DEPARTMENTS
ADMINISTRATION
EPIDEMIOLOGY AND DISEASE CONTROL
HOSPITAL EQUIPMENT AND MAINTANANCE
Zimbabwe National Maternal & Child Health
Family Planning Survey 1997
Executive Summary
Global performance from appreciable efforts invested in the promotion and the maintenance of the maternal and child health in Zimbabwe, since the 1991 MCH/FP Survey are presented in details in the main part of this report.
The 1997 MCH/FP Survey was conducted throughout the country in all provinces and 2 major cities, Harare and Gweru. Gweru City was selected in replacement of Bulawayo City. A total of 28 districts were surveyed, covering 179 administrative wards and 870 enumeration areas. The sampling frame was adapted and developed on the basis of the most recent Central Statistics Office’s master sampling frame.
The primary data were collected during the period 08 to 19 December 1997, simultaneously throughout the country.
The executive summary provided hereunder gives a synopsis of the findings by specific area, focusing on the observed salient facts. The findings are presented in the following sequence:
STUDY POPULATION AND INDICATORS.
EXPANDED PROGRAMME ON IMMUNIZATION.
GROWTH MONITORING AND NUTRITIONAL STATUS OF CHILDREN.
HOME MANAGEMENT OF CHILDHOOD ILLNESSES.
MATERNITY SERVICES AND TETANUS TOXOIDS VACCINATION.
CONTRACEPTION USE AND PRACTICES.
HEALTH EDUCATION AND HEALTH PROMOTION AWARENESS.
PREVALENCE OF DISABILITY AND DISABILITY PREVENTION AT COMMUNITY LEVEL.
SEXUALLY TRANSMITTED INFECTIONS AND HIV/AIDS.
APPENDICES.
Expanded Programme on Immunization Coverages.
Generally, EPI coverage has improved from the performance observed in the 1991 MCH/FP Survey. The specific coverages achieved in the former survey being already high, the increases recorded in the 1997 MCH/FP Survey were understandably not too marked. Specifically, vaccination coverage increased by 4.6% for BCG, 1.6% for Measles and by 2.9, 1.1, 3.2, 1.0 percent for DPT1, DPT3, OPV1 and OPV3 respectively.
Globally, the overall drop out rate (BCG - Measles) remained below 10% (7.9%), though 3 provinces recorded overall drop out rates higher than 10%; namely, Manicaland (16,6%), Midlands (12.6%) and Masvingo (10.18%). The majority o f children (85.8%) were fully immunized for their age. For those who had completed the course of primary immunization (86.04%), 96.6 percent achieved it before reaching one year of age.
The visible BCG scar was observed in 87% of the children while 96.3% of children received BCG vaccine. Overall, the discordance level BCG vaccination and visible BCG Scar was -9.84%, less than the discordance level observed in the 1991 MCH/FP Survey (-12%).
Growth Monitoring and Nutritional Status.
Children surveyed had an average age of 30.8 months weight of 11.32 kg and height of 81.7 cm. Girls children were slightly older (31.07 months) than boys (30.53 months). Only 10.3% of children were forced to have had low weight at birth. Bottle feeds were used for 5.7% of children and the average weaning age was 18 months.
Visits to health centre for children’s growth monitoring and nutritional surveillance were undertaken once every month by 76.6% of mothers/caretakers. The global malnutrition rate was 15.18% with no significant difference between boy (16.14%) and female (14.01%) children. Severe malnutrition ( WFA Z-score below - 3%) was 2.71%.
Home Management of Childhood Illnesses.
The prevalence of Diarrhea and ARI were 27 and 30 percent respectively. Of the 1 733 children with Diarrhoea, only 4.1% had blood in the stools. The majority of parents or caretakers (71.6%) were comfortable treating their children suffering from Diarrhoea at home while only 23.3% would resort to seeking treatment of health facility. The management of Diarrhoea at the health facility was characterized by high use of Antibiotics (39.4%)
The knowledge of the correct danger signs of Diarrhoeal Diseases and those of the Acute Respiratory Infections was relatively high, averaging 63.3%. Young mothers, aged less than 15 years and older (above 30 year of age) appeared to be less knowledgeable of the specific precursor signs of the imminent danger threatening the life of the sick child.
In the two weeks preceding the survey, 30.7% of children suffered from cough; Among them, 633 or 35.6% developed difficult breathing. Fewer parents than noted in the case of Diarrhoeal Diseases, would opt for home treatment for children with ARI (43.8%) and more would consult health workers (50.8%). The management of ARI conditions at health facility was characterized by a high use of antibiotics (29.4%) and antipyretics(26.2%)
Maternity Services and Tetanus Toxoids Vaccination.
The possession of ANC and TT cards was minimally good as only 44.2and 55,6 percent of mothers had TT and ANC cards respectively. Despite a high TT2 coverage rate of 76.7%, the proportion of children during the valid protection period was low at 49.8%. The prenatal care attendance was at 88.1%, marking a 7% decline from the level observed in the 1991 MCH/FP Survey.
On average , the women registered for the prenatal care services at a gestational age of 21 weeks and attended 5 ANC sessions before delivery. The lack of money was most frequently cited as the reason for the late and no booking at all for ANC (25.5 and 27.7 percent respectively). Thirty six percent of mothers who did not utilize prenatal services were motivated by religious reasons.
In their majority, women delivered at health institutions (71.5%). Only 49.4% of home deliveries were assisted by trained traditional birth attendants. The utilization of post natal care services was relatively high (71%); the first visit of PNC took place at six weeks post partum by 65.3% of mothers.
Contraception Use and Practices.
Most indicators point to improved knowledge and coverage of family planning services in Zimbabwe. As the contraceptive prevalence rate increased from 48% to 60%, the average number of live births per woman decreased from 3.5 to 2.9. Contraceptive use was highest in women between 20 and 40 years of age. However, adolescents, who are at more risk of obstetric complications, continue to give birth at the same rate as their counterparts six years ago.
Health Education and Health Promotion Awareness.
The health education and Promotion activities were found to be in improved in many aspects. Health workers remained the main source of Health information for 71% of the respondents. The radio coming second for only 15.6% of the people. Radio 2 emerged as the most preferred and listened station with an average of 90.3% listeners recorded in the survey.
Of the 6 052 respondents, 63% visited a health facility during the three months preceding the survey. Only 47% of the health facility users received some form of health education or information. The awareness of specific health conditions such as Malaria was high but the treatment seeking practices and the knowledge of the condition’s management were not very satisfactory. A lot of improvement is expected in this area. Infectious diseases, specifically HIV/AIDS, represented the most common conditions mothers wanted to know more about.
Prevalence of Disability and Disability Prevention at community level.
The Global disability found at community level amounted to 1.8%, with a predominance of the physical disability (1.3%) over the mental disability (0.5%). Only 70 children (1.2%) were reported to have developed abnormally slowly. The combined prevalence of developmental or growth problems in the children under five years of age was 3.2%. Abnormal limb was more frequent (0.72%) than others among which talking and moving problems were 0.57 and 0.54 percent respectively.
The community based rehabilitation programme remained known to few people (22%), may be due to the current level of the programme expansion. The national profile of the management of disability is dominated by physiotherapy and rehabilitative exercises (33.3%), training of caretakers (26.7%), surgery (13.3%), appliances provision ( 5.3%) and referrals to high capacity level (21.3%).
Sexually Transmitted Infections and HIV/AIDS.
A Universal awareness of diseases that are transmissible through sex was noted during this survey, where 95% of mothers knew about STI; HIV / AIDS was the most common with only 61.7% of mothers who knew about it. The number increased to 98.3% when respondent admitted to have heard about HIV/AIDS epidemics.
The modes of transmission and avoidance of HIV/ AIS were also highly known; The sexual intercourse with prostitutes was considered as the most plausible means of contracting HIV/AIDS (87.8%) and the use of Condom during sex (86%) to protect against HIV/AIDS. The use of condom or rather the ever use of condom was markedly low, as 82% of mothers reported to have never had a condom used during sexual intercourse by either of the partners.
Mothers (87.7%) were willing to test for HIV during pregnancy so as to know their HIV sero-status and, agreed to anti-retro viral therapy in case of positive HIV test in order to reduce HIV vertical transmission.
Thirty eight percent of mothers perceived nil risk of getting HIV/AIDS in their current modes of living, against 19.4% who considered themselves at great risk of contracting the HIV/AIDS virus.
The 1997 MCH/FP Survey was conducted during the period 08 to 19 December, 1997. The report presents major findings of this survey. The survey was supported by funding from the Ministry of Health and Child Welfare, Government of Zimbabwe with the assistance of partners in health.
Additional information on the survey and the findings can be obtained from:
The Director, Family and Child Health Department, Ministry of Health and Child Welfare, P.O. Box CY1122, Causeway, Harare, ZIMBABWE.
Telephone: +263-4-722697; Fax: +263-4-794734.