Trends in infant and child mortality in Mozambique during and after a period of conflict
Introduction
Infant mortality has traditionally been considered an important indicator for describing mortality conditions, health progress and, indeed, the overall social and economic well-being of a country. For several reasons, child mortality (mortality from age 1 to 4 years) needs to be examined in addition to infant mortality.1
In Mozambique, due to the socio-economical and socio-political environment which has prevailed since the country's independence in 1975, few studies of infant and child mortality have been done at national level.2 As in many other developing countries, in Mozambique, the civil registration system is not reliable. Most of the existing infrastructure is confined to urban areas or to relatively small parts of rural areas that cannot be regarded as representative of the rest of the country. Although registration of births, marriages and deaths is compulsory by law, coverage has been very low.3
Socio-economic and demographic changes which have occurred in the country have influenced the health status of the population, especially of children below 5 years of age. The civil war (1976–1992) displaced many people and substantial immigration occurred to all cities of the country, degrading the health of the population in its surroundings.4 Studies carried out at local level have reported high levels of childhood mortality.5., 6., 7.
Studies of differentials of childhood mortality by place of residence in other countries have reported higher levels of childhood mortality in rural than urban areas.8., 9., 10.
In 1997, a Demographic and Health Survey (DHS) was carried out in Mozambique. Although the official DHS report has analysed the differentials of childhood mortality by place of residence, figures on the level of mortality were given for the entire 10-year period preceding the survey (1987–1997). The purpose of this study is to describe trends over time of infant, child and under-five mortality in rural and urban areas.
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Background
The last national census in Mozambique (1997) estimated a total population of 15 278 334 with the majority (71.4%) living in rural areas.11
After independence from Portugal in 1975, the government initiated a socialist policy. There were considerable improvements in health and education, priority being given to the extension of primary health care to rural areas. The first years of independence were marked by economic growth and in the 1975–1980 period, the gross national product rose by over
Infant mortality
In urban areas, infant mortality declined between the periods 1973–1977 and 1988–1992 and then increased in the period 1993–1997. In rural areas, mortality declined between 1973–1977 and 1978–1982; increased in 1988–1992 and declined again in 1993–1997 (Fig. 1).
Child mortality
In the period 1983–1987, child mortality in urban and rural areas was 45/1000 and 91/1000, respectively. In the following period, mortality remained almost constant in urban areas and increased to 109/1000 in rural areas. In the last 4
Discussion
Although the latest two 5-year periods (approximately 15–24 years before the survey) will not be discussed in detail, it is important to state that the slight declines in infant, child and under-five mortality between 1973–1977 and 1978–1982 may have reflected the relative progress that the country experienced in the years following independence (1975), and possibly reflects the governmental policy at that time which prioritized the extension of primary health care in rural areas and mass
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