Non-specific effects of vaccination on child survival: prospective cohort study in Burkina Faso

BMJ 2004; 329 doi: (Published 02 December 2004) Cite this as: BMJ 2004;329:1309
  1. J Vaugelade (vaugelad{at}, demographer1,
  2. S Pinchinat, biostatistician2,
  3. G Guiella, researcher3,
  4. E Elguero, statistician1,
  5. F Simondon, epidemiologist1
  1. 1 Institut de Recherche pour le Développement, Laboratoire Population, Environnement et Développement, BP 64501, 34394 Montpellier Cedex 5, France
  2. 2 Biostatem, Parc Scientifique G Besse, F 30035 Nîmes, France
  3. 3 Unité d'Etudes et de Recherche en Démographie, 03 BP 7118, Ouagadougou 03, Burkina Faso
  1. Correspondence to: J Vaugelade
  • Accepted 25 September 2004


Objective To study the effect of vaccination on mortality before 2 years of age in a developing country.

Design Prospective cohort study.

Setting Rural communities in Burkina Faso.

Participants 9085 children born in the study area between 1985 and 1993.

Main outcome measure Child death rate.

Results Mortality before 2 years of age was lower in children who had been vaccinated: those vaccinated with BCG only had significantly lower mortality (risk ratio for vaccinated v unvaccinated children 0.37, 95% confidence interval 0.29 to 0.48) as did those vaccinated with diphtheria, tetanus, and pertussis only (0.24, 0.13 to 0.43). The second dose of diphtheria, tetanus, and pertussis was not associated with lower mortality (0.80, 0.58 to 1.12).

Conclusion Vaccination with diphtheria, tetanus, and pertussis as well as BCG is associated with better survival of children up to 2 years of age.


  • Contributors All the authors participated in the design of the study, interpretation of data, and revision of the final text. JV did the field research and drafted the paper; he is the guarantor. SP did the statistical analysis. GG participated in the demographic background analysis. EE participated in the statistical analysis. FS suggested this work.

  • Funding This study was funded by a field research grant from Unicef and Eau, agriculture, et santé en milieu tropical, and an analysis grant from WHO.

  • Competing interests SP has been a consultant statistician for Aventis Pasteur and Aventis Pasteur MSD on pertussis, rotavirus, and herpes zoster. EE has been funded by Aventis to attend a meeting.

  • Ethical approval No ethical committee existed in Burkina Faso at the time of the demographic survey and at the start of this analysis of the database. Nevertheless, this study was approved by the Ministry of Health of Burkina Faso.

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