PhD Thesis
Despite efforts devoted to reduce under-five mortality, it has been observed that the reduction trend is not reaching the targeted goals hence the need to explore the possible constraints. The overall objective of the study was to examine the influence of cultural dimensions on under-five mortality among agro-pastoral communities in Handeni District, Tanzania. The specific objectives were to assess health services utilisation in the study area, to examine the influence of cultural dimensions on household power dynamics, to examine influence of household health care seeking behaviour on incidence of under-five mortality and to examine gender determined roles and their influence on the health of under-five year’s among agro-pastoral communities. Data were collected using a structured questionnaire from 160 randomly selected agro-pastoralist households. The findings showed high availability of informal health facilities in the study area as well as high preference to informal health facilities by agro-pastoralists due to logistical and traditional reasons. Lack of permanent road and education affected access to formal health facilities which are concentrated at the district headquarters. It was observed that increased years of stay in the study area strengthened adherence to traditional and cultural values which favored use of informal health facilities than formal ones. It was found that 83.1% and 78.1% of the households’ decisions on selling household livestock and crops, respectively were made by male household heads. Women involved in selling livestock and crops were 10.6% and16.3%, respectively. This suggest that agro-pastoralist traditional life style in the study area favors men more than women as women are isolated from household decision making and deprived of authority over household resources and income. In turn, this tendency affects women and their children, particularly under-five years. On health care seeking behaviour the result for binary logistic regression showed that mother’s age (β = -0.430) at p < 0.05, number of children in household (β = -0.082) at p < 0.01 and masculinity (β = -1.014) at p < 0.05 were the main variables influencing health care seeking behaviour and consequently under-five mortality. Cultural values which favour inequality in household income use were also found to influence under-five mortality through health care seeking behaviour among agro-pastoralists. Furthermore, it was found that household decision making had negative and significant influence on health of under-five children (β = - 0.071) at p < 0.001, which implies that timely household decision contributes to the reduction of household incidence of under-five mortality. Control of household income had a negative and significant influence on the health of under-five years children (β = -1.828) at p < 0.05 indicating that participatory decision on the use of household income contributed to the increase of household incidence of under-five mortality. The same applies to participation in subsistence farming which had a negative and significant influence on the household health of under-five children (β = -1.013) at p < 0.05, a condition which contributed to the reduction of under-five mortality among agro-pastoral communities. This is because subsistence takes more time and had low production. The study recommends awareness creation campaigns to be done on the relevance of using formal health facilities as well as establishment of formal health facilities within the study area. Moreover, efforts should be made to ensure all villages are connected to reliable roads to improve access to the health facilities. However, necessary efforts should be made through Government and non-Governmental organizations to minimize influence of cultural values and traditional practices which facilitate unequal participation in household decision making and resource use. These have direct and indirect influence on the health of under-five children. In this view, urgent efforts are needed to assist in promoting health care seeking behaviour from informal to formal health facilities hence contribute towards reduction of under-five mortality. Lastly, participation of men and women in household decision making and control of household income should be encouraged among agro-pastoral communities. This will give women more time to care for children and facilitate timely treatment hence contributes to the improvement of their health.