Risk factors for child mortality in rural Tanzania.
Armstrong Schellenberg JR, Nathan R, Abdulla S, Mukasa O, Marchant TJ, Tanner M, Lengeler C.
Ifakara Health Research and Development Centre, Ifakara, Tanzania. dajobelo@aol.com
We conducted a community-based nested case-control study of post-neonatal deaths in children under 5 years, with frequency-matched controls chosen from a full sampling frame provided by a demographic surveillance system. Using a questionnaire, we studied treatment-seeking behaviour in fatal illness. In cases and controls we investigated demographic and socio-economic factors, health-seeking behaviour, the household environment including accessibility of health care, and individual child care factors. Half of the deaths (215/427) occurred at home, and one-third (146/427) at a health facility. Three-quarters (330/427) of the children who died had received treatment from a health facility in their fatal illness. Four independent risk factors for death were identified which were each associated with more than 5% of child mortality: not being carried on the back while the mother cooked [odds ratio (OR) 1.6: 1.3, 2.0], poor maternal education (OR 1.4: 95% CI 1.0, 1.9 for those with no education compared with those with complete primary education), lack of exclusive breastfeeding in the first 3 months of life (OR 1.4: 1.1, 1.8), and low socio-economic status (OR 1.3: 1.0, 1.6). The majority of children who died had sought treatment at a health facility during the fatal illness, which would lend support to interventions to improve case-management. The association between mothers carrying their children and child survival was unexpected and deserves further investigation.
Publication Types:
PMID: 12031072 [PubMed - indexed for MEDLINE]