title: Decreasing childhood mortality and increasing proportion of malaria deaths in rural Burkina Faso.
abstract: BACKGROUND
  Malaria is the leading cause of death among children less than five years of age in sub-Saharan Africa (SSA), however, precise estimates on the burden of malaria are lacking. The aim of this study was to describe temporal trends for malaria and all-cause mortality by combining a series of clinical and intervention studies conducted in Burkina Faso.
  
  
  METHODS
  Data from a demographic surveillance system was used to follow-up children under five years who participated in five observational and intervention studies between June 1999 and December 2004 in rural north-western Burkina Faso. Mortality data was analyzed with cause-specific mortality ascertained using the verbal autopsy method. Person-years (PY) of observations were computed and age-standardized mortality rates (MR) for all-causes and malaria (adjusted for missing causes of death) were calculated. Rate ratios to investigate mortality variations over years were calculated using multivariate Poisson regression.
  
  
  RESULTS
  The study followed 6,387 children aged less than five years (mean follow-up: 2.8 years; 16,099 PY). During the study period, 443 deaths were registered with malaria accounting for 49% of all deaths. All-cause and malaria-specific MR were 26.7 (95% CI: 24.2-29.2) and 15.8 (95% CI: 14.217.7) per 1,000 PY. All-cause MR declined over years of follow-up (from 31.2 to 16.3 per 1,000 PY in 1999/2000 to 2004, respectively) but malaria MR remained relatively stable (from 15.8 to 12.1 per 1,000 PY in 1999/2000 to 2004, respectively) resulting in an increasing relative effect of malaria on all-cause mortality. Variations in all-cause and malaria-specific mortality were observed with increasing age and across village town clusters.
  
  
  CONCLUSIONS
  The findings of this study support the continuously decreasing trend of all-cause mortality in most of SSA, but call for more efforts to comprehensively address malaria with existing control tools such as insecticide-treated bed nets and effective first-line combination therapies.
authors.affiliation: Department of Tropical Hygiene and Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Heribert
authors.initials: H
authors.lastname: Ramroth
authors.forename: Robert P
authors.initials: RP
authors.lastname: Ndugwa
authors.forename: Olaf
authors.initials: O
authors.lastname: Müller
authors.forename: Yazoume
authors.initials: Y
authors.lastname: Yé
authors.forename: Ali
authors.initials: A
authors.lastname: Sié
authors.forename: Bocar
authors.initials: B
authors.lastname: Kouyaté
authors.forename: Heiko
authors.initials: H
authors.lastname: Becher