OBJECTIVE: This study (1) examines spatio-temporal variation in diarrhoea prevalence and (2) for 2013 identifies and maps the factors associated with diarrhoea prevalence at district level.
METHODS: Data were drawn from Demographic Health Surveys (1990, 1999, 2003, 2008 and 2013). Moran index was used to analyse spatial dependence and clustering of diarrhoea prevalence in 2008 and 2013. Geographical Weighted Poisson Regression analysis was used to identify factors associated with diarrhoea prevalence for 2013.
RESULTS: Diarrhoea prevalence was higher in rural than in urban areas. Prevalence exhibited statistically significant spatial variation, but temporal variation and spatial dependence were not significant. Locally, diarrhoea prevalence hot spots clustered among five states in the North East zone. Non-improved sanitation, children 6-23 months not breastfed, dung floor, relative poverty, unemployed mothers and Gini coefficient were main predictors of diarrhoea prevalence.
CONCLUSIONS: Results of spatial analysis improved understanding of local spatio-temporal variation in diarrhoea prevalence and underlying factors. Intervention strategies should emphasize behaviour change regarding washing of hands and feeding utensils before and after feeding children, exclusive breastfeeding, safe water, improved sanitation and hygiene, particularly in hot spot states.

Despite global declaration of the right to life as a fundamental human right and substantial progress in reducing childhood mortality, unacceptably high number of children still die before their fifth birthday every day. Different factors have been studied and implicated for under-five mortality with mixed results. Mortality studies in the current study sites were lacking. Therefore, this study examined environmental and socioeconomic determinants of under-five mortality.
The study applied a matched case control study design on 381 cases of children who died before their fifth birthday and 762 controls born within 1 month in the same locality as the cases. We conducted weighted conditional logistic regression to assess the association between selected factors and mortality status.
The odds of death was found to be significantly lower among children of mothers whose educational status was grade nine or above (Adjusted odds ratio (AOR) of 0.34(0.16-0.72)). The odds of death was significantly higher among children whose mothers\' marital status were separated/divorced or widowed (AOR of 3.60(1.23-10.47)) and whose fathers were daily laborers (AOR of 2.34(1.29-4.23)). Presence of separate kitchen in the household for cooking was a proximate factor which was significantly associated with under-five mortality with AOR of 1.77(1.16-2.70).
Socioeconomic factors like maternal education, husband occupation and marital status of the mother were shown to be significantly associated with under-five mortality. Hence, in order to enhance reduction in childhood mortality, investing on maternal education targeting those at risk groups is recommended.

Reductions in under-five mortality in Africa have not been sufficient to meet the Millennium Development Goal #4 (MDG#4) of reducing under-five mortality by two-thirds by 2015. Nevertheless, 12 African countries have met MDG#4. We undertook a four country study to examine barriers and facilitators of child survival prior to 2015, seeking to better understand variability in success across countries. The current analysis presents indicator, national document, and qualitative data from key informants and community women describing the factors that have enabled Zambia to successfully reduce under-five mortality over the last 15 years and achieve MDG#4. Results identified a Zambian national commitment to ongoing reform of national health strategic plans and efforts to ensure universal access to effective maternal, neonatal and child health (MNCH) interventions, creating an environment that has promoted child health. Zambia has also focused on bringing health services as close to the family as possible through specific community health strategies. This includes actively involving community health workers to provide health education, basic MNCH services, and linking women to health facilities, while supplementing community and health facility work with twice-yearly Child Health Weeks. External partners have contributed greatly to Zambia\'s MNCH services, and their relationships with the government are generally positive. As government funding increases to sustain MNCH services, national health strategies/plans are being used to specify how partners can fill gaps in resources. Zambia\'s continuing MNCH challenges include basic transportation, access-to-care, workforce shortages, and financing limitations. We highlight policies, programs, and implementation that facilitated reductions in under-five mortality in Zambia. These findings may inform how other countries in the African Region can increase progress in child survival in the post-MDG period.

Despite notable progress reducing global under-five mortality rates, insufficient progress in most sub-Saharan African nations has prevented the achievement of Millennium Development Goal four (MDG#4) to reduce under-five mortality by two-thirds between 1990 and 2015. Country-level assessments of factors underlying why some African countries have not been able to achieve MDG#4 have not been published. Zimbabwe was included in a four-country study examining barriers and facilitators of under-five survival between 2000 and 2013 due to its comparatively slow progress towards MDG#4. A review of national health policy and strategy documents and analysis of qualitative data identified Zimbabwe\'s critical shortage of health workers and diminished opportunities for professional training and education as an overarching challenge. Moreover, this insufficient health workforce severely limited the availability, quality, and utilization of life-saving health services for pregnant women and children during the study period. The impact of these challenges was most evident in Zimbabwe\'s persistently high neonatal mortality rate, and was likely compounded by policy gaps failing to authorize midwives to deliver life-saving interventions and to ensure health staff make home post-natal care visits soon after birth. Similarly, the lack of a national policy authorizing lower-level cadres of health workers to provide community-based treatment of pneumonia contributed to low coverage of this effective intervention and high child mortality. Zimbabwe has recently begun to address these challenges through comprehensive policies and strategies targeting improved recruitment and retention of experienced senior providers and by shifting responsibility of basic maternal, neonatal and child health services to lower-level cadres and community health workers that require less training, are geographically broadly distributed, and are more cost-effective, however the impact of these interventions could not be assessed within the scope and timeframe of the current study.