Rapid risk household screening by neonatal arm circumference: results froma cohort study in rural Burkina Faso

Neonatal arm circumference (NAC) and other attributes of the newborn and it s household were analysed as potential predictors of child death in a cohor t of 1367 newborn children representing the majority of births in a rural a rea of Burkina Faso from 1992 to 1994. During 3872 person years observed 26 4 children died, resulting in an average mortality rate of 6.8% per year. 9 0 mm was chosen as the best cut-off to differentiate low NAC associated wit h high mortality from normal NAG. The hazard ratio of children with low NAC (15.7%) compared to others was 1.7 (P < 0.001) in Cox regression. Kaplan-M eier curves of cumulative survival showed that this higher risk lasted thro ughout the first two years of life. Multivariate Cox regression comparing N AC with other variables known or suspected to influence child survival yiel ded a model including mother's death, twin birth, affiliation to a particul ar health centre, home delivery and birth during the rainy or harvest seaso n as other significant risk factors beside NAG. Protective factors were mot her's participation in antenatal care despite considerable distance to the health centre, medium household size (5-7 members) and household cash crop production. We propose a simple risk score for rapid household screening in rural Burkina Faso and comparable settings elsewhere for identifying house holds at risk of experiencing child death. As much of the other variables' contribution to the explanation of survival pattern is absorbed by NAC in m ore parsimonious models, even simpler screening strategies based on NAC mak e sense. In the study area risk households will be offered periodical home visits by the local nurse promoting immunization, treatment of illness and strengthening the mothers' competence to recognize and manage frequent heal th problems of their children as part of a 'Shared Care' concept.