title: The high burden of infant deaths in rural Burkina Faso: a prospective community-based cohort study.
abstract: BACKGROUND
  Infant mortality rates (IMR) remain high in many sub-Saharan African countries, especially in rural settings where access to health services may be limited. Studies in such communities can provide relevant data on the burden of and risk factors for infant death. We measured IMR and explored risk factors for infant death in a cohort of children born in Banfora Health District, a rural area in South-West Burkina Faso.
  
  
  METHODS
  A prospective community-based cohort study was nested within the PROMISE-EBF trial (NCT00397150) in 24 villages of the study area. Maternal and infant baseline characteristics were collected at recruitment and after birth, respectively. Home visits were conducted at weeks 3, 6, 12, 24 and 52 after birth. Descriptive statistics were calculated using robust standard errors to account for cluster sampling. Cox multivariable regression was used to investigate potential risk factors for infant death.
  
  
  RESULTS
  Among the 866 live born children included in the study there were 98 infant deaths, yielding an IMR of 113 per 1000 live births (95% CI: 89-143). Over 75% of infant deaths had occurred by 6 months of age and the post neonatal infant mortality rate was 67 per 1000 live births (95% CI: 51-88). Infections (35%) and preterm births complications (23%) were the most common probable causes of death by 6 months. Multivariable analyses identified maternal history of child death, polygyny, twin births and poor anthropometric z-scores at week-3 as factors associated with increased risk of infant death.
  
  
  CONCLUSIONS
  We observed a very high IMR in a rural area of Burkina Faso, a country where 75% of the population lives in rural settings. Community-based health interventions targeting mothers and children at high risk are urgently needed to reduce the high burden of infant deaths in these areas.
authors.affiliation: Centre MURAZ Research Institute, Ministry of Health/Burkina Faso, PO Box 390, Bobo-Dioulasso, Burkina Faso. hamadial@yahoo.fr
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Hama Diallo
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.forename: Halvor
authors.initials: H
authors.lastname: Sommerfelt
authors.forename: Germain S
authors.initials: GS
authors.lastname: Traore
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskar
mesh_terms: D000328:Adult; D000367:Age Factors; D002050:Burkina Faso / Q000453:epidemiology; D002423:Cause of Death; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D053208:Kaplan-Meier Estimate; D008297:Male; D010298:Parity; D011247:Pregnancy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult