The role of health systems strengthening and HIV in under-five mortality trends: time series analyses from 2000 to 2010 in Mozambique

Abstract

Globally, the number of deaths of children under 5 (U5) decreased substantially from 12 million in 1990 to about 6.9 million in 2011; during the same period under five mortality (U5M) decreased steadily in Mozambique as a result of the implementation of several interventions. This study aimed to determine the role of health systems strengthening and HIV in U5 mortality trends in Mozambique. We performed an exploratory analysis with U5M as the outcome variable. First, we conducted a univariate analyses by provinces over time periods, as well as Pearson correlations between each independent predictor and the outcome; second a bivariate analysis was performed to determine the association between each independent variable and the outcome variable followed by a multivariate analysis. Model selection was achieved by using backward selection where in each step were removed the variable with the highest p-value, The final significance level selected was 0.05. Overall the U5M in Mozambique dropped substantially during 2000 to 2010 and for each additional year we predicted a decrease of 7.4 per 1000 live births of the U5M on average across all provinces (95% CI: -9.4 , -5.3). After adjusting for time trend population per health facility with β= 2.7 (95% CI 0.19, 5.2), health work force density with β= -0.41 (95% CI: -0.81, -0.01) and institutional birth attendance β= -0.45 (95% CI:-0.77, -0.14) remained significantly associated to U5M. These results suggest that improvements on health human resources particularly with maternal and child nurses and interventions which resulted in improvements of institutional birth attendance were important in the reductions of the U5M rates in Mozambique during the period of the study. If these results are confirmed with other studies, investments on health should prioritize innovative interventions to accelerate human resources trainings, health infrastructure buildings and better access and quality of services for pregnant women.