Document Detail


Decline of mortality in children in rural Gambia: the influence of village-level primary health care.
MedLine Citation:
PMID:  10747270     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Using data from a longitudinal study conducted in 40 villages by the UK MRC in the North Bank Division of The Gambia beginning in late 1981, we examined infant and child mortality over a 15-year period for a population of about 17 000 people. Comparisons are drawn between villages with and without PHC. The extra facilities in the PHC villages include: a paid Community Health Nurse for about every 5 villages, a Village Health Worker and a trained Traditional Birth Attendant. Maternal and child health services with a vaccination programme are accessible to residents in both PHC and non-PHC villages. The data indicate that there has been a marked improvement in infant and under-five mortality in both sets of villages. Following the establishment of the PHC system in 1983, infant mortality dropped from 134/1000 in 1982-83 to 69/1000 in 1992-94 in the PHC villages and from 155/1000 to 91/1000 in the non-PHC villages over the same period. Between 1982 and 83 and 1992-94, the death rates for children aged 1-4 fell from 42/1000 to 28/1000 in the PHC villages and from 45/1000 to 38/1000 in the non-PHC villages. Since 1994, when supervision of the PHC system has weakened, infant mortality rates in the PHC villages have risen to 89/1000 in 1994-96. The rates in the non-PHC villages fell to 78/1000 for this period. The under-five mortality rates in both sets of villages have converged to 34/1000 for 1994-96. When the PHC programme was well supported in the 1980s, we saw significantly lower mortality rates for the 1-4-year-olds. These differences disappeared when support for PHC was reduced after 1994. The differential effects on infant mortality are less clear cut.
Authors:
A G Hill; W B MacLeod; D Joof; P Gomez; G Walraven
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Tropical medicine & international health : TM & IH     Volume:  5     ISSN:  1360-2276     ISO Abbreviation:  Trop. Med. Int. Health     Publication Date:  2000 Feb 
Date Detail:
Created Date:  2000-04-11     Completed Date:  2000-04-11     Revised Date:  2006-11-07    
Medline Journal Info:
Nlm Unique ID:  9610576     Medline TA:  Trop Med Int Health     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  107-18     Citation Subset:  IM    
Affiliation:
Dept. of Population and International Health, Harvard School of Public Health, Cambridge, USA. AHill@hsph.harvard.edu
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MeSH Terms
Descriptor/Qualifier:
Child, Preschool
Community Health Aides
Community Health Services
Confidence Intervals
Female
Gambia / epidemiology
Humans
Infant
Infant Mortality*
Male
Mortality*
Primary Health Care*
Rural Health*
Rural Health Services
Seasons

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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