Change in the regional mortality ranking of Ngamiland in north-western Botswana is discussed from the early 1970s to 2001. Until the 1980s, Ngamiland, one of the most remote regions in Botswana, exhibited the highest rural district mortality level. But from the 1990s, the region moved toward a middle position on the mortality listing of rural districts. It is suggested that this change is related to the decreasing importance of traditional tropical diseases (mainly bilharzia and sleeping sickness) and the increasing importance of regionally different HIV/AIDS related mortality in recent years.