Volume 69, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


It has proven very difficult to determine the causes of early infant mortality and morbidity in Africa. We undertook a two-year, prospective birth cohort study in a rural Kenyan District Hospital to estimate cause-specific mortality and severe morbidity in infants too young to gain benefit from routine immunization approaches. A total of 2,359 infants eligible for the cohort were delivered. Of these, 136 (6%) were stillborn and 77 (3.5%) subsequently died. Prematurity (34%), birth asphyxia (27%), and infection (18.5%) were the predominant causes of death in the first 98 days of life, although infection accounted for 36% of all life-threatening illness episodes in the same period. The data suggest that health system constraints are likely to impede programmatic efforts to reduce early infant mortality and morbidity, and that infection prevention measures offer some promise for mortality reduction. Assessing the cost effectiveness of the latter, particularly for very specific interventions such as further maternal vaccination, will require very large trials.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 1994. Mother-Baby Package: Implementing Safe Motherhood in Countries. Geneva: World Health Organization.
  2. Bang A, Bang R, Baitule S, Reddy M, Deshmukh M, 1999. Effect of home based care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 354 : 1955–1961. [Google Scholar]
  3. Gove S, 1997. Integrated management of childhood illness by outpatient healthworkers: technical basis and overview. Bull World Health Organ 75 (Suppl 1) : 7–16. [Google Scholar]
  4. Fischer G, Ottolini M, Mond J, 1997. Prospects for vaccines during pregnancy and in the newborn period. Clin Perinatol 24 : 231–250. [Google Scholar]
  5. Anonymous, 1998. WHO meeting on maternal and neonatal pneumococcal immunization. Wkly Epidemiol Rec 25 : 187–188. [Google Scholar]
  6. Slutsker L, Bloland P, Steketee R, Wirima J, Heymann D, Breman J, 1996. Infant and second year mortality in rural Malawi: causes and descriptive epidemiology. Am J Trop Med Hyg 55 : 77–81. [Google Scholar]
  7. Snow R, Mungala V, Forster D, Marsh K, 1994. The role of the district hospital in child survival at the Kenyan Coast. Afr J Health Sci 1 : 11–15. [Google Scholar]
  8. National Council for Population and Development, 1999. Kenya Demographic and Health Survey, 1998. Nairobi: National Council for Population and Development, Central Bureau of Statistics & Office of the Vice-President and Ministry of Planning and National Development, Republic of Kenya.
  9. Ministry of Health, 2001. AIDS in Kenya. Sixth Edition. Nairobi: Ministry of Health and the National AIDS Control Council.
  10. World Health Organization, 1999. A Standard Verbal Autopsy Method for Investigating Causes of Death in Infants and Children. Geneva: World Health Organization.
  11. English M, Ngama M, Musumba C, Wamola B, Bwika J, Mohammed S, Ahmed M, Mwarumba S, Ouma B, McHugh K, Newton C, 2003. Causes and outcome of young infant admissions to a Kenyan district hospital. Arch Dis Child 88 : 438–443. [Google Scholar]
  12. Ministry of Health, 2001. Health Management Information Systems—Report for the 1996 to 1999 Period. Nairobi: Government of Kenya.
  13. McElroy P, ter Kuile F, Hightower A, Hawley W, Phillips-Howard P, Oloo A, Lal A, Nahlen B, 2001. All cause mortality among young children in Western Kenya. VI: The Asembo Bay cohort project. Am J Trop Med Hyg 64 : 18–27. [Google Scholar]
  14. Snow R, Armstrong J, Forster D, Winstanley M, Marsh V, Newton C, Waruiru C, Mwangi I, 1992. Winstanley P, Marsh K. Childhood deaths in Africa: uses and limitations of verbal autopsies. Lancet 340 : 351–355. [Google Scholar]
  15. Kulmala T, Vaahtera M, Ndekha M, Koivisto A, Cullinan T, Salin M, Shorn P, 2000. The importance of preterm births for peri and neonatal mortality in rural Malawi. Paediatr Perinat Epidemiol 14 : 219–226. [Google Scholar]
  16. Martin J, Hamilton B, Ventura S, Menacker F, Park M, 2002.National Vital Statistics Report: Births—Final Data for 2000. Hyattsville, MD: National Center for Statistics, USA, 2002.
  17. Wilcox A, 2001. On the importance—and the unimportance—of birthweight. Int J Epidemiol 30 : 1233–1241. [Google Scholar]
  18. Duke T, Willie L, Mgone J, 2000. The effect of introduction of minimal standards of neonatal care on in-hospital mortality. P N G Med J 43 : 127–136. [Google Scholar]
  19. Stoll B, 1997. The global impact of neonatal infection. Clin Perinatol 24 : 1–21. [Google Scholar]
  20. The WHO Young Infant Study Group, 1999. Bacterial etiology of serious infections in young infants in developing countries—results of a multicenter study. Pediatr Infect Dis J 18 (Suppl) : S17–S22. [Google Scholar]
  21. Shulman C, Dorman E, Talisuna A, Lowe B, Nevill C, Snow R, Jilo H, Peshu N, Bulmer J, Graham S, Marsh K, 1998. A community randomised controlled trial of insecticide treated bednets for the prevention of malaria and anaemia among primigravid women on the Kenyan coast. Trop Med Int Health 3 : 197–204. [Google Scholar]
  22. Brair M, Brabin B, Milligan P, Maxwell S, Hart C, 1994. Reduced antibody transfer of tetanus antibodies with placental malaria. Lancet 343 : 208–209. [Google Scholar]
  23. Okoko J, Wesumperuma H, Hart C, 2001. The influence of prematurity and low birthweight on transplacental antibody transfer in a rural West African population. Trop Med Int Health 6 : 529–534. [Google Scholar]

Data & Media loading...

  • Received : 22 Feb 2003
  • Accepted : 12 May 2003

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error