Registered infant and under-five deaths in Freetown, Sierra Leone from 1987-1991 and a comparison with 1969-1979.

Analysis of diagnoses recorded on under-fives' death certificates in Freetown from 1987 to 1991 revealed that they were attributed thus, acute respiratory infections (ARI); 35%, diarrhoeal diseases (DD); 18%, malaria; 14%, malnutrition; 11%, anaemia; 11%, measles; 9%, prematurity; 7%, convulsions; 6% and tetanus; 3%. Neonates and infants comprised 14% and 56% of all under-fives' deaths respectively. The perinatal mortality rate was 48/1,000 total births. Comparing these with findings reported from 1969 to 1979 and taking into account estimates of IMR and U5MR there appears to have been a significant reduction in the absolute numbers and proportion of deaths per 1,000 live births from tetanus (p < 0.0001) and from measles (p < 0.05). There appears to have been a decrease in certificates reporting DD and an increase in those reporting ARI, malnutrition and anaemia but these were not found to be statistically significant (p > 0.05). Deaths attributed to malaria have also not varied significantly.