Health and Communicable Disease in a Rural African Environment

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Abstract
In rural Gambian environments the greatest challenge to health and survival occurs in early childhood. Mortality in the 1st 5 yr of life accounts for > 2/3 of all deaths and is more frequent in the wet months of each year. About 50% of live births die before the 5th yr and death rates are highest between 6-24 mo. Over 5 yr of age mortality is much less frequent and is little influenced by season. Health indices in childhood change with season and with age. Growth rate is uneven in early life, being poor in the rains and good in the dry months. As age advances wet season growth rates improve and seasonal differences lessen. The growth defects of early life do not appear to have long term effects. In older children growth rate is comparable to that of North American children implying that the prevalent diet is capable of sustaining satisfactory growth. Adults attain moderate stature and good physique despite seasonal variations in body weight that appear to be related to farming activity. The impact of communicable disease at ages before efficient immune defenses are acquired, and the added effects of dietary limitations and poor child-care standards imposed by a subsistence agricultural economy are important factors shaping patterns of illness, death and malnutrition at young ages. In older individuals the acquisition of effective immunity to many prevalent endemic diseases and better acceptance of a bulky vegetable diet predispose to more stable health states.

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