Impact on mortality of a community-based programme to control acute lower respiratory tract infections.

Acute lower respiratory tract infections (ALRIs) are a major cause of death among young children in developing countries. A targeted programme designed to treat children with ALRI was implemented in 1988 in a primary health care project in rural Bangladesh. In the 2 years preceding the introduction of the programme (1986-87), non-ALRI-specific health services were provided, including promotion of oral rehydration therapy, family planning, immunization of children and mothers, distribution of vitamin A, referral of severely sick children to field clinics, and nutritional rehabilitation of malnourished children. The targeted ALRI programme, which was in place in 1988-89, was based on systematic ALRI case detection and management by community health workers, who were linked to a referral system for medical support. These two levels of intervention have been evaluated by comparing the ALRI-specific mortality in the programme area and a neighbouring control area during the two periods. During the first phase (1986-87), the ALRI mortality among under-5-year-olds was 28% lower in the intervention than in the comparison area (P less than 0.01). During the second phase (1988-89), the ALRI mortality was 32% lower in the intervention area than during the preceding phase, while there was no significant difference for the comparison area. These findings suggest that in the study region the combination of specific and nonspecific interventions can reduce ALRI mortality by as much as 50% and the overall mortality among under-5-year-olds by as much as 30%.

[Explanatory approach to child mortality. Reflections and perspectives]. / L'approche explicative en matiere de mortalite des enfants. Reflesions et perspectives.

PIP: After 1st stressing the complexity of explaining child mortality, a short overview of the various approaches to the problem is given. Included in the overview is research undertaken in different areas directly or indirectly concerned--particularly epidemiology and demography, but also in medical sciences, medical sociology, and anthropology. The purpose of this review is to point out the lack of coherence and shortcomings of research. Are they really explanatory or merely descriptive? Do they use the relevant techniques of observation and statistical analysis according to the objectives: Are they well integrated, without ambiguity, into the framework of a methodologically coherent thought? To many of these questions, the answer is often negative. To the partitioning of the different sciences concerning child mortality, this paper opposes the absolute necessity of a multidisciplinary approach, which should at the same time carry on the theoretical reflection on the cause of this complex phenomenon, and elaborate all research programs on the matter. (author's modified)^ieng

Epidemiology and causes of death among children in a rural area of Bangladesh.

From a longitudinal surveillance programme among a rural Bangladesh population of 260,000, the epidemiology and causes of child death (under age 5) over 3 years (1975-1977) were analyzed. The most significant causes of death were diarrhoea (watery and dysentery), tetanus, measles, fever, respiratory disease, drowning, skin disease, and other causes. Of an infant mortality rate of 142.6/1000 live births, neonatal tetanus (37.4/1000), diarrhoea (19.6/1000), and respiratory disease (10.4/1000) were the most significant identifiable causes. Many infant deaths (62.2/1000) were unidentified, taking place during the neonatal (1-28 days) period. The 1-4 year mortality averaged 34.3/1 000. Diarrhoea (15.1/1 000), measles (4.5/1 000), fever (2.9/1 000) and respiratory disease (1.6/1 000) accounted for most 1-4 year deaths. Mortality trends over the past 10 years showed sharp temporary fluctuations in response to 2 disasters but no definitive long-term trend. Most causes of death displayed seasonal fluctuation, and sex differentials were marked with female deaths exceeding male deaths for all ages after the neonatal period. Malnourished children from low socioeconomic status families had higher mortality rates than their better nourished and wealthier counterparts. Overall, the data suggest that the delivery of a few basic health measures (oral hydration and immunization) could result in substantial reduction of under 5 mortality.

PIP: From a longitudinal surveillance program among a rural Bangladesh population of 260,000, the epidemiology and causes of child death (under age 5) over 3 years (1975-77) were analyzed. The most significant causes of death were diarrhea (watery and dysentery), tetanus, measles, fever, respiratory diseases, drowning, skin disease, and other causes. Of an infant mortality rate of 142.6/1000 live births, neonatal tetanus (37.4/1000), diarrhea (19.6/1000), and respiratory disease (10.4/1000) were the most significant identifiable causes. Many infant deaths (62.2/1000) were unidentified, taking place during the neonatal period (1-28 days). The 1-4 year mortality averaged 34.3/1000. Diarrhea (15.1/1000), measles (4.5/1000), fever (2.9/1000), and respiratory disease (1.6/1000) accounted for most 1-4 year deaths. Mortality trends over the past 10 years showed sharp temporary fluctuations in response to 2 disasters but no definitive long-term trend. Most casues of death displayed seasonal fluctuation, and sex differentials were marked with female deaths exceeding male deaths for all ages after the neonatal period. Malnourished children from low socioeconomic status families had higher mortality rates than their better nourished and wealthier counterparts. Overall, the data suggest that the delivery of a few basic health measures (oral hydration and immunization) could result in substantial reduction of under 5 mortality.