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Socioeconomic Stress, Health and Child Nutritional Status in Zimbabwe at a Time of Economic Structural Adjustment a Three-Year Longitudinal Study

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Socioeconomic Stress, Health and Child Nutritional Status in Zimbabwe at a Time of Economic Structural Adjustment a Three-Year Longitudinal Study Research Report No 105 Leon A. Bijlmakers Mary T. Bassett David M. Sanders Socioeconomic Stress, Health and Child Nutritional Status in Zimbabwe at a Time of Economic Structural Adjustment A three-year longitudinal study Nordiska Afrikainstitutet Uppsala 1998 This report was commissioned and produced under the auspices of the Nordic Africa Institute’s programme on The Political and Social Context of Structural Adjustment in Sub-Saharan Africa. It is one of a series of reports published on the theme of structural adjustment and socioeconomic change in contemporary Africa. Programme Coordinator and Series Editor: Adebayo Olukoshi Indexing terms Structural adjustment Child health Child nutrition Zimbabwe Language checking: Peter Colenbrander ISSN 1104-8425 ISBN 91-7106-434-6 © the authors and Nordiska Afrikainstitutet 1998 Printed in Sweden by Motala Grafiska, Motala 1998 Contents Preface................................................................... 9 Tribute ..................................................................10 Map of Zimbabwe........................................................11 Abbreviations ............................................................12 1 Introduction ..........................................................13 1.1 Background .......................................................13 1.2 Rationale for the study and methodological considerations .........18 1.3 Objectives .........................................................19 1.4 Study sites ........................................................19 2 Methods ..............................................................22 2.1 Research components..............................................22 2.2 Household-based study .......................................... 22 2.3 Clinic-based study.................................................26 3 Changes in households’ social and economic situation (1993–95)..............................................................28 3.1 House ownership and household mobility .........................28 3.2 Household demographic characteristics............................29 3.3 Education .........................................................32 3.4 Economic activities ................................................32 3.5 Socio-economic status .............................................36 4 Changes in illness patterns and health seeking behaviour (1993–95)..............................................................53 4.1 Healthcare utilisation and paying status............................53 4.2 Illness and treatment seeking behaviour ...........................55 4.3 Cost of medical care ...............................................60 4.4 Utilisation and cost of maternal health services.....................62 5 Changes in child nutritional status (1993–95)..........................65 5.1 Unpaired analysis of household-based data ........................65 5.2 Paired analysis of household-based data ...........................73 5.3 Trends in clinic-based malnutrition rates (1991–95).................78 6 Trends in clinic-based health service utilisation and mortality (1991–95)....................................................81 6.1 Background........................................................81 6.2 Health service utilisation...........................................82 6.3 Clinic-based mortality .............................................87 6.4 Interpretation and discussion.......................................88 7 Discussion and conclusions...........................................94 7.1 Socio-economic developments during the period 1993–95 ..........94 7.2 Representativeness of the study....................................98 7.3 Discussion of main findings ..................................... 100 7.4 Conclusions and policy implications ............................. 107 References ............................................................. 111 Annex.................................................................. 114 List of tables 1.1 Economic indicators for Zimbabwe (1988–93) .......................14 1.2 Government expenditure on health (1988/89–1992/93) ..............15 2.1 Follow-up of households in the three consecutive survey years in Chitungwiza and Murehwa district .................................25 2.2 Number of adult participants in household interviews by year and by area .........................................................25 2.3 Follow-up of children for anthropometric measurements in the three survey years in Chitungwiza and Murehwa district............26 3.1 Households changing residence in the 12 months prior to survey by year and by area .................................................28 3.2 Mean household composition in Chitungwiza and Murehwa district by year......................................................29 3.3 Male and female-headed households in Chitungwiza and Murehwa district (1995).............................................30 3.4 Age of male and female heads of households in Chitungwiza and Murehwa district (1995).............................................31 3.5 Births and deaths in households during the 12 months prior to 1994 and 1995 surveys by area ....................................31 3.6 Educational level of male and female adults by area (1995)...........32 3.7 Major sources of income for Chitungwiza and Murehwa district households in 1994 and 1995 ........................................33 3.8 Number of sources of income per household by year in Chitungwiza and Murehwa district .................................34 3.9 Household sources of income in Chitungwiza and Murehwa district (1994 and 1995)..............................................35 3.10 New employment and loss of employment over the 12 months prior to survey in Chitungwiza and Murehwa district households (1994 and 1995) .........................................35 3.11 Reliance on remittances among households without formal employment in Chitungwiza and Murehwa district by year..........36 3.12 Remittances reported by female-headed households by area (1995) ..37 3.13 Estimated monthly household income in Chitungwiza and Murehwa district (1995).............................................38 3.14 Estimated monthly household income per person (1995) .............39 3.15 Reported change in 1995 household income compared to 1994 by area ........................................................39 3.16 Reported change in household income by income category in Chitungwiza and Murehwa district (1995)...........................40 3.17 Monthly household income by income source (1995).................40 3.18 Monthly household income by type of household (1995) .............41 3.19 Household income per person by type of household (1995) ..........41 3.20 Reported change in income by type of household in Murehwa district (1995) .......................................................41 3.21 Cattle ownership by Chitungwiza and Murehwa district households by year .................................................42 3.22 Maize production and self-sufficiency, and sale of crops by Chitungwiza and Murehwa district households by year .............43 3.23 Households claiming food shortage, during the 12-month period prior to survey (1994 and 1995)...............................44 3.24 Financial support of relatives staying elsewhere by year .............46 3.25 Households reporting major expenditures in the 12-month period prior to survey by year.......................................47 3.26 Types of reported major expenditure by year ........................47 3.27 Household expenditure on funerals in 1995..........................48 3.28 Household saving patterns by year..................................49 3.29 Households participating in funeral societies or local savings clubs by year .......................................................50 3.30 Households with financial debts by year ............................50 3.31 Households with children who dropped out of school and children who delayed school enrolment by year .....................51 3.32 Out-of-school youth by age category and by area (1995)..............52 4.1 Usual source of healthcare in Chitungwiza and Murehwa district (1993 and 1994)..............................................53 4.2 Household paying status by area (1994) .............................54 4.3 Households with medical aid, employer-sponsored healthcare and government sponsored care in Chitungwiza and Murehwa district (1994, 1995) .................................................55 4.4 Households reporting illness among their members by year .........56 4.5 Reported illness episodes among the total number of adults and children by year ....................................................57 4.6 Self-reported illness by year.........................................58 4.7 Treatment received by those who reported ill in Chitungwiza and Murehwa district by year ...........................................59 4.8 First place of treatment of those seeking treatment from the formal sector by year.......................................................60 4.9 Proportion of paying patients among those who sought treatment from a public health facility by year .......................60 4.10 Consultation fees and actual average cost of treatment incurred by those going to public health facilities by year ........................61 4.11 Home deliveries as a proportion of total reported deliveries in Chitungwiza and Murehwa district by period .......................63 4.12
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