Risk factors of infant and child mortality in rural Burkina Faso.
OBJECTIVE
The aim of the study was to quantify the effect of risk factors for childhood mortality in a typical rural setting in sub-Saharan Africa.


METHODS
We performed a survival analysis of births within a population under demographic surveillance from 1992 to 1999 based on data from a demographic surveillance system in 39 villages around Nouna, western Burkina Faso, with a total population of about 30000. All children born alive in the period 1 January 1993 to 31 December 1999 in the study area (n = 10 122) followed-up until 31 December 1999 were included. All-cause childhood mortality was used as outcome variable.


RESULTS
Within the observation time, 1340 deaths were recorded. In a Cox regression model a simultaneous estimation of hazard rate ratios showed death of the mother and being a twin as the strongest risk factors for mortality. For both, the risk was most pronounced in infancy. Further factors associated with mortality include age of the mother, birth spacing, season of birth, village, ethnic group, and distance to the nearest health centre. Finally, there was an overall decrease in childhood mortality over the years 1993-99.


CONCLUSIONS
The study supports the multi-causation of childhood deaths in rural West Africa during the 1990s and supports the overall trend, as observed in other studies, of decreasing childhood mortality in these populations. The observed correlation between the factors highlights the need for multivariate analysis to disentangle the separate effects. These findings illustrate the need for more comprehensive improvement of prenatal and postnatal care in rural sub-Saharan Africa.
Becher
Heiko
H
University of Heidelberg, Department of Tropical Hygiene and Public Health, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. heiko.becher@urz.uni-heidelberg.de
Müller
Olaf
O
Jahn
Albrecht
A
Gbangou
Adjima
A
Kynast-Wolf
Gisela
G
Kouyaté
Bocar
B
D000328:Adult; D000367:Age Factors; D002050:Burkina Faso / Q000453:epidemiology; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D009026:Mortality / Q000639:trends*; D010331:Paternal Age; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D016019:Survival Analysis