Clustering of childhood mortality in rural Burkina Faso.

BACKGROUND Childhood mortality is a major public health problem in sub-Saharan Africa. For the implementation of efficient public health systems, knowledge of the spatial distribution of mortality is required. METHODS Data from a demographic surveillance research project were analysed which comprised information obtained for about 30 000 individuals from 39 villages in northwest Burkina Faso (West Africa) in the period 1993--1998. Total childhood mortality rates were calculated and the geographical distribution of total childhood mortality was investigated. In addition, data from a cohort of 686 children sampled from 16/39 of the villages followed up during a randomized controlled trial in 1999 were also used to validate the results from the surveillance data. A spatial scan statistic was used to test for clusters of total childhood mortality in both space and time. RESULTS Several statistically significant clusters of higher childhood mortality rates comprising different sets of villages were identified; one specific village was consistently identified in both study populations indicating non-random distribution of childhood mortality. Potential risk factors which were available in the database (ethnicity, religion, distance to nearest health centre) did not explain the spatial pattern. CONCLUSION The findings indicate non-random clustering of total childhood mortality in the study area. The study may be regarded as a first step in prioritizing areas for follow-up public health efforts.