Child survival in a rural area in Zimbabwe: are we winning?

Health teams in a rural district in Zimbabwe have been implementing child survival programmes since 1984. A prospective study of the causes of morbidity and mortality in under-five children was done. Community based surveys assessing nutrition status, immunisation coverage and knowledge and use of sugar and salt solution for diarrhoea were carried out. Malnutrition, acute respiratory infections and diarrhoea accounted for 69.7 pc of the 902 under-fives admissions while 33 (67.4 pc) of the hospital deaths were under-fives. The mortality pattern parallelled that of morbidity. Malnutrition was more common in the dry communal areas and on the commercial estates. Full immunisation coverage rates in the 12-23-month-olds increased from 44.3 pc in 1984 to 70 pc in 1989; and up to 69 pc of the mothers correctly prepared and used sugar and salt solution for diarrhoea management. Although there appears to have been little impact on malnutrition, respiratory infections and diarrhoea, the study shows that a lot can be achieved even in a remote rural district given political will, community involvement, and dedicated staff. The maintenance of the current momentum and the introduction of further socio-economic reforms is a big challenge facing the health teams, community members and politicians.