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Trop Geogr Med. 1994;46(5):305-8.

Community-based surveillance of paediatric deaths in Cross River State, Nigeria.

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Department of Paediatrics, University of Calabar, Nigeria.


A house-to-house survey of paediatric deaths which occurred from January to December 1991 in the village of Nko, Cross River State, Nigeria, was carried out. Among the 471 total deaths recorded, the leading causes were malaria (29%), protein-energy malnutrition, pneumonia and diarrhoeal disease (11% each). Neonatal deaths were largely due to septicaemia, tetanus and birth asphyxia. Poor domestic and human waste disposal, lack of portable water and basic health facilities appear to be the important related factors to child health problems in this community. The provision of public toilets, safe water, primary health care centres and health education can definitely improve the health status of this rural community. Events in other rural communities in Nigeria are most likely to be similar to that in Nko. Such populations need to be identified and their problems urgently addressed.


In February 1992 in Nigeria, pediatricians and community health workers interviewed parents living in 1263 households in the rural tropical rainforest community of Nko in Ugep Local Government Area of Cross River State to determine the pattern of infant and child mortality in a typical rural community and to examine family and social patterns which may influence child mortality. There were no records of birth and death in Nko. They identified 471 pediatric deaths (=or 15 year olds) that occurred during 1991. Children between 1 and 5 years old comprised the largest group of pediatric deaths (43.3%) followed by those older than 5 years (33.3%), 1-12 month old infants (18.1%), and newborns (5.1%). The leading causes of neonatal death were septicemia (37.5%), tetanus (20.8%), and birth asphyxia (20.8%). The leading causes of infant death included malaria (46.5%), protein energy malnutrition (PEM) (10.5%), pneumonia (10.5%), and diarrhea (10.5%). Among preschoolers (1-5 year olds), the major causes of death were malaria (35.8%), PEM (18.1%), and diarrhea (13.7%). Pneumonia (16.6%), malaria (15.3%), and tuberculosis (13.4%) were the chief causes of death among school-aged children. Among all 471 pediatric deaths, malaria was the leading cause of death. Pediatric deaths peaked in the months of March and August, periods of high malaria transmission during the transitional period from dry to wet season and from wet to dry season. Only 5% of the deceased children had adequate immunization coverage. 52.9% of the children were not treated in health facilities, as the nearest health facility was in the town of Ugep, 15 km away from Nko. Insufficient waste disposal, lack of potable water, and streams polluted with human wastes contribute to the diarrhea deaths. An open toilet system, bushes littered with domestic wastes, and no water drainage system are breeding grounds for mosquitoes. Overcrowding in the homes foster the spread of infections. Protein-poor root crops predominate, leading to PEM.

[Indexed for MEDLINE]

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