What effect does the degree of a family’s poverty have on the health of young children?  Are girls the losers when it comes to healthcare in Tanzania?  The Ifakara Health Research and Development Centre, together with colleagues from research groups in six countries, studied health care for children under five in poor rural areas of southern Tanzania.

17 per cent of children in Sub-Saharan Africa (SSA) die before they reach the age of five.  This mortality rate is 30 times higher than that of developed countries and almost twice as high as south Asia, the region second on the list for childhood mortality.  Even more worrying, the mortality rates for young children in SSA, unlike elsewhere in the world, are increasing. This increase is not only due to AIDS but also to other diseases.

Over 2 000 children were included in the survey which took place in four rural districts of southern Tanzania, where most of the population are subsistence farmers.  Malaria, pneumonia and waterborne diseases such as cholera and diarrhoea are the region’s main health problems.  The average monthly expenditure is less than US$ 100 and 75 per cent of this goes on food.  A family’s wealth was judged by possession of such items as a radio, a bicycle, a tin roof, as well as the level of education and occupation of the head of the household.  The study found that:

• Over half of the children had been ill in the two weeks before the survey.
• 41 per cent of the sick children were taken to a public, NGO or private health sector facility for treatment.  This is high for SSA where people frequently turn to traditional healers when they fall sick.
• The treatment at the clinics was poor; few of the children with diarrhoea were given oral rehydration salts, and few of the children with pneumonia were given antibiotics.

Young children from poor families had a similar chance of being ill compared to those from the better-off families. But once they have fallen ill the care they receive is often worse. The children from the wealthier families were more likely to:

• have carers who are aware of danger signs, such as difficult breathing, fits or appearing very sleepy, persistent vomiting, or inability to breastfeed
• attend a health clinic, and have a shorter journey to the clinic
• receive anti-malarial drugs for fever, and antibiotics for pneumonia 
• be admitted to hospital. 

Even amongst the poorest members of society, there are differences in the health care that their children receive.  Programmes aimed at improving people’s health should try to redress the balance so that the poorest of the poor have access to the same health care as other members of society.

Source(s):
‘Inequities among the very poor: health care for children in rural southern Tanzania’, in The Lancet 361: 561-566, by J.A. Schellenberg et al, 2003 Full document.

Funded by: Department of Child and Adolescent Health and Development, World Health Organisation; Bill and Melinda Gates Foundation

id21 Research Highlight: 29 October 2003

Further Information:
Joanna Armstrong Schellenberg
Gates Malaria Partnership
London School of Hygiene and Tropical Medicine
50 Bedford Square
London WC1B 3DP
UK

Tel: +44 (0)20 7299 4721
Fax: +44 (0)20 7299 4720
Contact the contributor: joanna.schellenberg@lshtm.ac.uk

Ifakara Health Research and Development Centre, Tanzania

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