Beyond causes of death: The social determinants of mortality among children aged 1-59 months in Nigeria from 2009 to 2013

Abstract

BackgroundMillions of children worldwide suffer and die from conditions for which effective interventions exist. While there is ample evidence regarding these diseases, there is a dearth of information on the social factors associated with child mortality.MethodsThe 2014 Verbal and Social Autopsy Study was conducted based on a nationally representative sample of 3,254 deaths that occurred in children under the age of five and were reported on the birth history component of the 2013 Nigerian Demographic and Health Survey. We conducted a descriptive analysis of the preventive and curative care sought and obtained for the 2,057 children aged 1–59 months who died in Nigeria and performed regional (North vs. South) comparisons.ResultsA total of 1,616 children died in the northern region, while 441 children died in the South. The majority (72.5%) of deceased children in the northern region were born to mothers who had no education, married at a young age, and lived in the poorest two quintiles of households. When caregivers first noticed that their child was ill, a median of 2 days passed before they sought or attempted to seek healthcare for their children. The proportion of children who reached and departed from their first formal healthcare provider alive was greater in the North (30.6%) than in the South (17.9%) (p<0.001). A total of 548 children were moderately or severely sick at discharge from the first healthcare provider, yet only 3.9%-18.1% were referred to a second healthcare provider. Cost, lack of transportation, and distance from healthcare facilities were the most commonly reported barriers to formal care-seeking behavior.ConclusionsMaternal, household, and healthcare system factors contributed to child mortality in Nigeria. Information regarding modifiable social factors may be useful in planning intervention programs to promote child survival in Nigeria and other low-income countries in sub-Saharan Africa.

Under-five mortality in the Rongo Sub-County of Migori County, Kenya: Experience of the Lwala Community Alliance 2007-2017 with evidence from a cross-sectional survey

“…A preliminary list of variables available in the survey was created based on previous studies of associations with childhood mortality [ 15 , 17 , 34 , 37 – 40 , 42 – 46 , 56 , 57 ]. Cox regression models with clustering at the household level were used to estimate the effects of independent variables on survival with effects given as hazards ratios.…”

“…It has been suggested that the focus of the MDGs on national data ignored these within-country inequities [ 9 , 11 – 13 ], and that increased health spending often benefits those that were best off to start [ 11 , 12 , 14 ]. These subnational differences within countries highlight the need for local data to inform health services implementation efforts [ 15 – 17 ].…”

In-depth Validation of CHERG’S Verbal Autopsy-Social Autopsy (VASA) Tool for Ascertaining Determinants and Causes of Under-Five Child Mortalities in Karachi, Pakistan.

“…Moreover, VASA, an integrated approach, whereby VA is merged with SA to identify not only the medical causes of mortalities but also to identify the social contributors of child deaths. This integrated tool is under trial in some of the low resource settings across the globe (4,(6)(7)(8)(9). Literature suggests that CHERG (Child Health Epidemiology Reference Group) VASA integrated tool, which is based on the so-far most holistic conceptual framework, i.e., "The Pathway to Survival Conceptual Framework" (TPtoSCF) (10), have been utilized in several countries (6,7,9,11) for exploring the most relevant medical and social determinants of mortality events.…”

Methodologies of Verbal autopsy and Social autopsy tools, adopted by VASA studies in exploring under-five mortality determinants

“…The CF ultimately assists in developing new interventions and focusing the existing ones (in the presence of more explicit evidence) towards preventing child mortalities and ultimately has strong policy implications in child survival4. Global literature suggests evidence in support of using TPtoSCF for understanding the complete range of social determinants linked with child death events [24][25][26] .…”

“…This approach can give extended data on most relevant biological and social determinants related to specific death event and ultimately help in assigning a broader cause of death. However, the literature shows that such investigations have been undertaken by either way; administering VA and SA tools separately (but in synergy) for each death event [28][29][30][31] or using an integrated tool where SA is merged with VA, thereby making a single tool for recording data on biological and social determinants 8, [21][22][23][24][25][26][32][33][34][35] . However, logically, the single integrated tool should be based on an integrated CF that should be holistic in recording biological and social determinants of child mortality.…”