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Free Content Preventive measures in infancy to reduce under-five mortality: a case–control study in The Gambia

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Abstract:

Summary Objective  To investigate the relationship between child mortality and common preventive interventions: vaccination, trained birthing attendants, tetanus toxoid during pregnancy, breastfeeding and vitamin A supplementation. Methods  Case–control study in a population under demographic surveillance. Cases (= 141) were children under five who died. Each was age and sex-matched to five controls (= 705). Information was gathered by interviewing primary caregivers. Results  All but one of the interventions – whether the mother had received tetanus toxoid during pregnancy – were protective against child mortality after multivariate analysis. Having a trained person assisting at child birth (OR 0.2 95% CI 0.1–0.4), receiving all vaccinations by 9 months of age (OR 0.1; 95% CI 0.01–0.3), being breastfed for more than 12 months (Children breastfed between 13 and 24 months OR 0.1 95% CI 0.03–0.3, more than 25 months OR 0.1 95% CI 0.01–0.5) and receiving vitamin A supplementation at or after 6 months of age (OR 0.05; 95% CI 0.01–0.2) were protective against child death. Conclusions  This study confirms the value of at least four available interventions in the prevention of under-five death in The Gambia. It is now important to identify those who are not receiving them and why, and to intervene to improve coverage across the population.

French
Objectif: 

Investiguer la relation entre la mortalité infantile et les interventions préventives courantes: vaccination, accoucheuses formées, anatoxine tétanique au cours de la grossesse, allaitement et supplémentation en vitamine A. Méthodes: 

Etude cas-témoins au sein d’une population sous surveillance démographique. Les cas (n = 141) étaient des enfants de moins de cinq ans décédés. Chacun d’eux a été associé selon l’âge et le sexe à cinq contrôles (n = 705). L’information a été recueillie en interrogeant les pourvoyeurs de soins primaires. Résultats: 

Toutes sauf une des interventions - anatoxine tétanique reçue par la mère au cours de la grossesse - étaient protectrices contre la mortalité infantile, après une analyse multivariée. Les interventions telles que : avoir une personne formée aidant à l’accouchement (OR= 0,2; IC95%: 0,1 – 0,4), recevoir toutes les vaccinations à l’âge de neuf mois (OR= 0,1; IC95%: 0,02 – 0,3), allaitent durant plus de 12 mois (enfants allaités entre 13-24 mois OR= 0,1; IC95%: 0,03 - 0,3, durant plus de 25 mois OR= 0,1; IC95% : 0,01 - 0,5) et recevoir une supplémentation en vitamine A à ou après l’âge de six mois (OR= 0,05; IC95%: 0,01 - 0,2) étaient protectrices contre la mort des enfants. Conclusions: 

Cette étude confirme la valeur d’au moins quatre interventions disponibles pour la prévention des décès chez les moins de 5 ans en Gambie. Il est maintenant important d’identifier les enfants qui ne les reçoivent pas et pourquoi ils ne les reçoivent pas, et d’intervenir pour améliorer la couverture dans la population.

Keywords: Afrique sub-saharienne; Prevención; allaitement maternel primaire; child mortality; immunization; inmunización; lactancia primaria; mortalidad infantil; mortalité infantile; prevention; primary breastfeeding; prévention; sub-Saharan Africa; vaccination; África sub-Sahariana

Document Type: Research Article

DOI: https://doi.org/10.1111/j.1365-3156.2008.02204.x

Affiliations: 1:  Center for International Health, Preventive and Social Medicine, University of Otago, Dunedin, New Zealand 2:  Bacterial Diseases Programme, Medical Research Council Laboratories, Banjul, The Gambia 3:  Infectious Diseases Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK

Publication date: 2009-02-01

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