Academic journal article Bulletin of the World Health Organization

Risk Factor of Infant and Child Mortality in Rural Burkina Faso

Academic journal article Bulletin of the World Health Organization

Risk Factor of Infant and Child Mortality in Rural Burkina Faso

Article excerpt


A total of 10.5 million children under 5 years of age were estimated to have died worldwide in 1999, and the great majority of these deaths occurred in developing countries (1). Most childhood deaths have been attributed to diarrhoea, acute respiratory illness, malaria, measles, and malnutrition--conditions that are either preventable or treatable with low-cost interventions (2). The highest mortality rates worldwide are still in sub-Saharan Africa (SSA), where approximately 15% of newborn children are expected to die before reaching their fifth birthday (1).

Childhood mortality rates have declined considerably over the past few decades in most of SSA, but since the 1990s mortality rates have started to increase again in parts of the continent (1). This new trend has been attributed mainly to the effects of the AIDS epidemic and to the spread of chloroquine-resistant malaria (3-5).

In all of SSA except South Africa, reliable information on birth rates, death rates, and causes of deaths are lacking because of a poor public health infrastructure and non-existence of vital registration systems (6). Existing mortality estimates including approaches to identify relevant risk factors are thus based on data from Demographic and Health Surveys (DHSs), research sites with established Demographic Surveillance Systems (DSSs), and specific epidemiological studies (4, 7-21). Risk factors for childhood mortality can be grouped as follows: socioeconomic status, fertility behaviour, environmental health conditions, nutritional status and infant feeding, and the use of health services (20).

Here, we present findings from a comprehensive analysis of risk factors for mortality and their varying effects by age in a cohort of 10 122 liveborn children followed over a period of 7 years in a rural area of Burkina Faso, West Africa, and we compare these with results from the most recent DHS in Burkina Faso from 1998 to 1999 (22).

Study population and methods Study area

The study was conducted in the research zone of the Centre de Recherche en Sante de Nouna (CRSN) in the Nouna Health District in north-western Burkina Faso (23). Today, the study area comprises 41 villages and Nouna town. Subsistence farming is the main socioeconomic activity of the population. Formal health services in the CRSN study area comprise a hospital in Nouna town and four local health centres. Malaria, diarrhoea, and respiratory infections are major causes of childhood mortality. Malnutrition is highly prevalent in young children living in the study villages and has been associated with childhood mortality (24). Malaria transmission intensity is high but markedly seasonal (25).

Demographic Surveillance System

The database for this study is based on the DSS of the CRSN (21, 24, 26). A baseline census hail been undertaken in 1992, and two control censuses were done in 1994 and 1998. During the time of the second control census a cross-sectional study of all mothers within the study region regarding maternity health issues was performed; all births and deaths were also recorded. The average population size in the study period was about 30 000 inhabitants. Registration of vital events was by trained field staff who routinely collected the relevant information from specific village informants. The interval for data collection varied between 1 and 3 months (21). The variables registered include births, deaths, pregnancies, and migration in and out of the household, as well as information on all the dates related to these events. The DSS database also contains several other tables of data on various topics such as household economics and maternal health.

Study population

All children born between 1 January 1993 and 31 December 1999 in 39 villages of the CRSN study area were included. We identified a total of 10 122 births, of which 1043 children were identified in a cross-sectional study on maternal health in 1998. …

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