Changes in the pattern of infant and childhood mortality in upper river division, The Gambia, from 1989 to 1993.

Trends in infant and childhood mortality during 1989-93 in the Gambias Upper River Division were assessed through use of data from a national surveillance system and a postmortem questionnaire. This rural area has an active primary health care program with extensive vaccination coverage. Births during this period averaged 5400 a year (crude birth rate of 37.5/1000). A total of 3776 deaths of children under 5 years old were recorded during the 5-year study period with reasonable consistency over time. In 1993 the infant and child mortality rates were 80.1 and 18.8/1000 live births respectively. Inexplicable was the finding of significantly higher child mortality in villages with a primary health care center. Overall 41% of these deaths were attributable to malaria (23%) or acute respiratory infection (ARI) (18%). Acute gastroenteritis sepsis and malnutrition each accounted for slightly under 10% of mortality. Deaths attributed to ARI declined consistently over time; in 1993 the ARI mortality rate in infants was 7.7 deaths/1000 live births lower than in 1989. Mortality from other causes remained unchanged or increased slightly. Peak mortality occurred between July and December: the rainy season when nutrition is poorest and malaria transmission is at its peak.