Social determinants of child mortality in Niger: Results from the 2012 National Verbal and Social Autopsy Study

Abstract

BackgroundUnderstanding the determinants of preventable deaths of children under the age of five is important for accelerated annual declines – even as countries achieve the UN’s Millennium Development Goals and the target date of 2015 has been reached. While research has documented the extent and nature of the overall rapid decline in child mortality in Niger, there is less clear evidence to provide insight into the contributors to such deaths. This issue is the central focus of this paper.MethodsWe analyzed a nationally representative cross–sectional sample of 620 child deaths from the 2012 Niger Verbal Autopsy/Social Autopsy (VASA) Survey. We conducted a descriptive analysis of the data on preventive and curative care, guided by the coverage of proven indicators along the continuum of well child care and illness recognition and care–seeking for child illnesses encompassed by the BASICS/CDC Pathway to Survival model.ResultsSix hundred twenty deaths of children (1–59 months of age) were confirmed from the VASA survey. The majority of these children lived in households with precarious socio–economic conditions. Among the 414 children whose fatal illnesses began at age 0–23 months, just 24.4% were appropriately fed. About 24% of children aged 12–59 months were fully immunized. Of 601 children tracked through the Pathway to Survival, 62.4% could reach the first health care provider after about 67 minutes travel time. Of the 306 children who left the first health care provider alive, 161 (52.6%) were not referred for further care nor received any home care recommendations, and just 19% were referred to a second provider. About 113 of the caregivers reported cost (35%), distance (35%) and lack of transport (30%) as constraints to care–seeking at a health facility.ConclusionDespite Niger’s recent major achievements in reducing child mortality, the following determinants are crucial to continue building on the gains the country has made: improved socio–economic state of the poor in the country, investment in women’s education, adoption of the a law to prevent marriage of young girls before 18 years of age, and implementation of health programs that encourage breastfeeding and complementary feeding, immunization, illness recognition, prompt and appropriate care–seeking, and improved referral rates.

Using social autopsy to understand maternal, newborn, and child mortality in low-resource settings: a systematic review of the literature

“…Some secondary respondents to fill gaps.NeonatalData collection spanned from March-September 2012 for deaths dating back to 2006.

Women with pregnancy complications were no more likely than mothers without complications to deliver at a health facility (32.7% vs. 25.8%).

Although 95.8% of caregivers reported there was a serious or severe symptom, 60.3% received no care for their illness.

Of the 90 who did not seek care, 28.7% reported 2 constraints on average, including cost of transportation or health care, lack of transportation, and distance to facility

Population Health Metrics Research Consortium Verbal Autopsy Questionnaire; CHERG Social Autopsy QuestionnairePathway to Survival1.0Koffi AK, Maina A, Yaroh AG, Habi O, Bensaïd K, Kalter HD. [13]2016NigerCross-sectionalDeaths identified by the Niger National Mortality Survey conducted July-Aug. 2010.Caregivers (N = 550) interviewed about 601 childrenUnder 5 years old2–5 years with a mean of 2.7 yearsOf the 601 children tracked through the Pathway to Survival model, it would take 62.4% about 67 minutes to reach the first health care provider.About 113 of the caregivers stated that distance, lack of transport, and cost were the biggest constraints to seeking care at a health facility.96.2% of caregivers recognized that their child had a severe symptom. Median length from illness onset to care-seeking was 1 day.…”

Óbitos perinatais evitáveis por intervenções do Sistema Único de Saúde do Brasil

“…It also helps to improve the quality of information on the births and reduce deaths (1) . Possible obstacles to obtaining this information are the low quality or lack of evidence and difficulties accessing this evidence (16) . The low quality life records of some populations compromise the availability of information needed to determine health policies and priorities (2) .…”

A double-blind placebo-controlled trial of azithromycin to reduce mortality and improve growth in high-risk young children with non-bloody diarrhoea in low resource settings: the Antibiotics for Children with Diarrhoea (ABCD) trial protocol

“…Principal Investigators will receive brief monthly progress reports from the Data Coordinating Centre during the entire study period and will participate in regular telephone conferences with WHO staff. The monthly progress reports will include the number children assessed, number of children recruited, home visits due to be conducted, actual visits conducted, child hospitalisations, deaths and verbal and social autopsies [19] conducted. 4.…”