MORTALITY AND USE OF HEALTH-SERVICES SURVEYS IN RURAL ZAIRE

The Combatting Childhood Communicable Disease (CCCD) project is a comp rehensive public health programme designed to reduce child mortality b y 25% through the use of the following strategies: vaccination, oral r ehydration therapy, and prompt treatment for malaria. To evaluate this programme, cross-sectional surveys were conducted in neighbouring hea lth zones in Zaire in 1984 to determine the use of selected medical se rvices by the population and to estimate the child mortality rate befo re the CCCD programme began. A reinterview survey was conducted on a s ub-sample of women previously interviewed to determine the reliability of the mortality estimates. In both health zones 84-85% of women used antenatal services, 45% of children under age 6 who had had fever wer e treated with an antimalarial drug, 19-22% of children age 12-23 mont hs had been vaccinated against measles, and virtually no children who had had diarrhoea were treated with oral rehydration therapy. Women's underreporting of births and deaths resulted in low estimates of morta lity in both surveys. The reinterview survey provided more accurate es timates of mortality and led to a better understanding of the factors influencing underreporting. The estimated infant mortality rate was 74 deaths per 1000 livebirths; and the probability of dying before age 5 was 191 per 1000. Because births and deaths reported with incomplete dates were excluded from analysis, the mortality rates from the reinte rview survey are underestimates. Given the difficulty in obtaining acc urate estimates of mortality, primary importance should be given to de veloping and improving routine health information systems that measure changes in health status and provide information to evaluate programm es.