Epidemiology and control of infant and early childhood malaria: a competing risks analysis.

BACKGROUND

Against increasing malaria problems in most tropical countries, very little is known about the socio-epidemiological determinants of this condition.

METHODS

Using extensive information on a representative sample of 9774 newborns followed for 2 years and multi-state hazards models, this study investigates jointly the determinants of paediatric mortality from malaria and other causes.

RESULTS

Malaria contributes to one out of every 10 infant deaths. Malarial mortality covaries with dwelling conditions, antenatal care attendance, parity, infant 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 factors of malarial and non-malarial mortalities, even after correcting for unobserved heterogeneity.

CONCLUSIONS

These findings suggest that the impact of malaria on infant and early childhood health and survival might be much more important than usually thought. Antenatal care attendance, improved housing conditions and childhood immunization practices are potentially cost-effective strategies for malaria control. The competing risks analysis formulated here is offered as a suitable means of analysing cause-specific mortality differentials.