INFANT AND 2ND-YEAR MORTALITY IN RURAL MALAWI - CAUSES AND DESCRIPTIVE EPIDEMIOLOGY

Community information based on causes and circumstances of death in in fants and young children in was obtained in a prospective cohort of ba bies delivered to women enrolled in a malaria-prevention-in-Malawi pre gnancy study. Vital status information was obtained through home visit s every two months; for children who died, questions were asked concer ning age and date of death, symptoms preceding death, care sought, loc ation of death (home versus facility), and duration of illness. Of 3,2 74 liveborn singleton infants, 181, 397, and 152 deaths occurred in th e neonatal, postneonatal, and second year of life, respectively. For n eonates, proportionate mortality was greatest for sepsis/tetanus (16.7 %) and fever (8.6%); however, for more than half of neonatal deaths ev aluated the cause was not identified. Up to 30% of neonatal deaths may have been related to prematurity. In the postneonatal period, gastroi ntestinal illness (39.6%), fever (18.3%), and respiratory illnesses (1 4.7%) were the leading causes. Most postneonatal illnesses lasted 1 we ek or less. Two-thirds of postneonatal deaths occurred outside of a he alth care facility, although 80% were brought to a facility for care d uring their illness. Infectious disease syndromes continued to be impo rtant in the second year of life, with gastrointestinal (31.6%), fever (23.5%), and measles (20.6%) the most commonly reported causes of dea th. In this area of rural sub-Saharan Africa, neonatal mortality contr ibutes substantially to infant mortality, and prematurity is considere d to be an important component of early neonatal deaths; infectious di sease syndromes predominate in the postneonatal and second year of lif e. Strategies to reduce infant deaths in sub-Saharan Africa must consi der these factors, as well as the observations that most children who died had brief illnesses, were taken to a health care facility before death, yet died at home.