Trends in child mortality: a prospective, population-based cohort study in a rural population in south-west Uganda.
Zhang, Lei;
Maher, Dermot;
Munyagwa, Mary;
Kasamba, Ivan;
Levin, Jonathan;
Biraro, Samuel;
Grosskurth, Heiner;
(2013)
Trends in child mortality: a prospective, population-based cohort study in a rural population in south-west Uganda.
Paediatrics and international child health, 33 (1).
pp. 23-31.
ISSN 2046-9047
DOI: https://doi.org/10.1179/2046905512Y.0000000041
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BACKGROUND: Although there has been substantial global progress in decreasing child mortality over the past two decades, progress in sub-Saharan Africa has largely lagged behind. The temporal trends in child mortality and associated risk factors were investigated in a cohort of children in rural Uganda. METHODS: Information on children's vital status, delivery, breastfeeding, vaccination history, maternal vital and HIV status, and children's HIV status for 1993-2007 was retrieved from the Medical Research Council/Uganda Virus Research Institute's (MRC/UVRI) Annual Population Census and Survey in Uganda. Regression models were employed to assess the association of these factors with child mortality. RESULTS: From 1993 to 2007, the death rate (/1000 person-years) in children <13 years of age decreased significantly from 16 to six. Apart from neonates, age-specific death rates fell in all age-groups. A reduction since 1999 in the risk of child mortality was associated with vaccination, birth in a health facility, exclusive breastfeeding for 6 months, 2-3 years since the previous sibling's birth, maternal vital status, and negative mother and child HIV serostatus. Although HIV seropositive children had a 26-fold increased risk of death before 13 years of age, HIV prevalence in children was about 1% and so had a small overall impact on child mortality. CONCLUSION: These findings are consistent with those of repeated national cross-sectional surveys. Meeting the Millennium Development Goals for child survival in sub-Saharan Africa depends on faster progress in implementing measures to improve birth-spacing, safe delivery in health facilities, infant feeding practices and vaccination coverage.