Successes and failures in the fight against child mortality in sub-Saharan Africa: lessons from Senegal, a country with low AIDS prevalence

Gilles Pison, Institut National d'Études Démographiques (INED)
Laetitia Douillot, Institut de Recherche pour le Développement (IRD)
Géraldine Duthé, Institut National d'Études Démographiques (INED)
Malick Kante, Columbia University
Cheikh Sokhna, Institut de Recherche pour le Développement (IRD)
Jean-François Trape, Institut de Recherche pour le Développement (IRD)

Child mortality has declined in Sub-Saharan Africa over the last 60 years but the decrease has not been regular. It has accelerated over some periods, as during the last decade, and slowed down during others. Mortality has even increased during some periods, as in the 1990s. This was not solely attributable to AIDS. In order to determine any other diseases or factors that also played a part, Senegal is chosen for study – a country with very low AIDS prevalence but where trends in child mortality have closely resembled those of the whole region. In addition, Senegal has the advantage of possessing relatively numerous information sources available for tracing the evolution of child mortality on a national scale, as well as three demographic surveillance sites in a rural area where child mortality could be followed and the causes of deaths studied in detail over almost 25 years. The decline in child mortality in Senegal in the 1970s and 1980s is attributable to the reduction in deaths from infectious diseases, thanks largely to vaccinations. The situation reversed in the 1990s due to a combination of several factors: the development of chloroquine resistance leading to many malaria deaths; inefficiencies in the health services leading to failures in basic services, including vaccination; and an adverse economic climate. Mortality decline resumed rapidly in the 2000s due also to a combination of factors, among which the renewal of vaccination efforts and investments in anti-malaria programs played an important role. These factors are common to many countries in Sub-Saharan Africa and explain why many of them experienced the health crisis in the 1990s and the renewal of progress in the 2000s, irrespective of whether or not they were hit by the AIDS epidemic.