Child Health in Zambia

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Child Health in Zambia

ECONOMIC DEVELOPMENT

CHILD HEALTH in ZAMBIA

Our worst crime is abandoning the children, neglecting the fountain of life. Many of the

things we need can wait. The child cannot."

- Gabriela Mistral, a Chilean Poet -

Notes to the grader

If not cited as a footnote the data (ex; 102) used for analysis is from the World Development

Indicators Database. When data belongs to the WHO database

(http://www.who.int/whosis/database/core/core_select.cfm), the sentence indicates this but a

footnote is not added to save space. Not all the data used for analysis is included in the tables onthe first page of this paper.

If you would like to request a Data CD which includes all the data tables used

please e-mail: [email protected]

Bold phrases show the application of theory from the textbook (Todaro).

Regression analysis can be done to predict which one of the variables is better in

predicting child health. However few data recordings for many indicators do not

allow such analysis for Child Health in Zambia.

This paper will analyze the trends in Child Health in Zambia observed in the past 25 years as

well as recommending ways to achieve sound policy-making. Given the scarcity of data and the

lack of a holistic measure for child health due to high multicollinearity between variables, thereare limitations in assessing the changes. Although there are many indicators of child health

presented in the World Health Organization (WHO) database (i.e. diseases), the scope of this

paper will focus on infant mortality rate, life expectancy and malnutrition (stunting and wasting)

in explaining child health. Infant mortality rate in the past 10 years has been constant at 102 per

1000 live births compared to the increasing trend in the previous decade (1980; 90). Lifeexpectancy at birth has been continuously deteriorating over the past 25 years (i.e. 1980; 52,

2005; 38 in total years). Moreover, the prevalence of malnutrition increased about 66% when we

compare the first decade of the data with the second decade. Biometric indicators (stunting andwasting) are used as a proxy to child malnutrition. According to WHO country report for

Zambia, in 1999 the percentage for stunting and being underweight for children under 5-years

old were 53% and 27% respectively.[1] WHO data reveals the fact that there was near to nochange by 2002 in stunting (52.5%) but the percentage of underweight children fell to 23.3%.


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If we limit our assessment to the abovementioned variables, children in Zambia are worse-off

than they were two decades ago. However, in reality, before analyzing poverty levels, prevalence

of diseases, health services and other indicators of child health, one cannot assess the extent ofdecline in child health with certitude.

Evaluating the relevance of the chosen variables in predicting child health one could argue thatinfant mortality rate is a much better proxy than life expectancy in predicting child health. Even

if we use life expectancy to observe general trends in health it fails to explain suffering and ill-

health experienced in every additional year of living.[2] However, an increase in life expectancysignals improvements in the health of the total population and hence in child health. Costello and

Whites findings show that not only do poorer countries have higher mortality rates, but the

same is true of poorer regions within those countries. In fact in Zambia in 1996 infant

mortality rates varied from 66 in one of the most prosperous of the country's nine provinces to ahigh of 158 in one of the more remote provinces.[3] Finally, malnutrition of children, although

not a direct cause of death, is an important health indicator. High percentages of stunting and

wasting signal poor child health as well as the greater risk of illness and death for children.

Now we will assess the importance of these same variables in explaining development.

According to Sens Capabilities Approach, the challenge of development is to improve the

quality of life and higher standards of health for the children can only be achieved through

increasing the availability of functionings.[4] Therefore, high infant mortality rate and low lifeexpectancy in Zambia signal low levels of development caused by high levels of poverty, which

decreases the amount of choice opportunities people have in nourishing and providing basic

health needs for their children. This reality leaves Zambia into the hands of expert

organizations. As portrayed in the False-Paradigm-Model, expert interventions mostly causepoor countries to get trapped in underdevelopment.[5] Although the data shows that GDP growth

per capita has been trending upwards from late 1999 to our day, the infant mortality rate has beenincreasing mainly due to limited expenditure available for health needs (i.e. food, medication).Hence, this can be shown as evidence for growth without development in Zambia. Finally, we

can discuss the link between health and productivity. Strauss and Thomas stated that the

balance of evidence points to a positive effect of elevated nutrient intakes on wages, at leastamong those who are malnourished [and hence,] a healthy population is a prerequisite for

successful development.[6] Therefore, prevalence of malnutrition indicated by biometric

measures (height and weight) used to predict child health are valuable in predicting development.

Although it is crucial to observe health trends within the country, one should also consider world

trends to assess the magnitude of the decline in child health, in Zambia. For the purposes of

comparison the following set of countries will be used: Argentina, Brazil, China, India, Kenya,Nigeria and Zimbabwe. Comparing the infant mortality rates of these countries, we can see a

downward trend which signals development in child health. However, in Zambia the infant

mortality per 1000 live births increased from 90 in 1980s to a high 102 in 2005. In terms of life

expectancy, Zambia and Zimbabwe faced a downward trend whereas the other 6 countries faceda steady (i.e. Nigeria) or an upward trend. This shows that in Africa, developments in child

health are slower than the rest of the world and are not very significant even though most

countries managed to decrease their infant mortality to some extent. Finally, comparing the


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malnutrition prevalence in terms of height and weight, we can see a general downward trend in

all countries except Zambia, in stunting. However, wasting figures follow an upward trend in

Zambia, Zimbabwe and Argentina. Therefore, the improvements in preventing stunting amongstchildren are usually offset by the increases in wasting, limiting the positive impact on child

health.

For the same set of countries the per capita income and per capita income in PPP show an

upward trend with the exception of Zimbabwe. In Zambia the trend is also upwards, however it

remains the lowest amongst the abovementioned countries. In terms of HDI, which is a valuableindicator of the changes in child health, Zambia (0.407) ranks as the 165th country much below

Zimbabwe (0.491) which ranks as the 151st country.[7] Argentina (0.863) Brazil (0.792), China

(0.768) and India (0.611) are categorized as middle to high development.[8]

Now we will analyze some of the reasons which explain the abovementioned trends in child

health. The positive steady growth of GDP from 1999 onwards can be misleading in predicting

development in Zambia. Research shows that an estimated 5.8 per cent growth in 2006 [was] a

result of increased copper production, buoyant copper prices, an exceptionally good agriculturalperformance and a strong expansion in construction.[9] Despite these facts, poverty remains

high and child health suffers as a result. Since approximately 46% of the population is childrenand 14% (ages 7-14) are economically active, the poor working conditions in the copper mines

can also work against child health in Zambia.

Most of the health data for children are recorded for Zambia after the year of 2000, which

coincides with the signing of the Millennium Development Goals (MDGs). We can observe

minor improvements in water sanitation and disease prevention (i.e insecticide treated nets

provided for under 5-yr olds increased from 1% in 1999 to 7% in 2002). WHO data shows thatthe deaths among children under 5-years due to HIV as 16.1% (2000), which is highly correlated

with infant mortality rates in Zambia. The 2003 Report which assesses Zambias progress inachieving MDGs reveal that there are some improvements in decreasing infant mortality and inreversing HIV. If achieved, the under-5 mortality rate will be reduced by two-thirds by 2015.

However, most of the other goals fall under the category of improving, and are unlikely to

reach their targets.[10]

In the past five years government expenditures on health increased slightly (i.e. health

facilities).[11] This could be due to IMF interventions and other organizations as well as theincreased government revenues from a boom in the copper industry. Despite the advancements

laid out in the 2006 Poverty Reduction Growth Facility (PRGF) review by the IMF and the

promises made by Mwanawasa in the September 2006 presidential elections regarding the

copper boom and debt relief, the living conditions of the majority of the population are veryunsatisfactory, with about 70 per cent of the population liv ing below the poverty line.[12] The

World Banks 2006 Poverty and Vulnerability Analysis finds there is a continuing fall in life

expectancy; a deteriorating stock of human capital [health care workers; brain drain]; rising

malnutrition and ill-health; and continuing high levels of poverty[13] which provides evidencefor the findings presented in this paper. The increase in infant mortality rates are attributed

partly to the impact of HIV/AIDS, but also to long run economic decline, deterioration in health


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services, and reduced service utilization, partly as a result of the introduction of user

charges.[14]

The current picture shows that without foreign aid and investment (international co-operation),

given the governments limited capability of improving health conditions such as sanitation and

disease outbreaks (i.e. HIV, malaria, tuberculosis, diarrhea, measles ) and other challenges (i.e.droughts), significant improvements in child health are highly unlikely. Forming networks with

NGOs like UNICEF can be useful in providing basic medication needs (i.e. to prevent HIV

transmission in placenta), other basic health needs (insect-nets to prevent malaria) and parentaleducation (i.e. condom use, pre-natal care). In order to eliminate poverty and to foster well-being

in the economy, the government of Zambia should follow a step-by-step approach in arranging

health interventions and other support programs with international organizations (i.e. World

Bank, IMF). Even though expert interventions may have some disadvantages, for Zambia,being one of the most underdeveloped countries in the world, it seems like an alternative route

does not exist.

References

Databases

World Development Indicators

(EDSR McGill Library and Collections)

World Health Organization

http://www.who.int/whosis/database/core/core_select.cfm

Other Sources

A Costelloa, H Whiteb, Reducing Global Inequalities in Child Health. a Centre for InternationalChild Health, Institute of Child Health, University College London, 30 Guilford St, London

WC1N 1EH UK, b Institute for Development Studies, Sussex, UK.

OECD African Economic Outlook 2007, Zambia

http://www.oecd.org/dataoecd/27/1/38563134.pdf

WHO Country Report for Zambia

http://www.who.int/disasters/repo/8296.pdf

Aeneas C. Chuma, Resident Coordinator United Nations System in Zambia,

Millennium Development Goals Progress Report 2003.


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http://www.sarpn.org.za/documents/d0000856/P968-MDG_Zambia_2003.pdf

Government of Zambia, Central Board of Health

http://www.cboh.gov.zm/index.php?file=show_doc.html&id=2895&setLang=ukCHILD

UNICEF Zambia Child Health Week: An approach to delivery of child survival

interventions.

www.unicef.org/evaluation/files/zambia.doc

The World Bank Group; Millennium Development Goals, Zambia.

http://ddp-

ext.worldbank.org/ext/ddpreports/ViewSharedReport?&CF=&REPORT_ID=1305&REQUEST_TYPE=VIEWADVANCED&DIMENSIONS=162

Demographic Research: Volume 12, Article 12, a research article.

Quality of child health care and under-five mortality in Zambia: A case study of two districts inLuapula Province Augustus Kasumpa Kapungwe.

http://www.demographic-research.org 301

Helen M. Wallace, MD, MPH*, and Taha. El TahirTaha, MD, MPH**

Indicators for Monitoring Progress in Maternal and Child Health Care in Africa

* Graduate School of Public Health, San Diego State University, California, USA

** College of Medicine, University of Uuba, Juba, Sud

Wikipedia Encyclopedia

www.wikipedia.org

Indicators of Economic Development

http://www.edexcel.org.uk/VirtualContent/48298/5_3_Indicators_of_Development16_01_03.pdf

Todaro and Smith, Economic Development, ninth edition. Pearson, 2006.

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[1] http://www.who.int/disasters/repo/8296.pdf

[2] Todaro, p. 392

[3] http://adc.bmj.com/cgi/content/full/84/2/98

[4] Todaro, p.17-20

[5] Todaro, p.117

[6] Todaro, p. 401

[7] www.wikipedia.org; those countries with an HDI below 0.5 are categorized as low

development.

[8] www.wikipedia.org

[9] http://www.oecd.org/dataoecd/27/1/38563134.pdf

[10] http://www.sarpn.org.za/documents/d0000856/P968-MDG_Zambia_2003.pdf

[11] WHO database



[14] http://adc.bmj.com/cgi/content/full/84/2/98

Documents

Child Health in Zambia