GOAL 4: REDUCE CHILD MORTALITY

NATIONAL TARGET FIVE: REDUCE BY TWO-THIRDS, BETWEEN 1990 AND 2015, THE UNDER-FIVE MORTALITY RATE

Status  and  Trends

Most child deaths are due to malaria, pneumonia, diarrhoea, malnutrition and complications of low birth weight as well as HIV and AIDS. Malnutrition is the underlying factor in more than 50 per cent of child deaths. So is neonatal deaths accounting for 50 per cent of infant mortality. Census data and those from surveillance sites suggest a decline in both infant and under-five mortality rate. Under-five mortality decreased from 191 per thousand live births in 1990 to 133 in 2005 and further to 81 in 2010 in the Mainland and from 202 in 1990 to 101 in 2005 in Zanzibar.

Figure 4a: Progress in achieving MDG 4; under five mortality rates

Source: TDHS 2010  and PHDR 2009

Supportive Environment

The government has developed strategies that aim at reducing infant mortality and child mortality, especially malaria-related morbidity and mortality. Programmes include improved vaccination coverage, availability of services including drugs at the time of need, Integrated Management of Childhood Illnesses (IMCI) rolled-over to all districts, efficient implementation of planned programmes; malaria control through use of mosquito nets particularly insecticide-treated nets (ITNs). Five out of ten mothers and children sleep under ITNs. Also, Intermittent Preventive Treatment (IPT) during pregnancy and immediate medical treatment of malaria for children under five years within the first 24 hours of the onset of symptoms. In addition there are programmes such as Vitamin A Supplementation (VAS), Prevention of Mother to Child Transmission (PMCT); promotion of exclusive breastfeeding for the first six months of infancy; and effective management of childhood diarrhoea.

Major Challenges  and  Priorities

The main challenges in health services delivery include: under funding, which affects especially physical infrastructure and procurement of equipment and instruments; unavailability of drugs and care all times of need and inadequate human resource base. Others are medical technology is changing rapidly while the coping mechanism is not yet in place; the epidemics of HIV and AIDS, recurrent cholera outbreaks and the threat of Avian flue worsens the already weak system. These are compounded by increased cost of drugs, resistant strains of microbes which necessitate the use of expensive combination therapies         and multidrug treatment. Other challenges include substantial urban/rural, regional and socio-economic differences – rural poor children are more likely than their urban counterparts to die or be malnourished.
 

In rural areas, only 42 per cent of mothers deliver at health facilities compared to 82 per cent in urban areas. Infants born in rural areas have 30 per cent higher probability of dying before completing their first birthday than those born in urban areas. Other factors affecting child survival include education status of the family and more so that of the mother which influence substantially the economic status of infant’s family. 80 per cent of births from the richest quintile were delivered by skilled personnel compare to 30 per cent for the poorest quintile. Infants from the least educated and poorest mothers had a 25 per cent higher probability of dying before completing one year than infants of mothers       from the richest quintile.


Again early pregnancies and marriages have a significant bearing not only on mothers’ education but also on the survival of their infants and their own health. There is an overlap of the education level of the mothers and the wealth of the family. The education level has more effect on the outcome than the wealth and the obvious rural urban divide on the morbidity and mortalities observed. The utilization of delivery services varies widely from 32 per cent low in rural areas to a high 90 per cent in Dar es Salaam,   the  commercial  capital.

Quick Impact Interventions

Scaling up the IMCI and Tanzania Essential Health Intervention Project (TEHIP) credited for reducing the infant mortality in Tanzania as noted in the DHS 2004/05;

• Institutionalizing IMCI and TEHIP in health training centers and institutions of higher learning;
• Increasing the health sector budget to approach the level of at least US $ 28 per capita recommended by the Millennium Project;
• Scaling up of immunization programme; and
• Provision of Vitamin A supplements including correction of malnutrition and micronutrients.

Likelihood of achieving MDG

MDG targets on child and infant mortality are very much on track. Vaccination against measles is progressing well. Overall, MDG4 is likely to be achieved.