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Background  Under-five mortality has been declining rapidly in a number of sub-Saharan African settings. Malaria-related mortality is known to be a major component of childhood causes of death and malaria remains a major focus of health interventions. The paper explored the contribution of malaria relative to other specific causes of under-five deaths to these trends.    Methods  This paper uses longitudinal demographic surveillance data to examine trends and causes of death of under-five mortality in Rufiji, whose population has been followed for over nine years (1999–2007). Causes of death, determined by the verbal autopsy technique, are analysed with Arriaga’s decomposition method to assess the contribution of declining malaria-related mortality relative to other causes of death as explaining a rapid decline in overall childhood mortality.    Results  Over the 1999–2007 period, under-five mortality rate in Rufiji declined by 54.3%, from 33.3 to 15.2 per 1,000 person-years. If this trend is sustained, Rufiji will be a locality that achieves MDG4 target. Although hypotrophy at birth remained the leading cause of death for neonates, malaria remains as the leading cause of death for post-neonates followed by pneumonia. However, declines in malaria death rates accounted for 49.9% of the observed under-five mortality decline while all perinatal causes accounted for only 19.9%.    Conclusion  To achieve MDG 4 in malaria endemic settings, health programmes should continue efforts to reduce malaria mortality and more efforts are also needed to improve newborn survival.

malaria journal

The contribution of reduction in malaria as a cause of rapid decline of under-five mortality: evidence from the Rufiji Health and Demographic Surveillance System (HDSS) in rural Tanzania