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Patterns of Malaria: Cause-Specific and All-Cause Mortality in a Malaria-Endemic Area of West Africa

Heiko Becher^*,, Gisela Kynast-Wolf, Ali Sié, Robert Ndugwa, Heribert Ramroth, Bocar Kouyaté, AND Olaf Müller

Information on cause-specific mortality is sparse in sub-Saharan Africa. We present seasonal patterns of malaria and all-cause mortality from a longitudinal study with 60,000 individuals in rural northwestern Burkina Faso. The study is based on a demographic surveillance system and covers the period 1999–2003. Overall, 3,492 deaths were observed. Cause of death was ascertained by verbal autopsy. Age-specific death rates by cause and month of death were calculated. Seasonal and temporal trends were modeled with parametric Poisson regression. Infant and children less than 5 years of age mortality was 60.6 (95% CI, 56.2–65.3) and 31.9 (95% CI, 30.4–33.5) per 1,000 for all causes and 23.4 (95% CI, 20.7–26.4) and 13.3 (95% CI, 12.3–14.3) for malaria, respectively. Mortality was significantly higher in the rainy season. It is well described parametrically with a sinusoidal function. In adults, the highest all-cause mortality rates were observed in the dry season. Here, HIV/AIDS has become a leading cause of mortality.

Received March 13, 2007. Accepted for publication July 26, 2007.

Acknowledgments: The authors thank the field staff in Nouna/ Burkina Faso and Gabriele Stieglbauer for efficient help with data management and programming.

Financial support: This work was supported by the collaborative research grant SFB 544 "Control of Tropical Infections Diseases" of the German Research Foundation (DFG), subprojects Z2 and D1.

^* Address correspondence to Heiko Becher, INF 324, 69120 Heidelberg, Germany 69120. E-mail: heiko.becher{at}urz.uni-heidelberg.de

Both authors contributed equally.

Authors’ addresses: Heiko Becher, Gisela Kynast-Wolf, Robert Ndugwa, Heribert Ramroth, and Olaf Müller, Department of Tropical Hygiene and Public Health, University of Heidelberg, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany. Ali Sié, Centre de Recherche en Santé de Nouna (CRSN), BP 02, Nouna, Burkina Faso. Bocar Kouyaté, Centre National de Recherche et de la Formation au Paludisme, 01 BP 2208, Ouagadougou 01, Burkina Faso.

Reprint requests: Heiko Becher, Department of Tropical Hygiene and Public Health, University of Heidelberg, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany, Telephone: 49-6221-565031, Fax: 49-6221-565948, E-mail: heiko.becher{at}urz.uni-heidelberg.de.