Changing causes of death in the West African town of Banjul, 1942-97

objective: to determine trends in the causes of death in a west african town. mortality caused by infectious diseases is reported to be declining while degenerative and man-made mortality factors are increasingly significant. most mortality analyses for sub-saharan africa have involved extrapolation and have not been derived from community-based data. methods: historical data on causes of death coded by physicians were analysed for the urban population of banjul for the period 1942-97. as the calculation of rates is not possible in the absence of a reliable population denominator, age-standardized proportional mortality ratios (pmrs) for men and women by major groups of causes of death were calculated, using the 1942-49 data for reference purposes. findings: most deaths were attributable to communicable diseases. there was a shift in proportional mortality over the study period: the contribution of communicable diseases declined and that of noncommunicable diseases and injuries increased. these trends were more marked among men than women. conclusions: the data illustrate that while noncommunicable diseases and injuries are emerging as important contributors to mortality in sub-saharan africa, communicable diseases remain significant causes of mortality and should not be neglected.