EPIDEMIOLOGY AND CONTROL OF INFANT AND EARLY-CHILDHOOD MALARIA - A COMPETING RISKS ANALYSIS

Background. Against increasing malaria problems in most tropical count ries, very little is known about the socio-epidemiological determinant s of this condition. Methods. Using extensive information on a represe ntative sample of 9774 newborns followed for 2 years and multi-state h azards models, this study investigates jointly the determinants of pae diatric mortality from malaria and other causes. Results. Malaria cont ributes to one out of every 10 infant deaths. Malarial mortality covar ies with dwelling conditions, antenatal care attendance, parity, infan t feeding practices, intercurrent infections, and child's immunization status. Lack of antenatal care, lack of immunization in childhood and sub-standard living conditions of overcrowding are the major risk fac tors of malanial and non-malarial mortalities, even after correcting f or unobserved heterogeneity. Conclusions. These findings suggest that the impact of malaria on infant and early childhood health and surviva l might be much more important than usually thought. Antenatal care at tendance, improved housing conditions and childhood immunization pract ices are potentially cost-effective strategies for malaria control. Th e competing risks analysis formulated here is offered as a suitable me ans of analysing cause-specific mortality differentials.