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Child and maternal mortality during a period of conflict in Beira City, Mozambique.

Abstract：

BACKGROUND:Child mortality rates have been declining in most developing countries. We studied child and maternal mortality risk factors for child mortality in Beira city in July 1993, after a decade of conflict in Mozambique. METHODS:A community-based cluster sample survey of 4609 women of childbearing age was conducted. Indirect techniques were used to estimate child mortality ('children ever born' method and Preceding Birth Techniques (PBT) and maternal mortality (sisterhood method). Deaths among the most recent born child, born since July 1990, were classified as cases (n = 106), and two controls, matched by age and cluster, were selected per case. RESULTS:Indirect estimates of the probability of dying from birth to age 5 (deaths before age 5 years, (5)q(0) per 1000) decreased from 246 in 1977/8 to 212 in 1988/9. The PBT estimate of 1990/91 was 154 (95 percent confidence interval [CI]: 124-184), but recent deaths may have been underreported. Lack of beds in the household (odds ratio [OR] = 2.0, 95 percent CI: 1.1-3.8), absence of the father (OR = 2.4, 95 percent CI : 1.2-4.8), low paternal educational level (OR = 2.1, 95 percent CI: 0.8-5.4), young maternal age (OR = 2.0, 95 percent CI: 1.0-3.7), self-reported maternal illness (OR = 2.4, 95 percent CI : 1.2-4.9), and home delivery of the child (OR = 2.3, 95 percent CI : 1.2-4.5) were associated with increased mortality, but the sensitivity of risk factors was low. Estimated maternal mortality was 410/100 000 live births with a reference date of 1982. CONCLUSIONS:Child mortality decreased slowly over the 1980s in Beira despite poor living conditions caused by the indirect effects of the war. Coverage of health services increased over this period. The appropriateness of a risk approach to maternal-child-health care needs further evaluation. :In July 1993, public health specialists conducted a cluster sample survey of 4609 women aged 15-49 living in 3190 houses in Beira city to determine child and maternal mortality after 10 years of internal conflict in Mozambique and a nested case control study of risk factors for child mortality. The indirect estimate techniques were child ever born and preceding birth techniques for child mortality and the sisterhood method for maternal mortality. The case control study compared 106 deaths among the most recent born child born since July 1990 with two age- and cluster-matched controls. The proportion of dead sisters who died of pregnancy-related causes was only 10.3% compared to 25-33% in developing countries. In 1982, the estimated maternal mortality ratio was 410/100,000 live births. The lifetime risk of maternal mortality was 263/1000. The preceding birth technique obtained a much lower child mortality estimate than the child ever born technique (154 vs. 212/1000). The child ever born technique analyzed data from 1977-1978 to 1988-1989 and found that the probability of dying from birth to age 5 fell 14% (246-212). During this period, coverage of health services improved. Even though the preceding birth technique is usually more reliable for recent estimates, underreporting of recent child deaths likely contributed to the lower child mortality estimate. Risk factors for child mortality included no beds in the household (odds ratio [OR] = 2.02), absence of the father (OR = 2.43), low paternal educational level (OR = 2.08), young maternal age (OR = 1.96), self-reported maternal illness since birth of child (OR = 2.43), and home delivery (OR = 2.31). Yet the sensitivity of these risk factors was rather low (15-57%). These findings show that child mortality fell slowly during the 1980s despite the poor living conditions brought about by the indirect effects of the civil war. They point to the need to further evaluate the appropriateness of a risk approach to maternal and child health care needs.

journal_name

Int J Epidemiol

journal_title

International journal of epidemiology

authors

Cutts FT,Dos Santos C,Novoa A,David P,Macassa G,Soares AC

doi

10.1093/ije/25.2.349

subject

Has Abstract

pub_date

1996-04-01 00:00:00

pages

349-56

issue

eissn

0300-5771

issn

1464-3685

journal_volume

pub_type

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Child and maternal mortality during a period of conflict in Beira City, Mozambique.