18%).
- Finally, acute lower respiratory infections (ALRI) represent 13% to 14% of under-five deaths in the four provinces of Zambézia, Tete, Manica and Cabo Delgado.
© UNICEF Mozambique
In terms of cause-specific mortality rates among under-fives, the rural areas have the highest levels for diarrhoeal diseases (110 per 10,000 pyrs), malaria (551) and ALRI (163), while mortality rates for AIDS are similar at around 150 per 10,000 pyrs in both rural and urban areas.
- The study confirms malaria as the primary cause of child mortality in the country, responsible for about one third of deaths in children under five years of age.
- The specific neonatal causes (birth asphyxia, sepsis of the newborn and prematurity) are the secondary cause, contributing approximately 16% of the under-five deaths.
- Acute lower respiratory infections and AIDS, each contributing about 10% of the child deaths, followed by intestinal infectious diseases responsible for about 7%.
- The verbal autopsy method (also know as King-Lu method) has shown to be useful for attributing cause-specific mortality fractions.
- The country should pursue and intensify its efforts to reduce the incidence as well as the fatality rate of malaria, increasing the proportion of children sleeping under an insecticide treated net (currently 23%) – and reinforcing, where appropriate, its pulverisation programme as well as increasing the percentage of cases treated with anti-malarial drugs within 24 hours of onset of symptoms (currently 23%).
- The country should pursue and intensify its efforts to reduce neonatal mortality, increasing the proportion of deliveries assisted by health professionals (currently 55%), as well as its capacity for obstetrical intervention and timely referral of deliveries requiring specialised assistance.
- There is a need to increase the proportion of suspected pneumonias cases that procure health services (currently 65%) and receive antibiotic treatment (currently 22%).
- It is also necessary to increase the percentage of pregnant women that receive information on HIV and AIDS (currently 60%) and are tested (currently 29%) during their prenatal consultations, and of sero-positive women and babies that receive adequate treatment for the prevention of vertical transmission.
- Although statistics point at significant advances in the reduction of deaths from diarrhoeal diseases, the level of use of oral rehydration therapy (currently 54%) needs to be increased, and the knowledge of caretakers improved in order to reduce further mortality from this eminently preventable cause of death.
- Special efforts must be concentrated in the provinces of Zambézia and Cabo Delgado as they show high mortality rates for several of the most important causes of death in under-fives.