Preventive measures in infancy to reduce under-five mortality: a case-control study in The Gambia.
OBJECTIVE
To investigate the relationship between child mortality and common preventive interventions: vaccination, trained birthing attendants, tetanus toxoid during pregnancy, breastfeeding and vitamin A supplementation.


METHODS
Case-control study in a population under demographic surveillance. Cases (n = 141) were children under five who died. Each was age and sex-matched to five controls (n = 705). Information was gathered by interviewing primary caregivers.


RESULTS
All but one of the interventions - whether the mother had received tetanus toxoid during pregnancy - were protective against child mortality after multivariate analysis. Having a trained person assisting at child birth (OR 0.2 95% CI 0.1-0.4), receiving all vaccinations by 9 months of age (OR 0.1; 95% CI 0.01-0.3), being breastfed for more than 12 months (Children breastfed between 13 and 24 months OR 0.1 95% CI 0.03-0.3, more than 25 months OR 0.1 95% CI 0.01-0.5) and receiving vitamin A supplementation at or after 6 months of age (OR 0.05; 95% CI 0.01-0.2) were protective against child death.


CONCLUSIONS
This study confirms the value of at least four available interventions in the prevention of under-five death in The Gambia. It is now important to identify those who are not receiving them and why, and to intervene to improve coverage across the population.
Rutherford
Merrin E
ME
Center for International Health, Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. merrin.rutherford@gmail.com
Dockerty
John D
JD
Jasseh
Momodou
M
Howie
Stephen R C
SR
Herbison
Peter
P
Jeffries
David J
DJ
Mulholland
Kim
K
Adegbola
Richard A
RA
Hill
Philip C
PC
D001942:Breast Feeding / Q000706:statistics & numerical data; D017028:Caregivers; D016022:Case-Control Studies; D046688:Child Mortality; D002675:Child, Preschool; D005260:Female; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008880:Midwifery / Q000379:methods; D015999:Multivariate Analysis; D011247:Pregnancy; D011314:Preventive Health Services / Q000379:methods*; D013745:Tetanus Toxoid / Q000627:therapeutic use; D014611:Vaccination; D014801:Vitamin A / Q000627:therapeutic use
D013745:Tetanus Toxoid; D014801:Vitamin A