Changes in maternal and child mortality rates in three isolated Gambian villages over ten years

As an adjunct to the general nutrition research programme, the MRC Dunn Nutrition Unit has provided for the past 10 years a continuous medical service to three adjacent rural Gambian villages. There have been substantial reductions in annual childhood mortality rates. Perinatal mortality fell from 109.6 to 45.5 per 1000 births, infant mortality from 148.5 to 24.5 per 1000 live births, and mortality in children aged 1-4 years from 109.1 to 13.3 per 1000. There have been no pregnancy-related maternal deaths in the community for 8 years; 16 could have been expected given current estimates of maternal mortality elsewhere in rural Gambia. Of all the health and nutritional interventions introduced the single most important factor has apparently been the on-the-spot, 24 h availability of a physician or qualified midwife.