Paste Child, infant, and under-five age mortality are among the measure of the impact of child survival, health interventions and are the key indicator of countries socially and economic development (UNIGME, 2014). In Africa, about 76.5 per 1000 live birth dying before reaching the five years of age this rate is eight times higher than that in European countries which is 9.6 per 1000live births (WHO, 2016). Sub-Saharan Africa remains the highest under-five mortality in the world, the children are higher than fifteen times more likely to die before the age of five than children in developed countries (WHO, 2017).
UNCHS found that high rate of child mortality was from the urban area. There are some factors which contribute to higher child mortality rate in urban area, among the factor mentioned were commitment of the government interventions on water service management, poor participation of private sector and other stakeholder in sewerage system provision, adequacy of potable water and sewerage connection, inequality of income within a city and absence of sufficient revenue at the city (UNCHS, 2013). The urban theorist and UN-Habitat II confirm that, the impact of the adequacy of water access as well as sewerage management in an urban area and the insufficiency of urban management as the major components that affecting child mortality in an urban area (Barker, 1986 and Pruth homme, 1994).
Tanzania also has experience higher mortality rate in an urban area whereby 48.5 mortality rate found in the urban area and 46 mortality rate found in the rural area, this can be confirmed by the following Table below which shows the mortality rate by sex in Tanzania.
Table 1.1: Rural and Urban Infant and Under-Five Mortality by Sex
Infant Mortality Under-five Mortality
Total Male Female Total Male Female
Tanzania 46.2 50.9 41.3 66.5 72.7 60.2
Rural 46.0 50.9 41.3 65.9 71.8 59.9
Urban 48.5 53.9 42.9 71.2 78.4 63.8
Source: United Republic of Tanzania (2015)
At the end of Millennium Development Goal, the 2030 agenda for sustainable development goals was presented and the total of 17 Sustainable Development Goals (SDGs) was agreed and confirmed by the global leaders on the basis of Millennium Development Goals (UN, 2015). Sustainable Development Goal 3 targets 3.2, is to reduce the infant and under-5 mortality by the end of 2030. This target aims to reduce the “under-five mortality to as low as 25 per thousand live births” and “neonatal mortality as low as 12 per 1000 live births” (UN, 2015). The problem of under-five mortality needs very urgent attention from the health sector and government commitment. If the conditions remain unchanged, it estimated sixty million innocent children will die until 2030
In addressing this problem, the World has made an effort in reducing the under-five mortality rate, where some countries have been successes to reducing the rate of child mortality, for example, China has been able to lower under-five mortality from 28.4% to 1.3 in 2013 (Rose, 2017). According to WHO (2016), this initiative made by the world has reduced child mortality rate by fifty-six percent from ninety-three percent deaths live births in 1990 to forty-one percent in 2016. The government of Tanzania has made substantial progress to lower under-five mortality rate, whereby health sectors have been included in BRN (Big Result Now) initiatives. This initiative aiming to improve service delivery and come up with the intended outcome. The initiative based on four keys important area in health sectors, these are maximizing the health human resources and distribute them into health centers, health commodity, increasing the performance in management and maternal, neonatal and child health care (WHO CCS, 2016). WHO with the cooperation of the government of Tanzania, has come with the strategies on reducing the rate of morbidity and the rate of death for preventable and communicable disease through a suitable and effective mechanism through improving health systems and addressing environmental issues in the society (WHO CCS, 2016).
The figure below shows the decline in infant mortality rate globally and in Tanzania
Source: UNIGME, (2018)
Figure 1.1 Decline of infant mortality rate globally and in Tanzania
Source: UNIGME, (2018)
Figure 1.2 Decline of under-five mortality rate globally and in Tanzania
Despite of strategies progress made by the World to lower under-five mortality in every region, Sub-Sahara countries including Tanzania continuous to have higher infant and under-five mortality whereby 84 death per every 1000 live birth in 2015 which is equivalent to twice than the global average (SDG Report, 2017). SDG report shows that the children are more likely to die at the first twenty-eight days of his life. Reducing the mortality rate for infant and under-five death still need a greater attention to focus on this period because the measures are taking slowly compare it before. This can be proved by the report from SDG which shows that the neonatal death is still higher in Sub -Sahara African whereby 29 birth deaths per 1000 lives birth in 2015. The table below shows the regions recorded higher under-five mortality rates above the average (between 72.3 and 93.9 under-five deaths per 1,000 live births).
Table: 1.2: Five regions in Tanzania with higher under-five mortality
Under-5Mortality(5q0 )
Administrative Total Male Female
Tanzania 66.5 72.7 60.2
Kagera 93.9 100.3 87.2
Iringa 90.7 100 82.2
Rukwa 81.2 87.6 74.6
Pwani 75.4 83.1 67.4
Dar es Salaam 72.3 79.5 64.9
Source: URT, (2015)
1.2 Aim and Scope of the study
Despite of decreasing the child mortality rates in Tanzania, there is still higher rate of death it is estimated at about 270 children under 5 who die every day, largely due to preventable causes. Newborn babies are especially at risk of dying; 37percent of under-five mortality is due to neonatal death (UNICEF, 2016). In Tanzania according to the last census 2012, shows that the urban area has higher mortality rate than a rural area, where infant and under-five mortality in urban area were estimated 48.5 and 71.2 death per 1000 live birth respectively and rural area was 46 and 65.9 deaths per 1000 live birth respectively (URT 2015). The result of urbanization the, UN-Habitat projected that more than half of African will live in the urban area at the end of 2030 (UN-Habitat, 2008). This result of urbanization will create the greater challenge in the world, especially in developing countries hence more efforts needed to reduce child mortality in the urban area. Therefore, more studies are needed to examine the factors that associated with this high mortality rate in children in the urban area. The Study focused on a population at risk of under-five ages at Dar es Salaam city in Tanzania. The data was drawn from Tanzania Demographic and Health Survey-TDHS (2015-2016). This represents a national coverage study. The study uses the birth history data of the respondent’s mothers, from Tanzania Demography and Health.
1.3 Research Objective, Questions and Hypotheses
The main objective of the study is to determine which socioeconomic factors and environmental factors that influence under-five mortality in urban area specific in Dar es Salaam Tanzania.
This study, therefore, seeks to answer the following research question:
What are the most important socioeconomic status and environmental determinants of under-five mortality in an urbanized area of Tanzania?
Based on theoretical approaches the hypotheses to be tested are,
1. Wealth status of a family can reduce or increase under-five mortality
2. Mother level of education can reduce or increase chances of under-five mortality
3. A working mother can experience lower or higher under-five mortality
4. Improved environmental factors can reduce under-five mortality
1.4 Outline of the thesis
The second chapter of this thesis outlines the literature review based on the theoretical framework, Conceptual framework and Empirical framework. The chapter begins with an introduction to the literature review. This section is followed by descriptions of the theories used in this thesis and empirical review for other studies. The third chapter is explaining in brief about the Methodology, data used, explanations of the variables included in the regression, limitation of the study, explanations of the statistical models used as well as the validity and reliability of this study. Chapter four describes the analysis and discussion of findings. Chapter five, Contribution of the study or practical implication, future research and conclusion of the thesis. Chapter six is for references.
2.0 LITERATURE REVIEW
This area focused on relevant literature reviews on the determinants of under-five mortality and this section will include the theoretical, empirical and conceptual reviews. The knowledge and understanding from these reviews helped to identify the research gaps that still exist in literature and which this study attempted to bridge. Also, the reviews helped to guide the analytical framework adopted in this work. Hence, findings from previous studies provided this research work with the opportunity to compare and contrast results.
2.1 Theoretical Background
2.1.1 Mosley and Chen Model
To explain this new phenomenon, this thesis employs the Mosley and Chen Model (1984), this model explains how socioeconomic determinants, environmental determinants, nutritional status, personal illness control and growth faltering are some of the risk factors known to have a strong relation to child mortality. There is a general consensus in the literature that a household's socio-economic and environmental characteristics do have significant effects on under-five mortality (Kombo, 2009).
Based on the previous arguments that all social and economic determinants of child mortality automatically run through the same set of biological variable, or proximate determinants, to influence a strong effect on mortality. This framework intended to advise the policy maker and planners responsible for health sectors and medical interventions on how they can reduce the child mortality.
2.1.1.1 Proximate determinants
According to Mosley & Chen, in order to achieve maximum analytical value, the proximate determinants it should not only serve as indicators of the various mechanism producing growth faltering and death, they also should be measurable in population-based research. In some cases, the proximate determinants should be measured directly, in other cases indirectly.
2.1.1.2 Socioeconomic determinants
Mosley and Chen (1984) examine the changes in socioeconomic determinants when it operates through the proximate determinants to influence the level of morbidity and mortality. Socioeconomic determents are arranged into three broad categories of the variable that are usually followed in the social literature, first were individual level variable and individual productivity (Father, Mothers) traditions/norms/attitudes, the second was household level variable in income/wealth and lastly were Community-level variables which have Ecological and health system.
Individual productivity according to Mosley, this referred to skills, health and time. Skills refer to the educational level of mother and father. Education level normally mutual relationship between occupation and household income. Mother educational has a practice in health care, such as hygiene preventive health care and nutrition. For purpose of having a healthy child, the mother needs to take much time for different nursing, practice, such as visiting the clinic for food preparation, bathing the children and more knowledge.
For individual level on traditions/norms/altitudes, Mosley and Chen (1984) said that most of the traditional societies the mother has held the responsibility for child care, this will result to have little control over the allocation of resources to herself or her child, and most decisions in these areas are reserved for the elders. One key change to this concept in traditional societies produced by maternal education is a shift. It is important for children's survival that the mother not only has the basic responsibility to care for children but also has some power over the basic household purchases and health care practices.
As for the household level variables, as mentioned by Mosley & Chen, are described as “A variety of goods, services, and assets at the household level operate on child health and mortality through the proximate determinants.” Access to and use of health facilities and piped water are some of the mediating factors for majority affect the child's health. The size and quality of the house are important too. Lack of sufficient ventilation and overcrowded housing is deemed to adversely affect children's health. Other goods and services made with preventive care.
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