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Patterns of Age-Specific Mortality in Children in Endemic Areas of Sub-Saharan Africa

Understanding of the age- and season- dependence of malaria mortality is an important prerequisite for epidemiologic models of malaria immunity. However, most studies of malaria mortality have aggregated their results into broad age groups and across seasons, making it hard to predict the likely impact of interventions targeted at specific age groups of children. We present age-specific mortality rates for children aged < 15 years for the period of 2001–2005 in 7 demographic surveillance sites in areas of sub-Saharan Africa with stable endemic Plasmodium falciparum malaria. We use verbal autopsies (VAs) to estimate the proportion of deaths by age group due to malaria, and thus calculate malaria-specific mortality rates for each site, age-group, and month of the year. In all sites a substantial proportion of deaths (ranging from 20.1% in a Mozambican site to 46.2% in a site in Burkina Faso) were attributed to malaria. The overall age patterns of malaria mortality were similar in the different sites. Deaths in the youngest children (< 3 months old) were only rarely attributed to malaria, but in children over 1 year of age the proportion of deaths attributed to malaria was only weakly age-dependent. In most of the sites all-cause mortality rates peaked during the rainy season, but the strong seasonality in malaria transmission in these sites was not reflected in strong seasonality in the proportion of deaths attributed to malaria, except in the two sites in Burkina Faso. Improvement in the specificity of malaria verbal autopsies would make it easier to interpret the age and season patterns in such data.

Received August 21, 2006. Accepted for publication April 30, 2007.

Acknowledgments: We thank the contributions of the many fieldworkers, supervisory staff, and data managers in the different sites to the assembly of the database. We particularly want to acknowledge the following DSS sites that contributed data for this article: Kisumu demographic surveillance site, Kourweogo and Oubritenga demographic surveillance sites, Manhiça demographic surveillance site, Navrongo demographic surveillance site, Ifakara demographic surveillance site, and Rufiji demographic surveillance site. The assembly of the cross-site database was coordinated both by the INDEPTH secretariat and by the MTIMBA project.

Financial Support: Main financial support for the vital events registration: Ifakara: Swiss Agency for Development and Co-operation, Swiss National Science Foundation grant number 3270-059541-99; Kisumu: U.S. Centers for Disease Control and Prevention; Manhica: Spanish Agency for International Cooperation; Navrongo: Rockefeller Foundation; Oubritenga and Kourweogo: UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), the European Commission (INCO-DC, Directorate General XII), the Danish Agency for International Development and the Ministry for University and Scientific Research of Italy. Rufiji: IDRC Canada through the Tanzania Essential Health Interventions Program. Data analysis and interpretation was financed by the Swiss Tropical Institute.

^* Address correspondence to Fred N. Binka, INDEPTH Network Secretariat, Ghana. E-mail: fred.binka{at}indepth-network.org

Authors’ addresses: Salim Abdullah and Honorati Masanja, Ifakara Health Research & Development Centre, Tanzania. Kubaje Adazu, Kenya Medical Research Institute, Kisumu, Kenya. Diadier Diallo and Edith Ilboudo-Sanogo, Centre National de Recherche et Formation sur le Paludisme, Burkina Faso. Arial Nhacolo and Ricardo Thompson, Centro de Investigaçäo em Saúde da Manhiça, Ministério de Saúde, Manhiça, Mozambique. Abraham Hodgson and Seth Owusu-Agyei, Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana. Thomas Smith, Swiss Tropical Institute, Basel, Switzerland. Fred Binka, INDEPTH Network and Department Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, P.O. Box KD 213, Accra, Ghana.

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