POPULATION-DENSITY AND SPATIAL DIFFERENTIALS IN CHILD-MORTALITY IN ZIMBABWE

Large regional variations in under-five mortality exist within many su b-Saharan countries. Population density as a potential explanatory fac tor for these regional variations has seldom been considered despite i t being implicated as a determinant of mortality at other spatial scal es. In Zimbabwe, the ''Ndebele provinces''-Matabeleland North and Sout h-have significantly lower levels of under-five mortality than the oth er (''Shona'') provinces. This regional differential is explored using the Zimbabwe Demographic and Health Survey and census data. Factors o ther than population density that may contribute to the differential a re examined. After controlling for the effects of potentially confound ing socio-economic, demographic and environmental variables using Cox regression models children aged 1-4 yr living in the Ndebele provinces continued to have a level of mortality 45% lower than their counterpa rts in the Shona provinces. The possibility that regional variations i n health care provision and/or cultural factors contribute to the mort ality differential is also examined and rejected. Population densities in the Ndebele provinces are of a far lower order than in the Shona p rovinces. The main causes of child mortality in Zimbabwe in the time p eriod under consideration were diarrhoea, ALRI, measles and malaria. H ow population density may affect the transmission of these infections and, hence, mortality is discussed. It is suggested that population de nsity may provide an explanation for the spatial variation in child mo rtality in Zimbabwe. The implications of changing population densities for child health in urban and rural sub-Saharan Africa are briefly co nsidered. Copyright (C) 1997 Elsevier Science Ltd.