Health services utilization was analysed in a rural area of the The Gambia. In general, health workers were consulted frequently. However, verbal autopsies showed that children who died had rarely consulted health workers, particularly if they came from villages where such workers were not posted. Traditional healers were consulted frequently, independently of the presence of a village health worker. The relationship between cause specific mortality and the utilization of health services is discussed. Childhood mortality was similar in villages with or without a primary health care worker at the time of the study.
PIP: The study aim was to evaluate the impact of mortality and primary health care (PHC) services utilization prior to death, based on data from the mortality surveillance system in the Upper River Division (URD) of The Gambia. The sample of villages with greater than 400 persons included 355 villages with a voluntary village health workers (VHW) and/or a trained traditional birth attendant (TBA), and 9 villages without. Recording of births and deaths was accomplished by one registrar for every 200 children or under, and totaled 373 village registrars and 8 field workers covering a population of 133,000. Cause of death for children aged 5 years was determined by 3 physicians and collected for senior field assistants. Morbidity data for children was gathered from monthly forms completed by VHWs and BAs. VHWs and TBAs were trained 6=8 weeks at Basse Hospital and 4-6 weeks at Bansang Regional Hospital, respectively, with periodic retraining. Local PHC centers provided health education, environmental health education, immunization, nutrition, treatment and referral. There were 6 health centers in URD, which was the base of operations for travel to 5-6 sites 1-2 times per month for running clinics, evaluation of referred patients, and supervision of PHC activities. There were 16, 216 episodes of malaria, 6111 episodes of respiratory infection (ALRI), and 6380 episodes of acute gastroenteritis reported through the PHC system. That means .63, .23, and .25 episodes per person per year, respectively. More than 50% of cases of ALRI involved consultation with VHWs. There were 915 deaths among children aged 5 years in one year. Of the 94% reports on the deaths made by relatives, there were 85% dying at home, and 8% dying at a health center or hospitals. 13% (117) were inpatients during a portion of the precipitating illness. Survivors of illnesses were higher among those children receiving consultation with the VHW. Only 33% of children who died had consulted a VHW during the final illness. TBAs reported 50% of deaths recorded by the surveillance system. TBAs are selectively consulted.