Using the preceding birth technique, 2,229 mothers were interviewed at four antenatal centres (two of which were urban) over a three month period during a pilot study in Zimbabwe. Results of the study showed that there was a small difference between the under two and under five mortality. The smaller than expected difference could have been due to some degree of urbanisation being experienced at two of the centres, and to a systematic selection bias of the method. Other findings of the study showed that younger mothers (under 20 years of age) and older mothers (over 40 years) experienced higher proportions of mortality, than mothers in the age group between. The higher proportion of male mortality compared to that for females reflected the expected trend, but the size of the difference was somewhat surprising, and could have been due to recall bias. The mean birth interval was 36 months, rather than the expected 30 months, and analysis of mortality in relation to birth interval and maternal age showed that a birth interval of less than 18 months was associated with higher child mortality, significantly so with the second last child, independent of mother's age. Longer birth intervals (more than three years) among older mothers were associated with higher changes of child survival. It is concluded that the Brass-Macrae method is a useful technique to analyse levels and trends of child mortality.
PIP: The University of Zimbabwe and the Zimbabwe Congress of Trade Unions tested the ability of the Brass-Macrae methodology (i.e., preceding birth technique) to estimate current levels and trends in child mortality. Interviews were conducted with 2229 mothers attending the prenatal clinics of the Mbare and Glen View polyclinics in Harare and of a provincial hospital (Marondera) and district hospital (Mutoko), both in Mashonaland East Province. The overall child mortality rate was 53/1000 of the last live births and 54/1000 of the second last live births. Some degree of urbanization and a systematic selection bias of the method may have contributed to the small difference between the two rates. Among last live births, the provincial hospital in Marondera had the lowest child mortality rate, while the Mbare polyclinic in the capital city of Harare had the highest (43 vs. 61). The difference in child mortality rates for last live births between urban and rural areas was slight, while it was much greater for second last live births (2 vs. 11 points). Among second last live births, the district hospital in Mutoko had the lowest rate, while the Marondera provincial hospital had the highest rate (39 vs. 64). Child mortality levels peaked in the mothers' age groups less than 20 (88 for last live births) and more than 40 (84 for last live births and 78 for second last live births). Among last and second last live births, boys were more likely to die than girls (64 vs. 42, p 0.05, and 64 vs. 45, p 0.05, respectively). This difference could have been due to boys being more frail than girls or mothers being able to better recall boys deaths, since boys are highly valued. The mean birth interval was 36 months, but the expected interval was 30 months. A birth interval of less than 18 months was significantly associated with higher child mortality among second last live births (p 0.001), regardless of mother's age. Birth intervals of more than 3 years were associated with the best child survival rates in every maternal age group (e.g., 30-34 years, 8 vs. 52-250). This pilot study showed that the Brass-Macrae method is useful to estimate child mortality.