Background In low-resource settings, it is challenging to ascertain the burden and causes of under-5 mortality as many deaths occur outside health facilities. Verbal autopsy (VA) is an important tool that provides data on causes of death in communities with limited access to health care. We aimed to determine the causes of childhood deaths by VA in rural Gambia. Methodology We used WHO standard questionnaires to conduct VAs for deaths under-5 years of age in the Basse and Fuladu West Health and Demographic Surveillance Systems in rural Gambia between September 01, 2019, and December 31, 2021. Two physicians assigned a cause of death and discordant diagnoses were resolved by consensus. Causes of death were classified using the International Classification of Disease 10th edition codes. Results VAs were conducted for 89% (647/727) of deaths. Of these deaths, 49.5% (n=319) occurred at home, 50.1% (n=324) in females, 37.1% (n=240) in neonates, and 27.1% (n=175) in infants aged 1-11 months. Outside the neonatal period, pneumonia (27.0%, n=110), diarrhoeal diseases (23.3%, n=95), and sepsis (21.6%, n=88) were the commonest primary causes of death. In the neonatal period, unspecified perinatal causes of death (29.6%, n=71), birth asphyxia (23.8%, n=57) and prematurity/low birth weight (17.1%, n=41) were the commonest causes. Severe malnutrition (28.6%, n=185), unspecified perinatal deaths (10.7%, n=69), pneumonia (10.2%, n=66), and prematurity/low birth weight (10.2%, n=66) were the commonest underlying causes of death. Conclusion According to VA analysis, half of deaths amongst children under-5 in rural Gambia occur at home. Pneumonia, diarrhoea, and sepsis, and the underlying cause of severe malnutrition, as well as birth asphyxia in neonates, remain the predominant causes of child mortality in rural Gambia. Improved health care and health-seeking behaviour may reduce childhood deaths in rural Gambia.

Background In low-resource settings, it is challenging to ascertain the burden and causes of under-5 mortality as many deaths occur outside health facilities. We aimed to determine the causes of childhood deaths in rural Gambia using verbal autopsies (VA). Methodology We used WHO VA questionnaires to conduct VAs for deaths under-5 years of age in the Basse and Fuladu West Health and Demographic Surveillance Systems (HDSS) in rural Gambia between September 01, 2019, and December 31, 2021. Using a standardized cause of death list, two physicians assigned causes of death and discordant diagnoses were resolved by consensus. Results VAs were conducted for 89% (647/727) of deaths. Of these deaths, 49.5% (n = 319) occurred at home, 50.1% (n = 324) in females, and 32.3% (n = 209) in neonates. Acute respiratory infection including pneumonia (ARIP) (33.7%, n = 137) and diarrhoeal diseases (23.3%, n = 95) were the commonest primary causes of death in the post-neonatal period. In the neonatal period, unspecified perinatal causes of death (34.0%, n = 71) and deaths due to birth asphyxia (27.3%, n = 57) were the commonest causes of death. Severe malnutrition (28.6%, n = 185) was the commonest underlying cause of death. In the neonatal period, deaths due to birth asphyxia (p-value<0.001) and severe anaemia (p-value = 0.03) were more likely to occur at hospitals while unspecified perinatal deaths (p-value = 0.01) were more likely to occur at home. In the post-neonatal period, deaths due to ARIP (p-value = 0.04) and diarrhoeal disease (p-value = 0.001) were more likely to occur among children aged 1–11 months and 12–23 months respectively. Conclusion According to VA analysis of deaths identified within two HDSS in rural Gambia, half of deaths amongst children under-5 in rural Gambia occur at home. ARIP and diarrhoea, and the underlying cause of severe malnutrition remain the predominant causes of child mortality. Improved health care and health-seeking behaviour may reduce childhood deaths in rural Gambia.