The pattern of infant and childhood mortality in Upper River Division, The Gambia

Abstract

A system has been established to document births and deaths in children in a large, rural, West African population, using community reporters. Causes of death in children under the age of 5 years were investigated using post-mortem questionnaires completed by field assistants. There was a marked seasonal incidence of all major causes of death with peak rates in the rainy season. Acute lower respiratory infections (ALRI) were the most frequent cause of death in children under 5 years of age. Other major causes of death were malaria, acute gastro-enteritis and chronic diarrhoea with malnutrition. Mortality from all the major causes of death decreased with increasing village size. Our findings have implications for interventions against childhood mortality.

PIP: In preparation for the trial of a conjugated polysaccharide vaccine immunogenic in young children in The Gambia, a surveillance system was established in Upper River Division (URD) to detect deaths from all causes and from acute lower respiratory infections (ALRI) in children under five years old. The URD is the eastern-most administrative area in The Gambia, with a 1989 estimated population of 133,000. Field workers complete questionnaires on the basis of information provided by the mother or guardian of an under-five year old child dead since one month. The goal is to learn about the sequence and duration of events which took place during the child's last illness. 915 under-five year old deaths were reported over the period July 1988 to June 1989, for which post-mortem questionnaires were completed for all but 44 for various logistic reasons. Peak rates for all major causes of death were observed in the rainy season, ALRI were the most frequent cause of death, and other major causes of death included malaria, acute gastro-enteritis, and chronic diarrhea with malnutrition. Mortality from all the major causes decreased with increasing village size. The authors discuss the implications of these findings for interventions against childhood mortality.