Correlates and trend analysis study of under-five mortality among displaced populations: a case of meheba refugee camp

Abstract

Introdution: 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. Demographic health surveys conducted between 1992 and 2014 show notable reductions in under-five mortality levels from 191/1000 in 1992 to 75/1000 in 2014. 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 within rural areas. Studies conducted on the evolution of mortality in refugee camps suggest that camp mortality levels reach comparable levels or much lower than host population following effective survival interventions and the camp reaches the “post emergency phase”. Methodology: The study examined differential levels and trends of under-five mortality with correlating factors in Meheba refugee camp in Northwestern province of 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. The cummulative total of children reviewed in seven year reviewed period was 20,600 under-five years children with average population of 2943 children. STATA 12 and Microsoft Excel 2010 where used for data analysis and computation of findings. Results: Malaria and respiratory infections (Pneumonia and Non Pneumonia) accounted for 81% of under-five deaths reported in the period 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 1year (<1yr) with highest mortalities reported in 2013. 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. Conclusion: In 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-five years. The study found that increased health centre visitations were associated with reduction in under-five mortality and encourages intiatives targeted at sensitizing communities to seek health care. Furthermore, collaboration between the health systems, community and 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