Impact on mortality and fertility of a community-based malaria control programme in Saradidi, Kenya.

Mortality and fertility rates were measured from 1981 to 1983 by prospective registration of vital events as part of a community-based malaria control and health development programme in Saradidi, Kenya. There was no obvious effect of providing chloroquine phosphate for treatment of malaria in each village on mortality or fertility rates. Crude death rates were 13.1 in the year before intervention (1 May 1981 to 30 April 1982) and 12.3 after intervention (1 September 1982 to 31 August 1983). Neonatal mortality increased from 36.8 per 1000 live births pre-intervention to 49.1 during intervention. There was a slight decline in post-neonatal (one to 12 months) mortality (72.8 to 67.0) and a significant drop in early childhood mortality (25.2 to 18.2). The change in mortality rates in these two age groups were fully explained by a high rate of measles mortality in the pre-intervention period. Measles accounted for 35.7% of 284 reported deaths in infants one to 12 months of age and for 40.9% of 230 deaths in children one to four years old. There was little change in reported malaria-specific mortality rates in infants and young children most likely because of a high level of chloroquine use for treatment of presumptive illness. Perinatal mortality by area ranged between 60.4 and 81.3 pre-intervention to 79.5 to 97.2 after the control programme was instituted. Crude birth rates by area remained stable at about 40 and general fertility rates were about 200. Both pre-intervention and during intervention infants were significantly more likely to have died without medical consultation than children one to four years. However, 79.2% of 284 infants and 90.7% of 193 children died in spite of having consulted a health worker prior to death. The data suggest that a measles vaccine programme would significantly reduce mortality rates in infants and young children. The fact that the majority of infants and young children died in spite of receiving medical attention indicates both the inadequacy of curative medical services in this high mortality setting as well as the necessity for promoting preventive health measures.