Pattern of cause-specific childhood mortality in a malaria endemic area of Burkina Faso

BACKGROUND: Reliable mortality data are a prerequisite for planning health interventions, yet such data are often not available in developing countries, particularly in sub-Saharan Africa (SSA). Demographic surveillance systems (DSS) implementing the verbal autopsy (VA) method are the only possibility to observe cause-specific mortality of a population on a longitudinal basis in many countries. METHODS: This paper reports all-cause and cause-specific mortality rates in children under the age of five years from 1999 until 2003 in a malaria holoendemic area of north-western Burkina Faso. The DSS of the Nouna Health Research Centre, in which VA data were analysed, covers a rural population of about 30,000 (41 villages) and an urban population of about 25,000 (Nouna town). RESULTS: A total of 1,544 deaths were analysed, 87 (6%), 225 (14%), 317 (21%) and 915 (59%) of which occurred in the periods < 1 month, 1–5 months, 6–11 months and 1–4 years respectively. All cause mortality rates of children under five years were higher in the rural than the urban area (34 vs 24 per 1,000 person-years) and in the rainy than the dry season (35 vs 29 per 1,000 person-years). Malaria was the most frequent diagnosis (42%) with peak mortality rates in infants aged 6–11 months. CONCLUSION: Malaria is the most important cause of death in this remote area of SSA, even considering the low specificity of malaria diagnosis in young children. Strengthening the existing malaria control tools is of prime importance to reduce the high childhood mortality in the endemic areas of SSA

Process and effects of a community intervention on malaria in rural Burkina Faso: randomized controlled trial.

BACKGROUND: In the rural areas of sub-Saharan Africa, the majority of young children affected by malaria have no access to formal health services. Home treatment through mothers of febrile children supported by mother groups and local health workers has the potential to reduce malaria morbidity and mortality. METHODS: A cluster-randomized controlled effectiveness trial was implemented from 2002-2004 in a malaria endemic area of rural Burkina Faso. Six and seven villages were randomly assigned to the intervention and control arms respectively. Febrile children from intervention villages were treated with chloroquine (CQ) by their mothers, supported by local women group leaders. CQ was regularly supplied through a revolving fund from local health centres. The trial was evaluated through two cross-sectional surveys at baseline and after two years of intervention. The primary endpoint of the study was the proportion of moderate to severe anaemia in children aged 6-59 months. For assessment of the development of drug efficacy over time, an in vivo CQ efficacy study was nested into the trial. The study is registered under http://www.controlled-trials.com (ISRCTN 34104704). RESULTS: The intervention was shown to be feasible under program conditions and a total of 1.076 children and 999 children were evaluated at baseline and follow-up time points respectively. Self-reported CQ treatment of fever episodes at home as well as referrals to health centres increased over the study period. At follow-up, CQ was detected in the blood of high proportions of intervention and control children. Compared to baseline findings, the prevalence of anaemia (29% vs 16%, p < 0.0001) and malaria parameters such as prevalence of P. falciparum parasitaemia, fever and palpable spleens was lower at follow-up but there were no differences between the intervention and control group. CQ efficacy decreased over the study period but this was not associated with the intervention. DISCUSSION: The decreasing prevalence of malaria morbidity including anaemia over the study period can be explained by an overall increase of malaria prevention and treatment activities in the study area. The lack of effectiveness of the intervention was likely caused by contamination, pre-existing differences in the coverage of malaria treatment in both study groups and an unexpectedly rapid increase of resistance against CQ, the first-line treatment drug at the time of the study

Total Versus Subtotal Gastrectomy for Distal Gastric Poorly Cohesive Carcinoma

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