title: Trends in child mortality: a prospective, population-based cohort study in a rural population in south-west Uganda.
abstract: BACKGROUND
  Although there has been substantial global progress in decreasing child mortality over the past two decades, progress in sub-Saharan Africa has largely lagged behind. The temporal trends in child mortality and associated risk factors were investigated in a cohort of children in rural Uganda.
  
  
  METHODS
  Information on children's vital status, delivery, breastfeeding, vaccination history, maternal vital and HIV status, and children's HIV status for 1993-2007 was retrieved from the Medical Research Council/Uganda Virus Research Institute's (MRC/UVRI) Annual Population Census and Survey in Uganda. Regression models were employed to assess the association of these factors with child mortality.
  
  
  RESULTS
  From 1993 to 2007, the death rate (/1000 person-years) in children <13 years of age decreased significantly from 16 to six. Apart from neonates, age-specific death rates fell in all age-groups. A reduction since 1999 in the risk of child mortality was associated with vaccination, birth in a health facility, exclusive breastfeeding for 6 months, 2-3 years since the previous sibling's birth, maternal vital status, and negative mother and child HIV serostatus. Although HIV seropositive children had a 26-fold increased risk of death before 13 years of age, HIV prevalence in children was about 1% and so had a small overall impact on child mortality.
  
  
  CONCLUSIONS
  These findings are consistent with those of repeated national cross-sectional surveys. Meeting the Millennium Development Goals for child survival in sub-Saharan Africa depends on faster progress in implementing measures to improve birth-spacing, safe delivery in health facilities, infant feeding practices and vaccination coverage.
authors.affiliation: National Centre in HIV Epidemiology and Clinical Research, Faculty of Medicine, University of New South Wales, Australia. lzhang@kirby.unsw.edu.au
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: Dermot
authors.initials: D
authors.lastname: Maher
authors.forename: Mary
authors.initials: M
authors.lastname: Munyagwa
authors.forename: Ivan
authors.initials: I
authors.lastname: Kasamba
authors.forename: Jonathan
authors.initials: J
authors.lastname: Levin
authors.forename: Samuel
authors.initials: S
authors.lastname: Biraro
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
mesh_terms: D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012424:Rural Population; D014454:Uganda