Child and maternal mortality during a period of conflict in Beira City, Mozambique

Background. Child mortality rates have been declining in most. developing countries. We studied child and maternal mortality and risk factors for child mortality in Beira city in July 1993, after a decade of conflict in Mozambique. Methods. A community-based cluster sample survey of 4609 women of childbearing age was conducted. Indirect techniques were used to estimate child mortality ('children ever born' method and Preceding Birth Techniques [PBT]), and maternal mortality (sisterhood method). Deaths among the most recent born child, born since July 1990, were classified as cases (n = 106), and two controls, matched by age and cluster, were selected per case. Results. Indirect estimates of the probability of dying from birth to age 5 (deaths before age 5 years, (5)q(0) per 1000) decreased from 246 in 1977/8 to 212 in 1988/9. The PET estimate for 1990/91 was 154 (95% confidence interval [CI] : 124-184), but recent deaths may have been underreported. Lack of beds in the household (odds ratio [OR] = 2.0, 95% CI : 1.1-3.8), absence of the father (OR = 2.4, 95% CI : 1.2-4.8), low paternal educational level (OR = 2.1, 95% CI : 0.8-5.4), young maternal age (OR = 2.0, 95% CI : 1.0-3.7), self-reported maternal illness (OR = 2.4, 95% CI : 1.2-4.9), and home delivery of the child (OR = 2.3, 95% CI : 1.2-4.5) were associated with increased mortality, but the sensitivity of risk factors was low. Estimated maternal mortality was 410/100 000 live births with a reference date of 1982. Conclusions. Child mortality decreased slowly over the 1980s in Beira despite poor living conditions caused by the indirect effects of the war. Coverage of health services increased over this period. The appropriateness of a risk approach to maternal-child-health care needs further evaluation.