Is health a sustainable state? A village study in The Gambia

Lancet. 1993 May 22;341(8856):1327-30. doi: 10.1016/0140-6736(93)90827-4.


PIP: The economic conditions and demographic status of Keneba village in The Gambia is summarized in order to obtain a general idea about the ability of the population to sustain itself. In 1949 a field station was established with the goal of surveying nutrition and disease. In 1974, a field station was established with the goal of surveying nutrition and disease. In 1974, the Dunn Nutritional Unit took over and found that the principal cause of childhood malnutrition and weight faltering was the incidence of diarrheal diseases. A regular free clinic was set up to serve the Keneba population as well as the neighboring villages of Kantonkunda and Manduar; the medical team provided 24-hour outpatient care with ready access to hospital services. Family planning was promoted. Records indicated that consultation grew from 5000 in 1975 to 18,000 in the late 1980s for the survey population of 2500. There was initial resistance because the clinic was free and staffed by outsiders The population is described as Mandinka. Farmers market groundnuts and/or work for the United Kingdom's Medical Research Council station and the International Trypanotolerance Center, 170 Gambians are employed at the centers. Between 1950 and 1989 the population doubled to 1614 and is now 1516 (1991). Birth rates for the same period have remained high. Mortality for children up to 5 years of age has decline from 400/1000 in 1975 to 20/1000 in 1980. Out-migration is slowing population increases. Between 1951 and 1975, 364 young people aged 15-29 years migrated to the coast. Most are young single men who marry women from their home villages 60% of the time. The changes in Keneba's population birth, and death rates have also occurred elsewhere in The Gambia, regardless of the difference in provision of medical care. As long as net migration continues to be out-migration, carrying capacity can be maintained. The danger is from reduced mortality rates, continuing high birth rates, increased longevity, limited use of contraception, and unpredictable food resources. Medical care has emphasized provision of family planning and individual health. Choices regarding family size are still determined by agricultural production, economic needs, and old age social security. The answer to long term sustainability is dependent on an understanding of the high birth rate.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Birth Rate
  • Child, Preschool
  • Emigration and Immigration
  • Female
  • Gambia
  • Health Services*
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Male
  • Mortality*
  • Population Dynamics*
  • Rural Health