Increased risk of death from measles in children with a sibling of opposite sex in Senegal

OBJECTIVE

To examine whether contracting measles from a sibling of the opposite sex affects mortality.

DESIGN

Prospective registration during 15-20 years of all births and deaths, including 243 measles related deaths. Measles infection was not registered; however, as in fatal cases measles was probably contracted from a maternal sibling the risk of dying during measles outbreaks was examined in families with two boys, two girls, or a boy and a girl.

SETTING

31 small villages in two rural areas of eastern Senegal.

SUBJECTS

766 children living in families with two children aged under 10 years during outbreaks of measles, 107 (14%) of whom died of measles.

MAIN OUTCOME MEASURE

Deaths from measles, size of village, age and sex of maternal siblings.

RESULTS

The interval between outbreaks in the same village was greater than 10 years. The risk of dying of measles was significantly related to age, increasing with the age difference between siblings and decreasing with the size of village. In a multiple logistic regression analysis adjusting for these background factors, children in families with a boy and a girl had a significantly higher mortality than children in families with two boys or two girls (odds ratio = 1.81, 95% confidence interval 1.17 to 2.82). The increase in risk was the same for boys and girls in families with two children one of whom was a boy and one a girl.

CONCLUSION

Cross sexual transmission may be an important determinant of severity of measles infection.

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%.

Childhood morbidity and mortality in a large hospital over last four decades

Pediatric statistics in a 50-year-old large hospital were analysed to find out any change in pediatric admission rate, morbidity and mortality and outcome of common disorders during the last four decades. Information was collected from four block years from each of the last four decades and compared. An increase of almost 250% in the total pediatric admissions as compared to an increase of 150% in total hospital admissions over last four decades suggest an increased awareness of maternal and child health by the community. The pediatric mortality excluding neonates has not shown a significant fall over the last four decades, being 14.6, 12.7 and 13.0% in 1955-1958, 1974-1977 and 1984-1987, respectively. Diarrheal disorders, pneumonia, tetanus and infections of central nervous system continue to remain the common causes of hospital admissions in children. The morbidity and mortality in these disorders, in general, have shown a significant decline though less appreciable in pyogenic meningitis, encephalitis and tetanus cases.

Birth interval, mortality and growth of children in a rural area in Kenya

This paper analyses the impact of the length of birth intervals on mortality and growth of young children. An attempt has been made to improve the methodology of birth interval studies and the results of an analysis of longitudinal data from a rural area in Kenya with a relatively favourable level of health are presented. It is shown that children with short retrospective or short prospective birth intervals do not run a higher risk of mortality or growth retardation than children with longer intervals, neither during the perinatal period nor during the first 2 years of life. This suggests that the socioeconomic setting, in which a birth interval study is carried out, is of ultimate importance.