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Abstract
Background: Although there has been substantial global progress in decreasing child mortality over the past two decades, progress in sub-Saharan Africa has largely lagged behind. The temporal trends in child mortality and associated risk factors were investigated in a cohort of children in rural Uganda.
Methods: Information on children’s vital status, delivery, breastfeeding, vaccination history, maternal vital and HIV status, and children’s HIV status for 1993–2007 was retrieved from the Medical Research Council/Uganda Virus Research Institute’s (MRC/UVRI) Annual Population Census and Survey in Uganda. Regression models were employed to assess the association of these factors with child mortality.
Results: From 1993 to 2007, the death rate (/1000 person-years) in children <13 years of age decreased significantly from 16 to six. Apart from neonates, age-specific death rates fell in all age-groups. A reduction since 1999 in the risk of child mortality was associated with vaccination, birth in a health facility, exclusive breastfeeding for 6 months, 2–3 years since the previous sibling’s birth, maternal vital status, and negative mother and child HIV serostatus. Although HIV seropositive children had a 26-fold increased risk of death before 13 years of age, HIV prevalence in children was about 1% and so had a small overall impact on child mortality.
Conclusion: These findings are consistent with those of repeated national cross-sectional surveys. Meeting the Millennium Development Goals for child survival in sub-Saharan Africa depends on faster progress in implementing measures to improve birth-spacing, safe delivery in health facilities, infant feeding practices and vaccination coverage.
The study was part of a programme of research funded by the Medical Research Council (UK) and the United Kingdom Department for International Development. The study design, collection, analysis and interpretation of data, the writing of the paper and the decision to submit the paper for publication were done independently of the funders. The study had no sponsors other than the funders.