Improvements in childhood mortality in The Gambia

Hill, Allan G.; Macleod, W. Bentley; Sonko, Sheriff; Walraven, Gijs

doi:10.1016/s0140-6736(05)75344-7

Cited by 6 publications

(5 citation statements)

References 3 publications

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“…2 In The Gambia, data from population censuses and various other sources showed rapid improvements in mortality among those younger than 5 yr from the late 1960s to the late 1980s; however, as in Senegal, overall mortality stabilized or even increased in the early 1990s when chloroquine resistance emerged. 35 …”

Section: Resultsmentioning

confidence: 99%

The public health impact of chloroquine resistance in Africa

Trape

2001

The American Journal of Tropical Medicine and Hygiene

440

302

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Abstract. Between 1978 and Plasmodium falciparum resistance to chloroquine has been reported in all countries of tropical Africa. Despite the intensification of resistance during the last 2 decades, chloroquine remains in 2000 the first-line treatment for malaria in most of these countries. Here we review published data on the public health impact of antimalarial drug resistance in Africa. These data show that since the late 1980s convincing evidence of a major public health impact of the spread of chloroquine resistance has been available. Hospital studies in various African countries have documented a 2-or 3-fold increase in malaria deaths and admissions for severe malaria, an increase temporally related to the emergence of chloroquine resistance. Data from sentinel demographic surveillance systems in Senegal indicated that mortality attributable to malaria in children increased by as much as 6-fold among populations where low levels of malaria mortality had been achieved because of efficient health services before the emergence of chloroquine resistance. Increasing incidence of severe malarial anemia also contributed to human immunodeficiency virus dissemination. The dramatic impact of chloroquine resistance on malaria mortality has long been underestimated because only a low proportion of malaria attacks are potentially lethal among persons continuously exposed since birth to high levels of transmission. There is an urgent need to change treatment policies in Africa.

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Section: Resultsmentioning

confidence: 99%

The public health impact of chloroquine resistance in Africa

Trape

2001

The American Journal of Tropical Medicine and Hygiene

440

302

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“…In Bolivia, mortality was 52% lower in areas receiving a PHC program involving both community-based nurses and volunteers than in non-program areas [28]. A similar program in the Gambia reduced child mortality by 33% in PHC program areas compared with 16% in non-program areas [29,30]. These programs did not examine the effects of nurses and volunteers independently.…”

Section: Discussionmentioning

confidence: 99%

The effect of community nurses and health volunteers on child mortality: The Navrongo Community Health and Family Planning Project

Pence¹,

Nyarko²,

Phillips

et al. 2007

Scand J Public Health

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“…The effects on the survival of infants are less clear cut. Over the same period, we known that national mortality levels were improving steadily, even beyond the Farafenni Study Area (MacLeod et al 1998a;Hill et al 1999). When supervision of the village-level health services was vigorous and extra resources were directed to PHC, the mortality differentials between PHC and non-PHC villages widened.…”

Section: Discussionmentioning

confidence: 99%

Decline of mortality in children in rural Gambia: the influence of village‐level Primary Health Care

Hill¹,

Macleod²,

Joof

et al. 2000

Tropical Med Int Health

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Summary Using data from a longitudinal study conducted in 40 villages by the UK MRC in the North Bank Division of The Gambia beginning in late 1981, we examined infant and child mortality over a 15‐year period for a population of about 17 000 people. Comparisons are drawn between villages with and without PHC. The extra facilities in the PHC villages include: a paid Community Health Nurse for about every 5 villages, a Village Health Worker and a trained Traditional Birth Attendant. Maternal and child health services with a vaccination programme are accessible to residents in both PHC and non‐PHC villages. The data indicate that there has been a marked improvement in infant and under‐five mortality in both sets of villages. Following the establishment of the PHC system in 1983, infant mortality dropped from 134/1000 in 1982–83 to 69/1000 in 1992–94 in the PHC villages and from 155/1000 to 91/1000 in the non‐PHC villages over the same period. Between 1982 and 83 and 1992–94, the death rates for children aged 1–4 fell from 42/1000 to 28/1000 in the PHC villages and from 45/1000 to 38/1000 in the non‐PHC villages. Since 1994, when supervision of the PHC system has weakened, infant mortality rates in the PHC villages have risen to 89/1000 in 1994–96. The rates in the non‐PHC villages fell to 78/1000 for this period. The under‐five mortality rates in both sets of villages have converged to 34/1000 for 1994–96. When the PHC programme was well supported in the 1980s, we saw significantly lower mortality rates for the 1–4‐year‐olds. These differences disappeared when support for PHC was reduced after 1994. The differential effects on infant mortality are less clear cut.

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Improvements in childhood mortality in The Gambia

Cited by 6 publications

References 3 publications

The public health impact of chloroquine resistance in Africa

The public health impact of chloroquine resistance in Africa

The effect of community nurses and health volunteers on child mortality: The Navrongo Community Health and Family Planning Project

Decline of mortality in children in rural Gambia: the influence of village‐level Primary Health Care

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