Volume 78, Issue 1
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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.


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  1. Black RE, Morris SS, Bryce J, 2003. Where and why are 10 million children dying every year? Lancet 361 : 2226–2234.
  2. Victora CG, Wagstaff A, Schellenberg JA, Gwatkin D, Claeson M, Habicht JP, 2003. Applying an equity lens to child health and mortality: more of the same is not enough. Lancet 362 : 233–241.
  3. Garenne M, Gakusi E, 2006. Health transitions in sub-Saharan Africa: overview of mortality trends in children under 5 years old (1950–2000). Bull World Health Organ 84 : 470–478.
  4. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ, 2006. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 367 : 1747–1757.
  5. Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, 2003. How many child deaths can we prevent this year? Lancet 362 : 65–71.
  6. Muller O, Krawinkel M, 2005. Malnutrition and health in developing countries. Can Med Assoc J 173 : 279–286.
  7. Centers for Disease Control and Prevention (CDC), 2000. Cause-specific adult mortality: evidence from community-based surveillance–selected sites, Tanzania, 1992–1998. MMWR Morb Mortal Wkly Rep 49 : 416–419.
  8. Greenwood BM, Bradley AK, Greenwood AM, Byass P, Jammeh K, Marsh K, Tulloch S, Oldfield FS, Hayes R, 1987. Mortality and morbidity from malaria among children in a rural area of The Gambia, West Africa. Trans R Soc Trop Med Hyg 81 : 478–486.
  9. Greenwood BM, Bradley AK, Byass P, Greenwood AM, Menon A, Snow RW, Hayes RJ, Hatib-N’Jie AB, 1990. Evaluation of a primary health care programme in The Gambia. II. Its impact on mortality and morbidity in young children. J Trop Med Hyg 93 : 87–97.
  10. Mathers CD, Fat DM, Inoue M, Rao C, Lopez AD, 2005. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Organ 83 : 171–177.
  11. Muller O, Traore C, Becher H, Kouyate B, 2003. Malaria morbidity, treatment-seeking behaviour, and mortality in a cohort of young children in rural Burkina Faso. Trop Med Int Health 8 : 290–296.
  12. Anker M, 1997. The effect of misclassification error on reported cause-specific mortality fractions from verbal autopsy. Int J Epidemiol 26 : 1090–1096.
  13. Etard JF, Le Hesran JY, Diallo A, Diallo JP, Ndiaye JL, Delaunay V, 2004. Childhood mortality and probable causes of death using verbal autopsy in Niakhar, Senegal, 1989–2000. Int J Epidemiol 33 : 1286–1292.
  14. Korenromp EL, Williams BG, Gouws E, Dye C, Snow RW, 2003. Measurement of trends in childhood malaria mortality in Africa: an assessment of progress toward targets based on verbal autopsy. Lancet Infect Dis 3 : 349–358.
  15. Quigley MA, 2005. Commentary: verbal autopsies–from small-scale studies to mortality surveillance systems. Int J Epidemiol 34 : 1087–1088.
  16. Snow RW, Armstrong JR, Forster D, Winstanley MT, Marsh VM, Newton CR, Waruiru C, Mwangi I, Winstanley PA, Marsh K, 1992. Childhood deaths in Africa: uses and limitations of verbal autopsies. Lancet 340 : 351–355.
  17. Todd JE, de Francisco A, O’Dempsey TJ, Greenwood BM, 1994. The limitations of verbal autopsy in a malaria-endemic region. Ann Trop Paediatr 14 : 31–36.
  18. Network INDEPTH, 2002. International Network for the Continuous Demographic Evaluation of Populations and their Health. Population and Health in Developing Countries, Volume 1: Population, Health, and Survival at INDEPTH Sites. Ottawa, Canada: International Development Research Centre.
  19. Jaffar S, Leach A, Greenwood AM, Jepson A, Muller O, Ota MO, Bojang K, Obaro S, Greenwood BM, 1997. Changes in the pattern of infant and childhood mortality in upper river division, The Gambia, from 1989 to 1993. Trop Med Int Health 2 : 28–37.
  20. Garenne M, Kahn K, Tollman S, Gear J, 2000. Causes of death in a rural area of South Africa: an international perspective. J Trop Pediatr 46 : 183–190.
  21. Baiden F, Hodgson A, Adjuik M, Adongo P, Ayaga B, Binka F, 2006. Trend and causes of neonatal mortality in the Kassena-Nankana district of northern Ghana, 1995–2002. Trop Med Int Health 11 : 532–539.
  22. Lawoyin TO, Asuzu MC, Kaufman J, Rotimi C, Johnson L, Owoaje E, Cooper R, 2004. Using verbal autopsy to identify and proportionally assign cause of death in Ibadan, southwest Nigeria. Niger Postgrad Med J 11 : 182–186.
  23. Hammer GP, Some F, Muller O, Kynast-Wolf G, Kouyate B, Becher H, 2006. Pattern of cause-specific childhood mortality in a malaria endemic area of Burkina Faso. Malar J 5 : 47.
  24. Adjuik M, Smith T, Clark S, Todd J, Garrib A, Kinfu Y, Kahn K, Mola M, Ashraf A, Masanja H, Adazu K, Saracarlal J, Alam N, Marra A, Gbangou A, Mwageni E, Binka F, 2006. Cause-specific mortality rates in sub-Saharan Africa and Bangladesh. Bull World Health Organ 84 : 181–188.
  25. Delaunay V, Etard JF, Preziosi MP, Marra A, Simondon F, 2001. Decline of infant and child mortality rates in rural Senegal over a 37-year period (1963–1999). Int J Epidemiol 30 : 1286–1293.
  26. de Francisco A, Hall AJ, Schellenberg JR, Greenwood AM, Greenwood BM, 1993. The pattern of infant and childhood mortality in Upper River Division, The Gambia. Ann Trop Paediatr 13 : 345–352.
  27. Lawoyin TO, 2001. Risk factors for infant mortality in a rural community in Nigeria. J R Soc Health 121 : 114–118.
  28. Moore SE, 2006. Commentary: patterns in mortality governed by the seasons. Int J Epidemiol 35 : 435–437.
  29. Rayco-Solon P, Moore SE, Fulford AJ, Prentice AM, 2004. Fifty-year mortality trends in three rural African villages. Trop Med Int Health 9 : 1151–1160.
  30. Sankoh OA, Kynast-Wolf G, Kouyate B, Becher H, 2003. Patterns of adult and old-age mortality in rural Burkina Faso. J Public Health Med 25 : 372–376.
  31. Kynast-Wolf G, Hammer GP, Muller O, Kouyate B, Becher H, 2006. Season of death and birth predict patterns of mortality in Burkina Faso. Int J Epidemiol 35 : 427–435.
  32. Rowe AK, Rowe SY, Snow RW, Korenromp EL, Schellenberg JR, Stein C, Nahlen BL, Bryce J, Black RE, Steketee RW, 2006. The burden of malaria mortality among African children in the year 2000. Int J Epidemiol 35 : 691–704.
  33. Snow RW, Guerra CA, Noor AM, Myint HY, Hay SI, 2005. The global distribution of clinical episodes of Plasmodium falciparum malaria. Nature 434 : 214–217.
  34. Becher H, Kouyaté B, 2005. Health Research in Developing Countries. A Collaboration Between Burkina Faso and Germany. Heidelberg, Germany: Springer Verlag.
  35. Traoré C, 2004. Epidemiology of Malaria in Rural North-Western Burkina Faso. PhD thesis, Medical Faculty, Ruprecht-Karls-University, Heidelberg, Germany.
  36. Greenland S, Michels KB, Robins JM, Poole C, Willett WC, 1999. Presenting statistical uncertainty in trends and dose-response relations. Am J Epidemiol 149 : 1077–1086.
  37. SAS Institute, 2003. SAS Version 9. Cary, NC: SAS Institute.
  38. Greenwood BM, Greenwood AM, Bradley AK, Tulloch S, Hayes R, Oldfield FS, 1987. Deaths in infancy and early childhood in a well-vaccinated, rural, West African population. Ann Trop Paediatr 7 : 91–99.
  39. Muller O, Garenne M, Kouyate B, Becher H, 2003. The association between protein-energy malnutrition, malaria morbidity and all-cause mortality in West African children. Trop Med Int Health 8 : 507–511.
  40. Snow RW, Craig M, Deichmann U, Marsh K, 1999. Estimating mortality, morbidity and disability due to malaria among Africa’s non-pregnant population. Bull World Health Organ 77 : 624–640.
  41. Morris SS, Black RE, Tomaskovic L, 2003. Predicting the distribution of under-five deaths by cause in countries without adequate vital registration systems. Int J Epidemiol 32 : 1041–1051.
  42. Rudan I, El Arifeen S, Black RE, Campbell H, 2007. Childhood pneumonia and diarrhoea: setting our priorities right. Lancet Infect Dis 7 : 56–61.
  43. Smith T, 2006. Commentary: malaria death rates remain highly pertinent. Int J Epidemiol 35 : 704–705.
  44. Reyburn H, Mbatia R, Drakeley C, Carniero I, Mwakasungula E, Mwerinde O, Saganda K, Shao J, Kitua A, Olomi R, Greenwood BM, Whitty CJ, 2004. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ 329 : 1212.
  45. Chandramohan D, Setel P, Quigley M, 2001. Effect of misclassification of causes of death in verbal autopsy: can it be adjusted? Int J Epidemiol 30 : 509–514.
  46. English M, Punt J, Mwangi I, McHugh K, Marsh K, 1996. Clinical overlap between malaria and severe pneumonia in Africa children in hospital. Trans R Soc Trop Med Hyg 90 : 658–662.
  47. Greenwood BM, Bojang K, Whitty CJ, Targett GA, 2005. Malaria. Lancet 365 : 1487–1498.
  48. Traoré C, 2004. Epidemiology of Malaria in Rural North-Western Burkina Faso. Heidelberg, Germany: Medical Faculty, Ruprecht-Karls-University.
  49. Kouyaté B, Sie A, Yé M, De Allegri M, Müller O, 2007. The great failure of malaria control in Africa: a district perspective from Burkina Faso. PLOS Med 4 : e127.

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  • Received : 13 Mar 2007
  • Accepted : 26 Jul 2007

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