BANDAFASSI DEMOGRAPHIC SURVEILLANCE SYSTEM

SENEGAL

INSTITUT NATIONAL D’ÉTUDES DÉMOGRAPHIQUES PARIS PROGRAMME NATIONAL DE LUTTE CONTRE LE SIDA CENTRE NATIONAL DE LA RECHERCHE SCIENTIFIQUE/MUSÉUM NATIONAL D’HISTOIRE NATURELLE PARIS UNIVERSITÉ CHEIKH ANTA DIOP/INSTITUT DE RECHERCHE POUR LE DÉVELOPPEMENT DAKAR

SS EE NN EE GG AA LL

SenegalSenegal

SS EE NN EE GG AA LL

TambacoundaTambacounda RegionRegion

TambacuondaTambacuonda RegionRegion GambiaGambia GambiaGambia RegionRegion BBaannddaafffaassssiii DDSSSS AArrreeaa KedougouKedougou DepartmentDepartment

00 5050 100100 00 100100 200200 KilometersKilometers KilometersKilometers KilometersKilometers

LOCATION OF BANDAFASSI DSS SITE, : 10,500 under surveillance.

Gilles Pison, Emmanuelle Guyavarch, Abdoulaye Wade, Alexis Gabadinho, Catherine Enel, and Cheikh Sokhna

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1. BANDAFASSI DSS SITE DESCRIPTION

1.1 Physical Geography of the DSS Areas

The Bandafassi area is located in Senegal, between 12°46’ and 12°30’ north latitutude and between 12°16’ and 12°31’ east longitude, with altitude ranging from 60 to 426 meters above mean sea level. It is located in the Region of Tambacounda, in the Département of Kedougou, in Eastern Senegal, near the boarder between Senegal, and . It corresponds to about half the Arrondissement of Bandafassi. The Bandafassi area is about 25 km long by 25 km large and total 600 sq km.

It belongs to the Sudan savanna ecological zone. The climate is characterized by two seasons, a rainy season, from June to October, and a dry season, from November to May, with average rainfall of 1,097 mm per year during the period 1984-1995. The Bandafassi area is about 500 km distant from the capital Dakar.

1.2 Population Characteristics of the Bandafassi DSS Area

The Bandafassi area had a population of 10,509 inhabitants on 1st January 2000 and population density was low: about 18 inhabitants per square kilometer. It has 42 villages. The villages are small (240 inhabitants on average) and some are divided in hamlets. The population of the area is comprised of three ethnic groups who live in distinct villages. In order of settlement in the area, these are:

• The Bedik (25% of the population). This ethnic group, which was probably more extended in the past, has its own language, related to the Mande linguistic group. • The Mandinka (16% of the population). They are part of the widespread in the Western part of West Africa. • The Fula Bande (59% of the population). They are part of the Fula of West Africa and very close culturally to the sub-group of Guinea.

The Fula and a minority of the Mandinka are Moslems, while the majority of the Mandinka and the Bedik are animists, with a few christians among these two groups.

The area is rural, the main activities being cultivation of cereals (sorghum, maize, rice), peanuts and cotton, and cattle breeding. One part of the young male population engages each year in seasonal migrations to cities or other rural areas of the country.

There were primary schools in 10 villages in 2000, with 7 of them having only 1 teacher each. Secondary schools were in the cities of Kedougou (at a distance of 25 km on average) or Tambacounda (250 km). In 2000, 26% of adult women aged 15–29 years had been to school (for at least one year), and 10% of those aged 30-44 years.

The residential unit is a compound housing the members (15 on average) of an extended patrilineal family. Usually, a compound contains one hut for each ever-married woman and sometimes additional huts for unmarried adult sons and/or for the head of the compound. Polygyny is frequent: there are 180 married women for 100 married men. When a man has several wives, each one has her own hut close to the others. Children sleep in their mother's hut until about age 15. Teen-age girls leave the compound to marry, and boys build small huts to sleep in, often with age-mates.

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Older children may sleep in the huts of old or childless women, even if their mother lives in her own hut in the compound (Pison, 1982).

The vast majority of dwellings are huts covered with thatched roofs. Water is taken from river, backwater, wells or bore holes. Most of the compounds have no toilet facilities. There is no electricity. The area is one of the remotest in Senegal: distances to the main centers of the country are large (700 km from the capital of the country, Dakar, 250 km from the capital of the region, Tambacounda) and local roads are bad, often impracticable during the rainy season which lasts half of the year. The closest hospital where delivering women who need a cesarian section can be operated is at Tambacounda.

There is one unique public health post within the area, located in the village of Bandafassi, and run by a public nurse. For vaccinations, the area is divided into two different sectors, depending on different health services. The southern sector is covered by the public health post of Bandafassi where children are vaccinated, but the nurse also travels around by motor bike to vaccinate children in more remote villages. In the northern sector of the area, the Catholic mission in Kedougou sends a nurse to each village several times a year, to vaccinate and examine children and mothers. Vaccination coverage rate was nearly zero before 1987. The national immunization program (EPI) reached the area for the first time in 1987. In 1992, 39% of children aged 12-35 months were fully vaccinated.

2. BANDAFASSI DSS PROCEDURES

2.1 Introduction to the Bandafassi DSS

The original objective of the Bandafassi project in 1970 was to measure survival rates in different subgroups of a population defined by their genotypes (for example, comparing persons with the gene responsible for drepanocytosis (gene S) and those who did not have this gene). Genotypes had to be determined from blood samples, and survival rates estimated from the follow-up of persons with known genotype during several years. It was decided to follow the whole population of the Bandafassi area and to collect demographic information on births, deaths, marriages and migrations regularly. The genetic objective was rapidly abandoned and the project became a demographic and health project whose main objective was to study the demographic and health situation of a west African population with very high mortality levels, to observe changes over time and examine the factors involved (Pison et al., 1997).

The baseline survey was organised at different dates in the different sub-populations of the Bandafassi area: in 1970 for the Mandinka villages (1,095 inhabitants at that time), in 1975 for the Fula villages (3,701 inhabitants) and in 1980 for the Bedik villages (1,818 inhabitants). In 1975 and 1980, as mentioned above, the newly censused sub-population was added to the population yet followed up. The total population, which was 6,577 inhabitants on 1/1/1980, has increased to 10,509 inhabitants on 1/1/2000.

The Bandafassi studies are managed by a team of researchers from several institutions based in Senegal and in France. Several doctoral students from Senegal and France are also working in the project. In France, the main institution involved is the “Institut national d’études démographiques”, in Paris, in particular, the “Unité Population et développement”, with collaboration with the “Unité Dynamique et santé des populations humaines” from the “Centre national de la recherche scientifique” and the “Muséum national d’histoire naturelle”. In Senegal, the institutions involved are the “Unité de paludologie afro-tropicale” from the “Institut de recherche pour le

Chapter C18 Page 3 INDEPTH Monograph: Volume 1 Part C Bandafassi Demographic Surveillance System, Senegal développement”, the “Programme national de lutte contre le sida” of Ministry of Health, and the Cheikh Anta Diop University (University of Dakar), whose several students work in the project.

2.2 Bandafassi DSS Data Collection and Processing

2.2.1 Field Procedures

a) Initial census

The initial census was very similar in the different sub-populations of Bandafassi and in Mlomp. It consisted of a census and of several surveys which were organised just after it to improve the information of the census and collect other data necessary for subsequent studies. These included an age survey, to estimate or improve the ages of adults and children collected by the census, which were unreliable for most, especially in Bandafassi. We used an indirect method based on the classification of the population of a village by birth rank (Pison, 1980). It also included a genealogical survey, to collect genealogies going up to known ascendants and then down to living collateral relatives. One use of the genealogies in the project is to get a detailed information on the relationships between the members of a compound and in particular the relationship of each one with the head of the compound (Pison, 1985). Finally there was a union and birth histories survey for adult men and women. This was achieved totally in Mlomp, but only partially in Bandafassi.

At the census, a person has been considered as a member of the compound if the head of the compound declared her as such. This definition was broad and results in a de jure population under study. Thereafter, a criterion was used to decide whether a person was to be excluded, or included, in the population, and when.

A person exits from the study population either by death or emigration. As part of the population of Bandafassi engages in seasonal migrations, with seasonal migrants sometimes remaining one or two years outside the area before coming back, we decided that a person who was absent at three successive yearly rounds without returning in between had emigrated and was no longer resident in the study population at the date of the third round. Such a definition results in some vital events occurring outside the study area. For example, some births occur from women classified in the study population but physically absent at the time of delivery. These births are included in the events registered and are in the numerators for the calculation of rates. Information on them are however less accurate than that for the births who occurred really in the study area. For such new- born babies, special criteria of exit were adopted: in particular they are considered as emigrants at the same date that their mother.

A new person enters the study population either by birth from a woman of the study population or by immigration. Information on immigrants is collected from questions asked when the list of compounds of a village has been checked: are there new compounds or new families who settled since the last visit? or when the list of people of a compound has been checked: are there new persons in the compound since the last visit? Some of the immigrants are ancient villagers who left the area several years before and were excluded from the study population. We collect information to find in which compound they were registered and match the new information with ancient ones.

Movements from one compound to another one inside the area are routinely collected. For some categories of the population such as older widows or orphans who frequently come and go for short periods of time and live in between several compounds, they may be considered as members of all of them or of none. As a consequence, their movements are not always declared.

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b) Regular update rounds

The surveillance survey is a multi-round demographic survey with yearly rounds. Once each year, in January and February in Mlomp, in February and March in Bandafassi, all villages or hamlets are visited and information on events which occurred since the last visit is collected. This is done in three steps. In the first step, the list of people present in each compound at the preceding visit is checked and information is obtained on new births, marriages, migrations, deaths and current pregnancies. In Mlomp, information is provided by the head of the compound or another person if the head is absent. In Bandafassi, it is provided by the head of the compound or key informants in the village or hamlet. Not all the compounds are visited systematically in Bandafassi. Experience shows that in the this area, the villages or hamlets are small enough and there is so little privacy that information on vital events is known from nearly all the village or hamlet community. A well chosen informant can provide the basic information with errors not being more frequent, and probably less than if each head of compound was interviewed. Questionnaires used at each round are: an updated list of the members of the compound at the previous visit listing the names and characteristics of every one; and forms for each kind of event such as delivery, death, marriage and migrations. These forms are in use only in Mlomp while in Bandafassi the information on events is written directly on the nominative list.

c) Continuous surveillance

In Mlomp, local registers in the area or nearby provide information that is matched with that collected independently by the surveillance survey. For some registers, whose quality is fair, the information is systematically used to eventually correct errors and to complete the information collected at the yearly rounds. These are maternity clinics registers (for prenatal visits and deliveries), civil and parish registers (for births), and dispensary or hospital registers (for death, growth surveillance and vaccinations). At the beginning of the surveillance, the local dispensary agreed to collaborate with the research project. One of its tasks is to fill several registers, in particular a death register. Although the local registers rarely cover the entire population and are sometimes subject to errors, their use improves the quality and the precision of the data. In Bandafassi, such registers do not exist or are very incomplete so as they are usually not used. For each death identified in the first step of the annual survey, information on its cause is obtained from a close relative of the dead person, usually the mother in case of a child death, using a verbal autopsy questionnaire. In Bandafassi, the use of this questionnaire was introduced only in 1985. Before, the questions asked on causes of death were simple questions as "Why did the person die? Of what disease?" And since 1985, detailed verbal autopsies have been performed only for child deaths, before age 15. In Mlomp, verbal autopsies have been performed for all deaths since the beginning of the study.

Other information has been collected on one or several occasions, but they are not part of the routine data. These included: immunization status in Mlomp, but not in Bandafassi, where a specific immunization survey was organised in 1992 (Desgrées du Loû, 1996; Desgrées du Loû et al., 1994, 1995, 1996a, 1996b); serological, parasitological or resistance surveys, for STD or malaria studies (Diop et al., sous-presse ; Enel et al., 1992, 1994 ; Lagarde et al., 1995, 1996a, 1996b, 1997, 1998, sous-presse); or contraceptive prevalence and breastfeeding or nutrition surveys on several occassions.

d) Field supervison and quality assurance

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2.3 Data management and Analysis

a) Data handling and processing

Information collected by the base line and the follow-up surveys have been coded and stored in databases. They have been conceived in the seventies and the eighties with some adaptations since. The information collected by each annual survey is processed in two steps: first, it is processed in the villages during the survey, using portables and “4ème dimension” software. Shortly after the end of the round, this information verified, and then added to the database run with the PostgreSQL software.

b) Data quality assurance and links to the field

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c) Data analysis and dissemination

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3. BANDAFASSI DSS BASIC OUTPUTS

3.1 Demographic Indicators Generated by the DSS Sites

Surveillance Population Size 10,509 Age Group Structure (% ) <1 year 4.0 0-4 years 17.2 5-14 years 26.5 15-64 years 52.0 65+ years 4.3 Age Dependency Ratio (% ) (<15 plus 92.3 65+) / (15-64) Sex Ratio (men for 100 women) 96.0 Average Household Size (persons) 14.6 % literate aged 15 years and over Females 7% (in 2000) Males Total Fertility Rate (number of children) 6.5 Infant Mortality Rate (per 1,000 live 135 births) Under Five Mortality Rate (5q0 per 254 children born alive) Life expectancy at birth Females 48 years Males 45 years Annual Birth Rate (per 1000) 46 Annual Death Rate (per 1000) 20

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Natural Annual Population Growth Rate 26 Observed Annual Population Growth Rate 20 Maternal Mortality Ratio (maternal deaths 826 per 100.000 live births) (period 1988-1997)

3.2 Fertility and child mortality trends

Over the surveillance periods, the trends in fertility have been quite different in the two rural sites of Bandafassi and Mlomp. In Bandafassi, the total fertility rate has not changed over the last 20 years, it was 6.4 children per woman on average during the period 1980-89, and 6.5 during the period 1990-99. In Mlomp, on the contrary, total fertility has declined rather rapidly from 5.3 children per woman in 1985-89 to 4.3 in 1990-94 and 3.6 in 1995-99.

Trends in child mortality also differ between the two sites. In Bandafassi, child mortality was very high and has decreased over the surveillance period: under five mortality rate (5q0) was 470 per 1,000 in 1976-79, 351 per 1,000 in 1980-89 and 254 per 1,000 in 1990-99. In Mlomp on the contrary, child mortality was comparatively low, and it has not diminished: under five mortality rate (5q0) was 87 per 1,000 in 1985-89, 124 per 1,000 in 1990-94 and 100 per 1,000 in 1995-99.

Population Pyramid

85+ M F 80-84 A E 75-79 L M 70-74 E A 65-69 L E 60-64 55-59 50-54 45-49 40-44 Age

35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 12108642024681012 Percent Total Population (Male + Female)

Male Percent of Total Population Female Percent of Total Population

Figure 1. Population pyramid for the Bandafassi DSS Site

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Table 1. Age and Sex Specific Mortality in the Bandafassi DSS Site

Deaths (nDx) Person Years (nPYx) Age

Male Female Male Female

0 145 120 949 953 1-4 118 96 3,192 3,106 5-9 12 25 3,304 3,423 10-14 6 12 1,632 2,368 15-19 10 10 1,936 2,213 20-24 10 7 1,633 1,095 25-29 4 12 947 1,599 30-34 7 8 863 829 35-39 11 10 831 1,129 40-44 6 4 628 888 45-49 8 8 796 1,022 50-54 12 11 803 715 55-59 15 15 546 723 60-64 12 15 407 595 65-69 28 25 398 549 70-74 26 20 265 362 75-79 10 22 125 212 80-84 11 14 49 68 85+ 3 13 27 102

Total 454 447 19,331 21,954

Births 2,122

CDR 21.82 CBR 51.40 CGR 29.57

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Table 2 Age Specific Fertility Rates in the Bandafassi DSS Site

Bandafassi - 1985 - 1989 Bandafassi - 1990 – 1995 Bandafassi - 1995 - 1999

Age py Births Births / py Py Births Births / py py Births Births / py group (x1000) (x1000) (x1000)

10-14 1083.16 21 19.39 3977.91 35 8.80 5342.05 10 1.87 15-19 984.97 252 255.85 3544.45 721 203.42 4107.66 722 175.77 20-24 727.38 237 325.83 3155.35 986 312.48 3457.14 1057 305.74 25-29 655.82 167 254.64 2770.06 784 283.03 3034.63 917 302.18 30-34 582.39 127 218.07 2321.57 536 230.88 2816.70 741 263.07 35-39 507.70 82 161.51 2110.57 311 147.35 2517.00 417 165.67 40-44 404.15 32 79.18 1833.36 124 67.64 2186.44 149 68.15 45-49 496.33 8 16.12 1604.81 24 14.96 1943.47 29 14.92 50-54 400.50 5 12.48 1589.15 8 5.03 1645.55 4 2.43

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4. REFERENCES

Aaby P., Pison G., Desgrées du Loû A., Andersen M. (1995) - Lower neonatal and postneonatal mortality for female-female twins than male-male and male-female twins in rural Senegal. Epidemiology, 6:419-422.

Desgrées du Loû A., Pison G. (1994) Barriers to universal child immunization in rural Senegal, five years after the accelerated Expanded Program on Immunisation. Bulletin of the World Health Organization, 72 (5):751-759.

Desgrées du Loû A., Pison G., Aaby P. (1995) - Role of immunizations in the recent decline in childhood mortality and the changes in the female/male mortality ratio in rural Senegal American Journal of Epidemiology, 142 : 643-52.

Desgrées du Loû A.(1996) - Sauver les enfants : le rôle des vaccinations : une enquête longitudinale en milieu rural à Bandafassi au Sénégal. Les études du CEPED, 262 p.

Desgrées du Loû A., Pison G., Samb B., Trape J.F. (1996a) - L’évolution des causes de décès d'enfants en Afrique : une étude de cas au Sénégal avec la méthode d'autopsie verbale. Population, (4-5): 845-881.

Desgrées du Loû A., Pison G. (1996b) - The role of vaccination in the reduction of childhood mortality in Senegal. Population An English Selection, 8 : 95-121.

Diop O., Pison G., Diouf I., Enel C., Lagarde E. (sous-presse) Incidence of hiv-1 and hiv-2 infections in a rural community in southern Senegal. AIDS.

Enel C., Pison G. (1992) - Sexual relations in the rural area of Mlomp (Casamance, Senegal) in Dyson T. (ed.), Sexual behaviour and networking: anthropological and socio-cultural studies on the transmission of HIV., Derouaux Ordina Editions, Liège, 249-267.

Enel C., Pison G. , Lefebvre M. (1993) - De l'accouchement traditionnel à l'accouchement moderne au Sénégal Cahiers Santé, 3: 441-6.

Enel C., Pison G., Lefebvre M. (1994a) - Migrations and nuptiality changes. A case study in rural Senegal. in Bledsoe C., Pison G. (ed.), Nuptiality in Sub-Saharan Africa : Contemporary Anthropological and Demographic Perspectives., Clarendon Press, Oxford University Press, 92- 113.

Enel C., Lagarde E., Pison G. (1994b) - The evaluation of surveys of sexual behaviour: a study of couples in rural Senegal. Health Transition Review, supplement to volume 4:111-124.

Lagarde E., Enel C., Pison G. (1995) - Reliability of Reports of Sexual Behaviour: A Study of Married Couples in Rural West Africa. American Journal of Epidemiology,141:1194-200

Lagarde E., Pison G., Enel C. (1996a) - Knowledge, attitudes and perception of AIDS in rural Senegal: relationship to sexual behaviour and behaviour change. AIDS, 10 : 327-34.

Lagarde E., Pison G., Enel C. (1996b) - A study of sexual behavioural change in rural Senegal. J Acquir Immune Defic Syndr Hum Retro, 11 : 282-7.

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Lagarde E., Pison G., Enel C. (1997) - Improvement in AIDS knowledge, perceptions and behaviours over a short period in a rural community of Senegal. International Journal fo STD and AIDS, 8 : 681-87.

Lagarde E., Pison G., Enel C. (1998) - Risk behaviours and AIDS knowledge in a rural community of Senegal : relationship with sources of AIDS information. International Journal of Epidemiology, 27 : 890-6.

Lagarde E., Enel C., Karim S., Gueye-Ndiaye A., Piau J.P., Pison G., Ndoye I., Mboup S. (sous- presse) Religion and protective attitudes behaviours towards AIDS and STDs in rural Senegal. AIDS.

Langaney A., Pison G. (1979) - Rougeole et augmentation temporaire de la masculinité des naissances : coïncidence ou causalité ? C.R. Acad. Sc., Paris, série D, t. 289, 1255-1258.

Le Guenno B., Pison G., Enel C., Lagarde E., Seck C. (1992a) - HIV2 seroprevalence in three rural : low levels and heterogeneous distribution. Trans. Roy. Soc. Trop. Med. Hyg.; 86: 301-2.

Le Guenno B., Pison G., Enel C., Lagarde E., Seck I. (1992b) - Clinical and immunological impact of HIV2 infection in a rural community of Senegal Journal of Medical Virology, 38 (1): 67-80.

Pison G. (1979) - Age déclaré et âge réel : une mesure des erreurs sur l'âge en l'absence d'état civil. Population, 3, 637-648.

Pison G. (1980) - Calculer l'âge sans le demander. Méthode d'estimation de l'âge et structure par âge des Peul Bandé (Sénégal Oriental). Population, 4-5, 861-892.

Pison G. (1982) - Dynamique d'une population traditionnelle : les Peul Bandé (Sénégal Oriental). P.U.F., Paris, 278 p. (Cahier de l'I.N.E.D., n° 99).

Pison G. (1985a) - Calculating Age without Asking for it. Method of Estimating the Age and Age- Structure of the Fula Bande (Eastern Senegal), Selected papers on Population n° 9, INED-INSEE- ORSTOM-Ministère de la Coopération.

Pison G. (1985b) - Nouvelles méthodes de collecte dans les enquêtes à petite échelle. IUSSP International Population conference, Florence, 5-12 juin 1985, tome 4, 23-38.

Pison G., Langaney A. (1985) - The Level and Age Pattern of Mortality in Bandafassi (Eastern Senegal) : Results from a Small-Scale and Intensive Multi-Round Survey. Population Studies, 39 (3), 387-405.

Pison G. (1986a) - La démographie de la polygamie. Population, 1, 93-122.

Pison G. (1986b) - L'intérêt des observatoires de population pour mesurer la mortalité aux jeunes âges in "Estimation de la mortalité du jeune enfant (O-5 ans) pour guider les actions de santé dans les pays en développement", INSERM, vol. 145, Paris, 37-48.

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Pison G. (1987) - Polygyny, Fertility and Kinship in Sub-Saharan Africa, in E. van de Walle (ed.), "The Cultural Roots of African Fertility Regimes". Proceedings of the Ife Conference, Population Studies Center, University of Pennsylvania, Philadephia.

Pison G., Bonneuil N. (1988a) - The Impact of Crowding on Measles Mortality. Evidence from the Bandafassi data (Senegal). Reviews of Infectious Diseases, 10 (2), 468-470.

Pison G., Langaney A. (1988b) - Age Patterns of Mortality in Eastern Senegal : Comparison of Micro and Survey Approaches, in "Micro-Approaches to Demographic Research", J.C. Caldwell, A.G. Hill and V. Hull (ed.), , Kegan Paul International, London, pp. 297-317.

Pison G., Aaby P., Knudsen K. (1992) - Increased risk of death from measles in children with a sibling of opposite sex in Senegal. British Medical Journal,; 304: 284-7.

Pison G. , Trape J.F., Lefebvre M. , Enel C. (1993a) - Rapid decline in child mortality in a rural area of Senegal. - International Journal of Epidemiology, 22(1): 72-80.

Pison G., Le Guenno B.,Lagarde E., Enel C., Seck C. (1993b) - Seasonal migration: a risk factor for HIV infection in rural Senegal J Acquir Immune Defic Syndr, 6 (2): 196-200.

Pison G., Desgrées du Loû A. (1993c) - Bandafassi (Sénégal). Niveaux et tendances démographiques 1971-1991. Dossier et recherches n° 40; Institut National d'Etudes Démographiques, Paris, 40 p.

Pison G., Lagarde E., Enel C. (1997a) - Comportements sexuels, migrations saisonnières et risques d'infection par le VIH et les maladies sexuellement transmissibles : étude des changements en zone rurale au Sénégal. in ANRS Le sida en Afrique. Recherches en sciences de l'homme et de la société, Collection Sciences Sociales et Sida, ANRS, pp 17-22.

Pison G, Desgrées du Loû A, Langaney A. (1997b) - Bandafassi: a 25 years propspective community study in rural Senegal (1970-1995). In Das Gupta M et al. (eds.) Prospective community studies in developing countries , , Clarendon Press, Oxford University Press, 253-75.

Pison G., Aaby P. (1998) - Pourquoi la rougeole tue encore en Afrique. Pour la Science, n°246, avril 1998, 40-4.

Pison G., Kodio B., Guyavarch E., Etard J.F. (sous-presse) - Niveaux, causes et variations de la mortalité maternelle en Afrique. Une étude de cas en milieu rural au Sénégal. Population.

Spira R., Lagarde E., Bouyer J., Karim S., Enel C., Toure-Kane N., Piau J.P., Ndoye I., Mboup S. Pison G. (sous-presse) Preventive attitudes towards the threat of Aids: process and determinants in rural Senegal. AIDS Education and Prevention.

Trape JF., Pison G., Preziosi MP., Enel C., Desgrées du Loû A, Delaunay V., Samb B., Lagarde E., Molez JF., Simondon F. (1998) - Impact of chloroquine resistance on malaria mortality. C.R Acad. Sci. Paris Sciences de la vie, 321 : 689-97.

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5. ACKNOWLEDGEMENTS

The following institutions have provided financial support to the Bandafassi/Mlomp projects : Institut national d’études démographiques, Centre national de la recherche scientifique, Muséum national d’histoire naturelle, Agence national de recherches sur le sida, Institut français de recherche pour le développement, European Community, World Health Organization, Institut national de la santé et de la recherche médicale.

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