Mortality and morbidity from acute lower respiratory tract infections in Tari, Southern Highlands Province 1977-1983.

Monthly demographic surveillance by village reporters has been ongoing in the Tari Basin since 1970. Cause of death is ascertained by verbal autopsy. 20% of deaths between 1977 and 1983 were from acute lower respiratory tract infection (ALRI). ALRI mortality rates were highest in the very young and the elderly and have risen since the early 1970s but declined in the 1981-1983 period when pneumococcal vaccine was being tested in Tari. 44% of ALRI deaths in children under 5 years of age occurred before the age of 6 months but ALRI mortality remained high during the second year of life. Utilization of health services before death was highly age-dependent, with the vast majority of young children but few elderly people receiving some form of medical attention. However, less than half the children who died of ALRI received inpatient care. Fortnightly morbidity surveillance of children between 1981 and 1983 showed that ALRI was the commonest cause of severe morbidity; children suffered 2-3 episodes of ALRI in the first year of life, 20% of which were moderate or severe disease. Improved case management, nutritional status and hygiene in addition to good coverage with pertussis and measles vaccines and immunization with efficacious pneumococcal and H. influenzae vaccines are required to reduce mortality and morbidity from ALRI.