Why Child Mortality in Sub-Saharan Africa has Ceased Declining since the Early 1990s. The Example of Senegal, a Country where the Hiv Epidemic has Remained at a Low Level

Abstract

The decline in child mortality in Sub-Saharan Africa that had been observed since the 1950s slowed down over the last fifteen years, and there has even been an increase in certain countries. This was not solely attributable to AIDS. In this paper the trends in Senegal have been examined in detail, as an example of a country little affected by AIDS but where trends in child mortality have closely resembled those of the whole region. In three Senegalese rural population observatories the decline in child mortality in the 1970s and 1980s was attributable to the reduction in deaths from infectious diseases, thanks largely to vaccinations. The situation reversed 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 a poor economic climate. These factors are common to many countries in Sub-Saharan Africa and explain why many of them have experienced this health crisis, irrespective of whether or not they are stricken by the AIDS epidemic.