Effects Of Health Programs on Child Mortality in Sub-Saharan Africa -- Copyright -- Preface -- Contents -- Executive Summary -- DISEASE- AND INTERVENTION-SPECIFIC FINDINGS -- GENERAL CONCLUSIONS -- 1 Introduction -- 2 Trends in Mortality and Causes of Death in Africa -- TRENDS IN CHILD MORTALTY -- Data Collection and Estimation Techniques -- Current Levels of Mortality and Trends Since 1960 -- CAUSES OF DEATH AMONG AFRICAN CHILDREN -- Verbal Autopsies -- Studies of Causes of Death Among Infants and Children -- Effects of AIDS on Child Mortality -- SUMMARY -- 3 Immunization Programs -- MEASLES -- EPIDEMIOLOGY -- VACCINE EFFICACY -- WHY AFRICA MIGHT BE DIFFERENT -- EVIDENCE OF MORTALITY AND MORBIDITY EFFECTS FROM AFRICA -- Effects of General Measles Immunization Programs -- Effects of Measles Vaccinationin Field Trials and Model Programs -- Vaccine Field Trial in Khombole, Senegal -- Kasongo Project in Zaire -- Pahou Primary Health Care Project, Benin -- Estimates of Effect from Cases of Vaccine Failure -- Effect of Programs on Incidence in Africa -- NONLINEARITIES IN RELATIONSHIP BETWEEN COVERAGE AND EFFECT -- Vaccination and Frequency of Epidemics -- Effect of Vaccination on Age Distribution of Cases -- Changes in the Proportion of Secondary Cases -- Other Factors -- PROGRAM HISTORY, COVERAGE, AND QUALITY -- TREATMENT OF MEASLES (INCLUDING VITAMIN A) -- SUMMARY -- PERTUSSIS (WHOOPING COUGH) -- PERTUSSIS IN DEVELOPED COUNTRIES -- Epidemiology -- Vaccine Efficacy -- PERTUSSIS IN AFRICA -- Epidemiology -- Vaccine Efficacy -- PROGRAM EFFORT -- SUMMARY -- TUBERCULOSIS AND LEPROSY -- EPIDEMIOLOGY OF TUBERCULOSIS -- PREVENTION AND TREATMENT OF TUBERCULOSIS -- EFFICACY OF BACILLE CALMETTE-GUÉRIN (BCG) VACCINATION -- BCG Efficacy Against Tuberculosis in Africa -- EPIDEMIOLOGY OF LEPROSY -- PROGRAM COVERAGE -- SUMMARY -- TETANUS -- EPIDEMIOLOGY.

PROGRAMS TO REDUCE THE INCIDENCE OF NEONATAL TETANUS -- Incidence of Neonatal Tetanus Among Hospital Deliveries -- Evidence of the Effect of Training of Traditional Birth Attendants -- Evidence of the Effect of Programs that Provide Tetanus Toxoid Immunization to Women -- PROGRAM COVERAGE -- PROGRAMS TO REDUCE NONNEONATAL TETANUS MORTALITY -- SUMMARY -- CONCLUSION -- 4 Other Interventions Targeted at Single Diseases -- DIARRHEAL DISEASE CONTROL PROGRAMS -- EPIDEMIOLOGY -- TREATMENT -- SUMMARY -- MALARIA CONTROL PROGRAMS -- EPIDEMIOLOGY -- MALARIA MORTALITY IN SUB-SAHARAN AFRICA -- PROGRAM OPTIONS -- STUDIES OF THE EFFECT OF MALARIA ERADICATION ON MORTALITY -- Pare-Taveta Malaria Scheme (1954-1959) -- Kisumu Project -- Garki Project -- PRESUMPTIVE TREATMENT OF FEVERS WITH ANTIMALARIAL DRUGS -- Studies of the Effect of Programs Designed to Increase PresumptiveTreatment of Fevers with Chloroquine -- Saradidi Health Development Project -- Village Health Workers in The Gambia -- Conclusions About the Effectiveness of Programs to Increase Presumptive Treatment -- Studies of Self-Treatment -- PROGRAMS BASED ON CHEMOPROPHYLAXIS AMONG PREGNANT WOMEN -- PROGRAMS BASED ON VECTOR CONTROL -- SUMMARY -- ACUTE RESPIRATORY INFECTIONS -- EPIDEMIOLOGY -- INTERVENTIONS -- SUMMARY -- 5 Nutrition and Nutrition Programs -- INTRODUCTION -- PROTEIN-ENERGY MALNUTRITION (PEM) -- Causes of Malnutrition -- Studies of Malnutrition and Mortality in Other Regions -- Studies of the Relationship Among PEM, Morbidity, and Mortality in Africa -- PEM and Morbidity -- PEM and Mortality -- PEM and Measles Mortality -- Studies of the Effect of Nutrition Programs on Mortality in Africa -- Supplementary Feeding Programs -- Growth Monitoring -- Programs Designed to Change Breastfeeding and Weaning -- LOW BIRTHWEIGHT -- Studies of the Relationship Between Low Birthweight and Mortality.

Risk Factors for Low Birthweight -- Physically Demanding Work -- Short Birth Intervals -- Prenatal Care -- Malaria -- Effects of Programs on the Incidence of Low Birthweight -- VITAMIN A DEFICIENCY -- Studies of Vitamin A Deficiency, Morbidity, and Mortality -- Studies of Vitamin A Supplementation and Mortality Reduction -- SUMMARY -- 6 Integrated and General Health Programs -- INTRODUCTION -- CASE STUDIES OF LONG-TERM MORTALITY TRENDS -- Mlomp, Senegal -- Keneba, The Gambia, 1950-1984 -- Niakhar, Senegal, 1962-1989 -- HOSPITALS AND HEALTH CENTERS -- PRIMARY HEALTH CARE PROGRAMS -- Village Health Workers -- Pahou Primary Health Care Project -- CHILD SURVIVAL AND EXPANDED PROGRAMS ON IMMUNIZATION -- Evaluation of CCCD in Liberia -- Evaluation of CCCD in Zaire -- SUMMARY -- 7 Conclusions and Recommendations -- DISEASE- AND INTERVENTION-SPECIFIC CONCLUSIONS -- Measles -- Diarrheal Diseases -- Malaria -- Acute Respiratory Infections -- GENERAL OBSERVATIONS ABOUT THE EVALUATION OF HEALTH PROGRAMS IN AFRICA -- Appendix A Case Studies of Child Mortality -- SIERRA LEONE (WESTERN AREA) -- MACHAKOS, KENYA -- NATIONAL ESTIMATES FOR KENYA -- DAKAR AND SAINT-LOUIS, SENEGAL -- NIAKHAR, SENEGAL -- BAMAKO, MALI -- MALUMFASHI, NIGERIA -- FOUR PROVINCES OF SUDAN -- KASONGO, ZAIRE -- Appendix B Demographic and Health Survey (DHS) Reports -- References.