Declining child mortality in northern Malawi despite high rates of infection with HIV

Objective:To determine whether routine surveys; such as the Demographic and Health Surveys (DHS); have underestimated child mortality in Malawi : Methods :Rates and causes of child mortality were obtained from a continuous-registration demographic surveillance system (DSS) in Malawi for a population of 32 000. After initial census; births and deaths were reported by village informants and updated monthly by project enumerators. Cause of death was established by verbal autopsy whenever possible. The likely impact of human immunodeficiency virus (HIV) infection on child mortality was also estimated from antenatal clinic surveillance data. Overall and age-specific mortality rates were compared with those from the 2004 Malawi DHS. Findings:Between August 2002 and February 2006; 38 617 person-years of observation were recorded for 20 388 children aged 15 years. There were 342 deaths. Re-census data; follow-up visits at 12 months of age and the ratio of stillbirths to neonatal deaths suggested that death registration by the DSS was nearly complete. Infant mortality was 52.7 per 1000 live births; under-5 mortality was 84.8 per 1000 and under-15 mortality was 99.1 per 1000. One-fifth of deaths by age 15 were attributable to HIV infection. Child mortality rates estimated with the DSS were approximately 30 lower than those from national estimates as determined by routine surveys Conclusion: The fact that child mortality rates based on the DSS were relatively low in the study population is encouraging and suggests that the low mortality rates estimated nationally are an accurate reflection of decreasing rates

Mortality and health among internally displaced persons in western Kenya following post-election Violence; 2008: novel use of demographic surveillance

Objective To evaluate mortality and morbidity among internally displaced persons (IDPs) who relocated in a demographic surveillance system (DSS) area in western Kenya following post-election violence. Methods In 2007; 204 000 individuals lived in the DSS area; where field workers visit households every 4 months to record migrations; births and deaths. We collected data on admissions among children 5 years of age in the district hospital and developed special questionnaires to record information on IDPs. Mortality; migration and hospitalization rates among IDPs and regular DSS residents were compared; and verbal autopsies were performed for deaths. Findings Between December 2007 and May 2008; 16 428 IDPs migrated into the DSS; and over half of them stayed 6 months or longer. In 2008; IDPs aged 15.49 years died at higher rates than regular residents of the DSS (relative risk; RR: 1.34; 95confidence interval; CI: 1.004.1.80). A greater percentage of deaths from human immunodeficiency virus (HIV) infection occurred among IDPs aged . 5 years (53) than among regular DSS residents (25.29) (P 0.001). Internally displaced children 5 years of age did not die at higher rates than resident children but were hospitalized at higher rates (RR: 2.95; 95CI: 2.44.3.58). Conclusion HIV-infected internally displaced adults in conflict-ridden parts of Africa are at increased risk of HIV-related death. Relief efforts should extend to IDPs who have relocated outside IDP camps; particularly if afflicted with HIV infection or other chronic conditions