International Journal of Epidemiology 2001;30:485-492
© International Epidemiological Association 2001
Child Health in Africa |
Clustering of childhood mortality in rural Burkina Faso
a Department of Tropical Hygiene and Public Health,
University of Heidelberg Medical School, Heidelberg, Germany.
b Centre de Recherche en Santé de Nouna (CRSN), BP
02, Nouna, Burkina Faso.
Prof. Heiko Becher, Department of Tropical Hygiene and Public Health, University of Heidelberg Medical School, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany. E-mail: heiko.becher{at}urz.uni-heidelberg.de
Abstract
Background Childhood mortality is a major public health problem in sub-Saharan Africa. For the implementation of efficient public health systems, knowledge of the spatial distribution of mortality is required.
Methods Data from a demographic surveillance research project were analysed which comprised information obtained for about 30 000 individuals from 39 villages in northwest Burkina Faso (West Africa) in the period 1993–1998. Total childhood mortality rates were calculated and the geographical distribution of total childhood mortality was investigated. In addition, data from a cohort of 686 children sampled from 16/39 of the villages followed up during a randomized controlled trial in 1999 were also used to validate the results from the surveillance data. A spatial scan statistic was used to test for clusters of total childhood mortality in both space and time.
Results Several statistically significant clusters of higher childhood mortality rates comprising different sets of villages were identified; one specific village was consistently identified in both study populations indicating non-random distribution of childhood mortality. Potential risk factors which were available in the database (ethnicity, religion, distance to nearest health centre) did not explain the spatial pattern.
Conclusion The findings indicate non-random clustering of total childhood mortality in the study area. The study may be regarded as a first step in prioritizing areas for follow-up public health efforts.
KEY MESSAGES
- A demographic surveillance system in a rural area in
Burkina Faso provides data for childhood mortality analysis
(1993–1998).
- The spatial scan statistic was used to
identify spatial and space-time clustering of childhood
mortality.
- Regions of different sizes, however, always
including one particular village with significantly increased mortality,
were identified.
- Data from a controlled trial which included
this particular village showed a similar result.
- Available
demographic and other variables (e.g. ethnicity, religion) did not explain
the finding.
Keywords Childhood mortality, clustering, demographic surveillance, spatio-temporal analysis
Accepted 15 February 2001
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