Long-term reductions in mortality among children under age 5 in rural Haiti: effects of a comprehensive health system in an impoverished setting.
OBJECTIVE
Evidence regarding the long-term impact of health and other community development programs on under-5 mortality (the risk of death from birth until the fifth birthday) is limited. We compared mortality in a population served by health and other community development programs at the Hôpital Albert Schweitzer (HAS) with national mortality rates among children younger than 5 years for Haiti between 1958 and 1999.


METHODS
We collected information on births and deaths in the HAS service area between 1995 and 1999 and assembled previously published under-5 mortality rates at HAS. Published national rates for Haiti served as a comparison.


RESULTS
In the early 1970s, the under-5 mortality rate at HAS declined to a level three fourths lower than that in Haiti nationwide. More recently, HAS rates have remained at one half those for Haiti nationwide. Child survival interventions in the HAS service area were substantially higher than in Haiti nationwide although socioeconomic characteristics and levels of childhood malnutrition were similar in both areas.


CONCLUSIONS
HAS's programs have been responsible for long-term sustained reduction in mortality among children aged less than 5 years. Integrated systems for health and other community development programs could be an effective strategy for achieving the United Nations Millennium Goal to reduce under-5 mortality two thirds by 2015.
Perry
Henry
H
Future Generations, Franklin, West Virginia 26807, USA. henry@future.org
Berggren
Warren
W
Berggren
Gretchen
G
Dowell
Duane
D
Menager
Henri
H
Bottex
Erve
E
Dortonne
Jean Richard
JR
Philippe
Francois
F
Cayemittes
Michel
M
D019985:Benchmarking; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D018672:Community Health Planning; D003159:Community-Institutional Relations; D006205:Haiti / Q000453:epidemiology; D019456:Health Transition; D017052:Hospital Mortality / Q000639:trends; D006764:Hospitals, Community / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D011203:Poverty; D011320:Primary Health Care / Q000458:organization & administration*; D018570:Risk Assessment; D019035:Rural Health Services / Q000458:organization & administration* / Q000600:supply & distribution; D016019:Survival Analysis