Mortality and morbidity from malaria were measured among 3000 children under the age of 7 years in a rural area of The Gambia, West Africa. Using a post-mortem questionnaire technique, malaria was identified as the probable cause of 4% of infant deaths and of 25% of deaths in children aged 1 to 4 years. The malaria mortality rate was 6.3 per 1000 per year in infants and 10.7 per 1000 per year in children aged 1 to 4 years. Morbidity surveys suggested that children under the age of 7 years experienced about one clinical episode of malaria per year. Calculation of attributable fractions showed that malaria may be responsible for about 40% of episodes of fever in children. Although the overall level of parasitaemia showed little seasonal variation, the clinical impact of malaria was highly seasonal; all malaria deaths and a high proportion of febrile episodes were recorded during a limited period at the end of the rainy season.

The epidemiology of infection due to Neisseria meningitidis and Neisseria lactamica was studied in a northern Nigerian community. A low meningococcal carriage rate was observed throughout the two-year survey. Initially, most meningococci isolated from nasopharyngeal carriers belonged to serogroup C or to serogroup Y. Following an outbreak of group A meningococcal disease, more group A meningococcal carriers were detected. Antibody studies indicated that infection with group A meningococci had been more widespread in the community than was suggested by regular carrier surveys. Carriage of meningococci was detected most frequently in children one to nine years of age. Children were identified as the first carriers in households more frequently than adults. The half-life of carriage was three months. The meningococcal carriage rate did not increase during the hot dry season when epidemics of meningococcal disease occur most frequently in Nigeria. Neisseria lactamica was isolated from the nasopharynx of children more frequently than were meningococci.

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Serologic markers of hepatitis B virus (HBV) infection were measured in children from Manduar and Keneba, two adjacent villages in The Gambia, in 1980 and in 1984. The rate of HBV infection over the 4 years differed markedly: in Manduar 71% of children who were less than 5 years of age in 1980 became infected, whereas in Keneba only 37% became infected. Male children were more frequent carriers of either HBs or e antigen than were female children. Marked clustering of hepatitis B surface antigen (HBsAg) antigenemia within sibling relationships was shown in both villages. The chance of the youngest child in a household being a carrier of HBsAg was strongly related to the number of antigen-positive siblings. Four years later, 53% of children who were initially positive for HBsAg and 33% who were positive for hepatitis B e antigen still carried these antigens. Jaundice was not observed.

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