Reducing under-five mortality in Makonde district’s public healthcare institutions: an exploratory investigation into the potential role of emerging technologies.

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 xi 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.