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IJE Advance Access published online on November 29, 2004
International Journal of Epidemiology, doi:10.1093/ije/dyh259
© 2004 by International Epidemiological Association
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Accepted May 14, 2004

Original paper

Childhood mortality and probable causes of death using verbal autopsy in Niakhar, Senegal, 1989-2000

Jean-François Etard 1*, Jean-Yves Le Hesran 1, Aldiouma Diallo 1, Jean-Pierre Diallo 1, Jean-Louis Ndiaye 1, and Valérie Delaunay 2

1 Institut de Recherche pour le Développement (IRD) BP 1386 Dakar, Sénégal
2 Laboratoire Population-Environnement-Développement, UMR 151 IRD--Université, de Provence, Marseille, France

* To whom correspondence should be addressed.
Jean-François Etard, E-mail: etard{at}ird.sn


  Abstract

Background In African rural settings, medically certified information on causes of death is largely lacking. The authors applied the verbal autopsy to identify causes of death before 15 years old in a rural area of Senegal where a demographic surveillance system is operating.

Methods Between 1989 and 2000, a postmortem interview was conducted using a standardized questionnaire which was independently reviewed by two physicians who assigned the probable underlying cause of death. Discordant diagnoses were discussed by a panel of physicians. Causes of death were grouped into a few categories; cause-specific mortality rates and fractions were generated.

Results Between 1989 and 1997, all-cause mortality fluctuated. Diarrhoeal diseases, malaria and acute respiratory infections explained between 30% and 70% of the mortality before 10 years of age. In children 1-9 years old, malaria death rate increased between 1989 and 1994 and thereafter did not change. The 1998-2000 years were marked by a peak in mortality, attributed to a meningitis outbreak in children more than one year old paralleled by an increase in death rate from fever of unknown origin, diarrhoeal diseases, and acute respiratory infections in children under 5 years.

Conclusions Verbal autopsy provided useful information on the mortality structure responsible for the 1998-2000 peak in mortality. It underlined that, outside outbreak situations, malaria was a leading cause of death for 1-9 year old children and that diarrhoea, acute respiratory infections, or fever from unknown origin accounted for up to 50% of the deaths among the children under 5 years.

Keywords: Cause of death; infant; child; communicable diseases; preschool; rural population; Senegal.
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