David Sanders

The economy, the health sector and child health in Zimbabwe since independence

This paper examines the changes in the economic environment which have taken place in Zimbabwe since independence in April 1980, concentrating on those which are relevant to health. It also describes the post-independence restructuring of the health sector itself. Finally, it considers some changes which have taken place in the health status of children. Despite a prolonged drought, economic recession and the imposition of economic stabilisation measures, there is evidence of a sharp improvement in infant and young child mortality. This has resulted almost certainly from an energetic expansion and reorientation of health care provision, and particularly from greatly improved access to immunisation and oral rehydration therapy. The adverse effects of drought and stabilisation measures have been partially offset by aid-supported relief feeding and particular health programmes. However, the economic crisis has resulted in a decline in real incomes for a large number of households since the immediate post-independence boom. This is reflected in high levels of childhood undernutrition which seem to have remained static despite the health care drive. This emerging divergence between death rates and quality of life as reflected by nutrition levels is reflective on the one hand of rapid expansion in effective health care provision, and on the other of little change in socio-economic conditions for the majority of the population.

Socioeconomic factors associated with child health and nutrition in peri‐urban Zimbabwe

Relationships between the nutritional status of children and several dimensions of socioeconomic status were investigated during the rainy season for 277 children under 5 years of age. The study took place in Chitungwiza, a peri‐urban community in Zimbabwe in 1985, five years after its political independence. Three measures of nutrition — underweight, stunting and wasting — were used. Variation in nutritional status was explained principally by the socioeconomic status of parents which included education, occupation, income, and housing tenure. Other important factors were being born in modern health facilities, absence of disease, normal birth weight, expenditures on food, protein intake, and low crowding.

Liberalisation for Development: Zimbabwe's adjustment without the fund

The outlines of Zimbabwe’s economic performance since independence in 1980 are familiar: boom was followed by decline, and the period since 1982 can be described as one of stagnation.

A High Prevalence of Hypothyroidism in Association with Endemic Goitre in Zimbabwean Schoolchildren

One-hundred-and-eighty-eight ostensibly normal, pubertal schoolchildren, aged 9-16 years, residing in Chinamora Communal Land, Zimbabwe, had blood taken to assess thyroid function. Total goitre rate in the area was 44 per cent in primary schoolchildren: 91 of the subjects tested were goitrous. Thyroid stimulating hormone levels (TSH) were above normal (5.0 mu/l) in 66 subjects overall, of whom 39 were goitrous. The 36 subjects with TSH levels above 7.0 mu/l also had total thyroxine (T4) estimations performed: of these, 19 were below 60 nmol/l. The results indicate a high prevalence of hypothyroidism in this at risk group. The implications of these results are discussed, notably the impairment of mental function that is likely to result.

Paediatric Pneumonia in Zimbabwe: Management and Pharmaceutical Costs of Inpatient Care

Acute respiratory infection exacts a heavy toll on the children of Zimbabwe. During 1986-7 significant resources were committed to manage this condition that accounted for 35 per cent of outpatient visits. Moreover, pneumonia or acute lower respiratory infection (ALRI) represented the greatest proportion of paediatric hospital inpatient discharge diagnoses (32 per cent) and was responsible for 33 per cent of under 5 deaths in Harare. Case management and pharmaceutical cost patterns for paediatric ALRI inpatients are compared for representative rural district and provincial hospitals and an urban central hospital in Harare. The case-mix of patients was similar at all three hospital levels. Significantly, mildly ill patients between the ages of 7 months and 5 years were uniformly over-treated based on management protocols recommended both in the Essential Drug List for Zimbabwe and by the World Health Organization (WHO). The resulting excessive expenditure was Z

Assisting national governments to improve infant health: the case of Zimbabwe

26000 (1Z

AIDS in Africa: the implications of economic recession and structural adjustment

= 0.59U

Economic adjustment and current trends in child survival: the case of Zimbabwe

in 1986) for this category of patient in 1986. Reasons for the lack of compliance with WHO management protocols are explored.

ECONOMIC STRATEGIES, ADJUSTMENT AND HEALTH POLICY: ISSUES IN SUB-SAHARAN AFRICA FOR THE 1990s1

Consequence sur le niveau sanitaire chez les enfants de la recession economique au Zimbabwe