Reducing under-five mortality in Makonde district’s public healthcare institutions: an exploratory investigation into the potential role of emerging technologies.
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Date
2022
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Abstract
Under-five mortality rate remains unacceptably high globally, with Sub-Saharan Africa being
the region with the worst under-five mortality outcomes. The United Nations reported that an
average of 15 000 under-fives died daily in 2018, translating to 5.3 million under-fives dying
annually. The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME)
estimated that up to 5.5 million under-fives died in 2021. The outbreak of the Coronavirus
Disease 2019 (COVID-19) worsened the situation for child healthcare in low-resource settings
due to overwhelmed and strained healthcare systems. Promoting the health and well-being of
under-fives remains a priority of the United Nations and its member states, as evidenced by the
setting of under-five mortality goals in both the expired Millennium Development Goals and
the current Sustainable Development Goals. Globally, under-five mortality outcomes are
meagrely improving, registering a 4 per cent improvement in 18 years. Zimbabwe is one of the
countries with high under-five mortality rates, with the Midlands and Mashonaland West
provinces having the worst under-five mortality rates, according to the 2019 Multiple Indicator
Cluster Survey (MICS) report. Despite the evidence of emerging technologies helping to
reduce under-five mortality rates in other regions and countries like the United States of
America, the United Kingdom and South-West Nigeria, the potential of such technologies to
reduce under-five mortality rates in Zimbabwe’s public healthcare institutions has not been
explored. Although Zimbabwe has registered improvements in under-five mortality rates over
the years through such programmes as free healthcare for under-fives in public health facilitie s,
child immunisation programmes, provision of nutritional supplements and prevention of
mother-to-child transmission (PMTCT), the rates are still unacceptably high and above the
SDG target of 23 per 1 000 live births, making Zimbabwe ranked amongst the fifty countries
with the highest early childhood mortality in the world. The country’s poor under-five mortalit y
rates suggest that the existing methods need to be complemented by different approaches.
Guided by three theoretical frameworks, the Diffusion of Innovation, the Unified Theory of
Acceptance and Use of Technology and the Capabilities Approach, the researcher explored the
potential role of emerging technologies in reducing under-five mortality in Makonde District,
Zimbabwe. The key deliverables of this study included a framework for the adoption of
emerging technologies to reduce under-five mortality in resource-constrained settings like
Makonde district. An exploratory sequential mixed-methods design was used, in which 20
healthcare professionals from Makonde public health facilities participated in interviews and a
focus group, while 90 healthcare professionals and 391 mothers of under-five children
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responded to questionnaires. The researcher used purposive and snowball sampling to identify
interview and focus group participants, where experience and whether one works in the
paediatric ward, works with children or pregnant women were critical considerations. Mothers
of under-fives were randomly sampled. The study revealed that the participants arguably value
under-fives the most and would accept any technology intended to improve their health and
wellbeing. They perceive emerging technologies as helpful in areas like improving diagnosis,
minimising loss to follow-ups and providing data-driven, evidence-based and personalised
paediatrics. The impediments to adoption included the fear of medico-legal hazards,
centralisation of digital health decision-making, network problems, resistance to change and
demoralised workforce. There is generally poor knowledge of emerging technologies by
healthcare professionals in Makonde District. The study proffers recommendations on what
needs to be done for emerging technologies to be adopted in Makonde District’s public
healthcare institutions to reduce under-five mortality. An adoption framework is also
presented.
Description
Doctoral Degree. University of KwaZulu-Natal, Durban.