title: The contribution of reduction in malaria as a cause of rapid decline of under-five mortality: evidence from the Rufiji Health and Demographic Surveillance System (HDSS) in rural Tanzania.
abstract: BACKGROUND
  Under-five mortality has been declining rapidly in a number of sub-Saharan African settings. Malaria-related mortality is known to be a major component of childhood causes of death and malaria remains a major focus of health interventions. The paper explored the contribution of malaria relative to other specific causes of under-five deaths to these trends.
  
  
  METHODS
  This paper uses longitudinal demographic surveillance data to examine trends and causes of death of under-five mortality in Rufiji, whose population has been followed for over nine years (1999-2007). Causes of death, determined by the verbal autopsy technique, are analysed with Arriaga's decomposition method to assess the contribution of declining malaria-related mortality relative to other causes of death as explaining a rapid decline in overall childhood mortality.
  
  
  RESULTS
  Over the 1999-2007 period, under-five mortality rate in Rufiji declined by 54.3%, from 33.3 to 15.2 per 1,000 person-years. If this trend is sustained, Rufiji will be a locality that achieves MDG4 target. Although hypotrophy at birth remained the leading cause of death for neonates, malaria remains as the leading cause of death for post-neonates followed by pneumonia. However, declines in malaria death rates accounted for 49.9% of the observed under-five mortality decline while all perinatal causes accounted for only 19.9%.
  
  
  CONCLUSIONS
  To achieve MDG 4 in malaria endemic settings, health programmes should continue efforts to reduce malaria mortality and more efforts are also needed to improve newborn survival.
authors.affiliation: Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York 10032, USA. amk2213@columbia.edu.
authors.forename: Almamy M
authors.initials: AM
authors.lastname: Kanté
authors.forename: Rose
authors.initials: R
authors.lastname: Nathan
authors.forename: Stéphane
authors.initials: S
authors.lastname: Helleringer
authors.forename: Mrema
authors.initials: M
authors.lastname: Sigilbert
authors.forename: Francis
authors.initials: F
authors.lastname: Levira
authors.forename: Honorati
authors.initials: H
authors.lastname: Masanja
authors.forename: Don
authors.initials: D
authors.lastname: de Savigny
authors.forename: Salim
authors.initials: S
authors.lastname: Abdulla
authors.forename: James F
authors.initials: JF
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000367:Age Factors; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008288:Malaria / Q000453:epidemiology* / Q000401:mortality*; D008297:Male; D012424:Rural Population; D016019:Survival Analysis; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult