title: New malaria-control policies and child mortality in senegal: reaching millennium development goal 4.
abstract: BACKGROUND
  The Demographic Surveillance System established in 1962 in Niakhar, Senegal, is the oldest in Africa. Here, we analyze trends in overall child mortality, malaria, and other causes of death in Niakhar from the beginning of data collection to 2010.
  
  
  METHODS
  After an initial census, demographic data were updated yearly from 1963 through 2010. From 1984, causes of death were determined by the verbal autopsy technique.
  
  
  RESULTS
  During 1963-2010, infant and under-5 mortality rates decreased from 223‰ to 18‰ and from 485‰ to 41‰, respectively. The decrease was progressive during the entire observation period, except during 1990-2000, when a plateau and then an increase was observed. Malaria-attributable mortality in under-5 children decreased from 13.5‰ deaths per 1000 children per year during 1992-1999 to 2.2‰ deaths per 1000 children per year in 2010. During this period, all-cause mortality among children aged <5 years decreased by 80%.
  
  
  CONCLUSIONS
  Inadequate treatment for chloroquine-resistant malaria and an epidemic of meningitis during the 1990s were the 2 factors that interrupted a continuous decrease in child mortality. Direct and indirect effects of new malaria-control policies, introduced in 2003 and completed during 2006-2008, are likely to have been the key cause of the recent dramatic decrease in child mortality.
authors.affiliation: Institut de Recherche pour le Développement, UMR 198 URMITE, UK. jean-francois.trape@ird.fr
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Trape
authors.forename: Claire
authors.initials: C
authors.lastname: Sauvage
authors.forename: Ousmane
authors.initials: O
authors.lastname: Ndiaye
authors.forename: Laëtitia
authors.initials: L
authors.lastname: Douillot
authors.forename: Adama
authors.initials: A
authors.lastname: Marra
authors.forename: Aldiouma
authors.initials: A
authors.lastname: Diallo
authors.forename: Badara
authors.initials: B
authors.lastname: Cisse
authors.forename: Brian
authors.initials: B
authors.lastname: Greenwood
authors.forename: Paul
authors.initials: P
authors.lastname: Milligan
authors.forename: Cheikh
authors.initials: C
authors.lastname: Sokhna
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Molez
mesh_terms: D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods*; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control*; D012675:Senegal / Q000453:epidemiology