Infant Mortality

Infant mortality and parity in recent Tanzanian history, Dr cand Bonaventure Ngowi

Lecture on infant mortality, University of Dar es Salaam, December 2005, by Gunnar Thorvaldsen

Excerpts from theses on infant mortality in the regions of Tanzania

The following master theses have been defended at the University of Dar es Salaam and are available unabridged from the University's Demographic Training Unit and the University Library. They were defended from 1988 to 1997 and have a similar statistical approach although the variables focused on are somewhat different from thesis to thesis. At this web site major parts have been copied as pdf files, primarily the conclusions and recommendations. If you don't already have Acrobat Reader installed, it can be downloaded from Adobe's website. A brief summary and a table showing the most significant variables, is also available. As the overview below shows, six regions were studied in twelve theses, Dodoma being analyzed by different authors.

Summary

During the ten year period from 1887 to 1997, ten master dissertations on infant and child mortality were defended at the University of Dar Es Salaam. The contents, structure and the use of different statistical methods are to some extent common for all the dissertations. They all have a regional scope, analyzing rural and/or urban settings, and for every district except Mbeya, the students have focused on different socio-economic factors influencing infant and child mortality. In some districts they concentrated on digging deeper into one potential single causal factors such as breastfeeding and women's reproductive health respectively in Dodoma, marriage patterns in Kibaha, parents' education and age of mother and parity in Mbeya.

Of particular interest is the dissertations regionalal perspective, emphasizing that Tanzania is a country with different mortality levels, and that the different mortality levels have their own multicausal explanations.

Some findings

In Kilimanjaro, Mbeya and Kibaha, i e both in low and high mortality areas, we find that mothers' age, parity and birth intervals are singled out as important variables. Women under the age of 20 years, with parity one or above five and birth intervals less than 24 months were the most vulnerable groups in all three districts. These maternal variables, the three last one often a consequence of the mother's low age, are closely connected to traditions and cultural behaviour and the patterns seem to dominate in rural areas.

Maternal education and occupation as well as to some extent the education of the child's father, were important variables when trying to understand in what way education is linked to the mothers' consciousness and access to knowledge about proper child care. In some districts there was a huge mortality difference between children born to illiterate women and those with education. However, other studies showed small differences in death rates for children born to women with no formal education compared to women with education on the primary level. These different results give us a clear example of how difficult it is to measure to what extent indirect and direct causes operate at different levels and in different settings. As one student wrote: 'It is not education per se that influences child mortality, but rather the mechanism through which it operates.' Mothers' education was also discussed in the context of the increased working opportunities.On the one hand the positive effect from the income and on the other hand the negative consequence ' the mother being away from home. For some districts these scenarios were often described as having negative effects on infant and child care due to the fact that the servants replacing the mother often are illiterate.

Source of water, type of toilet and availability of health facilities are all factor that influence infant and child mortality, but it is clear from the studies that these factors operate differentially. While health facilities can be a crucial factor to explain the mortality level in one area, analysis in other areas shown only weak effects. All dissertations except one from Mbeya deal with both infant and child mortality. Since the discussion often ends up with a description where infant and child mortality is regarded as one under-five group, it would have been a strength to distinguish child from infant mortality and also neonatal from later infant mortality.