Study Area And Population

The studies were conducted in a rural area of Senegal in Sahelian West Africa. The nearly 30 000 inhabitants are of the Sereer ethnic group, over 90% are farmers and grow millet, for their own consumption, and groundnuts, mainly for sell, during the rainy season from June to October. Electricity and indoor piped water are not available. Only the larger villages have outdoor piped water, while the others use wells. Less than 20% of the compounds have pit latrines. Main declared religions are Islam (75%) and Christianism (20%),but these have been adopted during the last 30 years and traditional animistic beliefs and practices are still strong. The social organization consists of extended families and polygamic marriages.

Both mortality and fertility are high. From 1994 to 1996, the infant mortality rate and the child mortality rate were 77 and 182 per thousand, respectively, while the total fertility rate was 7.1 live-born children per woman.24 Morbidity and nutrition, in particular transmission ofmalaria and wasting in preschool children, are very dependent on season. They peak at the end of the rainy season in October-November and are at their lowest level during the dry season.

The area has been under demographic and epidemiological surveillance since the sixties. From 1987 to 1997, information about all births, deaths, migrations and weaning events was collected weekly by highly trained fieldworkers, while bi-monthly rounds were used from 1997 to 1999. Several studies on pertussis vaccines included organization of monthly vaccination sessions according to the Senegalese Expanded Program of Immunization (EPI), from 1989 to 1997.25 A high level of participation (about 80% of infants) was obtained by systematic call of eligible infants during home visits by field workers the week before the session and by transport services. Anthropometric measurements (length measured to the nearest mm and weight measured to the nearest 10 g) were taken routinely.

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