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

BackgroundUnder-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.MethodsThis 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.ResultsOver 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%.ConclusionTo 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.

Morbidity and mortality of children aged 2–59 months admitted in the Tanzania Lake Zone’s public hospitals: a cross-sectional study

“…Previous reports suggest the same leading morbidities among under-fives in developing countries including Tanzania [ 12 , 27 – 29 ]. Furthermore, the leading causes of hospital admissions among under-fives and adults have been fever, vomiting, diarrhoea and coughing [ 3 , 12 , 30 , 31 ].…”

“…Despite the decline in mortality, major underlying causes of in-patient death risks in this study were severe anaemia, severe malaria and severe pneumonia. Data from sub-Saharan and Asian countries indicate malaria, diarrhoea, pneumonia, anaemia and malnutrition as some of the major causes of deaths among children below the age of 5 years [ 3 , 18 , 32 , 33 ]. However, severe anaemia as a cause of death from this study may be linked with severe malaria.…”

Childhood Illness Prevalence and Health Seeking Behavior Patterns in Rural Tanzania

“…The under-5 mortality rates were about 61.4 deaths per 1,000 live births in Rufiji in 2012, while the rates were much higher in Ifakara: about 66.6/1000 in Ifakara rural and 78.0/1,000 in Ifakara urban in 2011 [ 21 , 22 ]. Major causes of mortality for children under five in these regions include malaria, ARI, diarrheal disease, prematurity and low birth weight, and birth injuries and asphyxia [ 23 , 24 ]. Further details about these HDSS are available in existing publications [ 25 , 26 ].…”

Trends in socioeconomic disparities in a rapid under-five mortality transition: a longitudinal study in the United Republic of Tanzania

“…Major causes of mortality for these children included malaria and fever, pneumonia, prematurity and low birth weight, birth injuries, asphyxia, anaemia and malnutrition. 23 …”