Performance of cause-specific childhood mortality surveillance by health workers using a short verbal autopsy tool

Full notification of deaths and compilation of good quality cause of death data are core, sequential and essential components of a functional civil registration and vital statistics (CRVS) system. In collaboration with the Government of Papua New Guinea (PNG), trial mortality surveillance activities were established at sites in Alotau District in Milne Bay Province, Tambul-Nebilyer District in Western Highlands Province and Talasea District in West New Britain Province.Provincial Health Authorities trialled strategies to improve completeness of death notification and implement an automated verbal autopsy methodology, including use of different notification agents and paper or mobile phone methods. Completeness of death notification improved from virtually 0% to 20% in Talasea, 25% and 75% using mobile phone and paper notification strategies, respectively, in Alotau, and 69% in Tambul-Nebilyer. We discuss the challenges and lessons learnt with implementing these activities in PNG, including logistical considerations and incentives.Our experience indicates that strategies to maximise completeness of notification should be tailored to the local context, which in PNG includes significant geographical, cultural and political diversity. We report that health workers have great potential to improve the CRVS programme in PNG through managing the collection of notification and verbal autopsy data. In light of our findings, and in consultation with the main government CRVS stakeholders and the National CRVS Committee, we make recommendations regarding the requirements at each level of the health system to optimise mortality surveillance in order to generate the essential health intelligence required for policy and planning.

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A Qualitative Inquiry into the Application of Verbal Autopsy for a Mortality Surveillance System in a Rural Community of Southern India

World Health & Population ◽

10.12927/whp.2011.22514 ◽

2011 ◽

Vol 13 (1) ◽

pp. 30-39 ◽

Cited By ~ 5

Author(s):

Prem Mony ◽

Mario Vaz

Keyword(s):

Rural Community ◽

Verbal Autopsy ◽

Surveillance System ◽

Qualitative Inquiry ◽

Southern India ◽

Mortality Surveillance

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A Feasibility Study to Assess Non-clinical Community Health Workers’ Capacity to use Simplified Protocols and Tools to Treat Severe Acute Malnutrition in Niger State Nigeria

10.21203/rs.3.rs-577712/v1 ◽

2021 ◽

Author(s):

Olatunde Adesoro ◽

Olusola Oresanya ◽

Helen Counihan ◽

Prudence Hamade ◽

Dare Eguavon ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Severe Acute Malnutrition ◽

Full Recovery ◽

Childhood Mortality ◽

Acute Malnutrition ◽

Community Case Management ◽

Integrated Community Case Management ◽

Clinical Community

Abstract Background: Severe acute malnutrition (SAM) is a major determinant of childhood mortality and morbidity. Although integrated community case management (iCCM) of childhood illnesses is a strategy for increasing access to life-saving treatment, malnutrition is not properly addressed in the guidelines. This study aimed to determine whether non-clinical Community Health Workers (called Community-Oriented Resource Persons, CORPs) implementing iCCM could use simplified tools to treat uncomplicated SAM.Methods: The study used a sequential mixed-method design and was conducted between July 2017 and May 2018. Sixty CORPs already providing iCCM services were trained and deployed in their communities with the target of enrolling 290 SAM cases. Competency of CORPs to treat and the treatment outcomes of enrolled children were documented. SAM cases with MUAC of 9cm to < 11.5cm without medical complications were treated for up to 12 weeks. Full recovery was at MUAC≥12.5cm for two consecutive weeks. Supervision and quantitative data capturing were done weekly while qualitative data were collected after the intervention.Results: CORPs scored 93.1% on first assessment and increment of 0.11 (95% CI: 0.05 – 0.18) points per additional supervision conducted. The cure rate from SAM to full recovery, excluding referrals from the denominator in line with the standard for reporting SAM recovery rates, was 73.5% and the median length of treatment was seven weeks. SAM cases enrolled at 9cm to <10.25cm MUAC had 29% less likelihood of recovery compared to those enrolled at 10.25cm to <11.5cm. CORPs were not burdened by the integration of SAM into iCCM and felt motivated by children’s recovery. Operational challenges like bad terrains for supervision, supply chain management and referrals were reported by supervisors, while Government funding was identified as key for sustainability.Conclusion: The study demonstrated that with training and supportive supervision, CORPs in Nigeria can treat SAM among under-fives, and refer complicated cases using simplified protocols as part of an iCCM programme. This approach seemed acceptable to all stakeholders, however, the effect of the extra workload of integrating SAM into iCCM on the quality of care provided by the CORPs should be assessed further.

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Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan: evidence from two longitudinal cohort studies 15 years apart

10.21203/rs.2.12395/v3 ◽

2020 ◽

Author(s):

Chelsea L Hansen ◽

Benjamin JJ McCormick ◽

Syed Iqbal Azam ◽

Khalil Ahmed ◽

Julia M Baker ◽

...

Keyword(s):

Socioeconomic Status ◽

Child Health ◽

Cohort Studies ◽

Protective Factor ◽

Health Workers ◽

Considerable Change ◽

Childhood Mortality ◽

Autopsy Study ◽

Rural Village ◽

Significant Difference

Abstract Background: Oshikhandass is a rural village in northern Pakistan where a verbal autopsy study from 1989-1991 showed that diarrhea and pneumonia were the top causes of under-5 mortality. Intensive surveillance, active community health education and child health interventions were delivered in 1989-1996; here we assess improvements in under-5 mortality, diarrhea, and pneumonia over this period and 15 years later.Methods: Two prospective open-cohort studies in Oshikhandass from 1989-1996 (Study 1) and 2011-2014 (Study 2) enrolled all children under age 60 months. Study staff trained using WHO guidelines conducted weekly household surveillance and promoted knowledge on causes and management of diarrhea and pneumonia. Information about household characteristics and socioeconomic status was collected. Hurdle models were constructed to examine putative risk factors for diarrhea and pneumonia.Results: Against a backdrop of considerable change in the socioeconomic status of the community, under-5 mortality, which declined over the course of Study 1 (from 114.3 to 79.5 deaths/1000 live births (LB) between 1989 and 1996), exceeded Sustainable Development Goal 3 by Study 2 (19.8 deaths/ 1000 LB). Reductions in diarrhea prevalence (20.3 to 2.2 days/ Child Year [CY]), incidence (2.1 to 0.5 episodes/ CY), and number of bloody diarrhea episodes (18.6% to 5.2%) seen during Study 1, were sustained in Study 2. Pneumonia incidence was 0.5 episodes /CY in Study 1 and 0.2/CY in Study 2; only 5% of episodes were categorized as severe or very severe in both studies. While no individual factors predicted a statistically significant difference in diarrhea or pneumonia episodes, the combined effect of water, toilet and housing materials was associated with a significant decrease in diarrhea; higher household income was the most protective factor for pneumonia in Study 1. Conclusions: We report a 4-fold decrease in overall childhood mortality, and a 2-fold decrease in childhood morbidity from diarrhea and pneumonia in a remote rural village in Pakistan between 1989-2014. We conclude that significant, sustainable improvements in child health may be achieved through improved socioeconomic status and promoting interactions between locally engaged health workers and the community, but that continued efforts are needed to improve health worker training, supervision, and the rational use of medications.Trial Registration: Not Applicable

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A shortened verbal autopsy instrument for use in routine mortality surveillance systems

BMC Medicine ◽

10.1186/s12916-015-0528-8 ◽

2015 ◽

Vol 13 (1) ◽

Cited By ~ 27

Author(s):

Peter Serina ◽

Ian Riley ◽

Andrea Stewart ◽

Abraham D. Flaxman ◽

Rafael Lozano ◽

...

Keyword(s):

Verbal Autopsy ◽

Surveillance Systems ◽

Mortality Surveillance

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Epidemiological transition in a rural community of northern India: 18-year mortality surveillance using verbal autopsy

Journal of Epidemiology & Community Health ◽

10.1136/jech-2011-200336 ◽

2011 ◽

Vol 66 (10) ◽

pp. 890-893 ◽

Cited By ~ 10

Author(s):

Rajesh Kumar ◽

Dinesh Kumar ◽

J Jagnoor ◽

Arun K Aggarwal ◽

P V M Lakshmi

Keyword(s):

Rural Community ◽

Verbal Autopsy ◽

Epidemiological Transition ◽

Northern India ◽

Mortality Surveillance

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Determining the Cause of Death: Mortality Surveillance Using Verbal Autopsy in Indonesia

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.16-0815 ◽

2017 ◽

Vol 97 (5) ◽

pp. 1461-1468

Author(s):

Abdul Wahab ◽

Ifta Choiriyyah ◽

Siswanto Agus Wilopo

Keyword(s):

Cause Of Death ◽

Verbal Autopsy ◽

Mortality Surveillance

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Verbal autopsy of neonatal deaths in Khatauli Block of District Muzaffarnagar, Uttar Pradesh, India

Nepal Journal of Epidemiology ◽

10.3126/nje.v4i5.12019 ◽

2014 ◽

Vol 4 (5) ◽

pp. 423-427

Author(s):

K Muzammil ◽

JV Singh ◽

R Shankar

Keyword(s):

Verbal Autopsy ◽

Rural Areas ◽

Neonatal Jaundice ◽

Health Workers ◽

Uttar Pradesh ◽

Cross Sectional ◽

Neonatal Deaths ◽

Medical Certification ◽

Cause Of Deaths ◽

At Home

BackgroundVerbal autopsy is a method of inquiry to ascertain the likely cause of death in populations where vital registration of deaths is incomplete and unreliable. Over 75% of deaths in India occur at homes; more than half of these do not have a certified cause. Further, most of the deaths in the rural areas of India occur at home and that is why a medical certification by a qualified practitioner is not possible. Keeping these facts in mind, this study was designed having objectives as to find out the causes of neonatal deaths through verbal autopsy and its feasibility to be used by health workers.Material & Methods:This cross-sectional epidemiological study was conducted in randomly selected rural areas of Khatauli Block of District Muzaffarnagar, Uttar Pradesh, India. Verbal autopsy data was collected by a team of health workers adequately trained for the same well in advance. Data related to reported neonatal deaths in the study area in the specified period of time was collected on structured & pre-tested questionnaire used as study tool by interviewing the parents, relatives or neighbours of the deceased. Data thus collected was verified twice by the coordinator and principal investigator respectively and analyzed by using Epi info statistical package.Results:A total of 24 perinatal deaths were reported, out of which 7 (29.2%) were stillbirth and 17 (70.8%) were neonatal deaths. ANC was received by 14 mothers (58.3%). Half of the deliveries were conducted by untrained Dai. About 20 deliveries (83.3%) were at home and 10 (58.8%) of the deceased were early neonates. The cause of deaths found by means of verbal autopsies were mainly: pneumonia - 4 (23.5%), diarrhoea - 2 (11.8%) neonatal jaundice - 03 (17.6%) etc.Conclusion:Pneumonia, diarrhoea & neonatal jaundice alone constitute about 53% of the total neonatal deaths. The use of the verbal autopsy tool by health workers to find out the cause of neonatal deaths is very much feasible.DOI: http://dx.doi.org/10.3126/nje.v4i5.12019 Nepal Journal of Epidemiology 2014; 4(5):423-27

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Using Participatory Workshops to Assess Alignment or Tension in the Community for Minimally Invasive Tissue Sampling Prior to Start of Child Mortality Surveillance: Lessons From 5 Sites Across the CHAMPS Network

Clinical Infectious Diseases ◽

10.1093/cid/ciz563 ◽

2019 ◽

Vol 69 (Supplement_4) ◽

pp. S280-S290 ◽

Cited By ~ 4

Author(s):

John Blevins ◽

Elizabeth O’Mara Sage ◽

Ahoua Kone ◽

Maria Maixenchs ◽

Pratima L Raghunathan ◽

...

Keyword(s):

South Africa ◽

Child Health ◽

Minimally Invasive ◽

Childhood Mortality ◽

Small Samples ◽

Tissue Sampling ◽

High Tension ◽

Gates Foundation ◽

Mortality Surveillance ◽

Health And Mortality

Abstract The Child Health and Mortality Prevention Surveillance (CHAMPS) program is a 7-country network (as of December 2018) established by the Bill & Melinda Gates Foundation to identify the causes of death in children in communities with high rates of under-5 mortality. The program carries out both mortality and pregnancy surveillance, and mortality surveillance employs minimally invasive tissue sampling (MITS) to gather small samples of body fluids and tissue from the bodies of children who have died. While this method will lead to greater knowledge of the specific causes of childhood mortality, the procedure is in tension with cultural and religious norms in many of the countries where CHAMPS works—Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. Participatory Inquiry Into Community Knowledge of Child Health and Mortality Prevention (PICK-CHAMP) is a community entry activity designed to introduce CHAMPS to communities and gather initial perspectives on alignments and tensions between CHAMPS activities and community perceptions and priorities. Participants’ responses revealed medium levels of overall alignment in all sites (with the exception of South Africa, where alignment was high) and medium levels of tension (with the exception of Ethiopia, where tension was high). Alignment was high and tension was low for pregnancy surveillance across all sites, whereas Ethiopia reflected low alignment and high tension for MITS. Participants across all sites indicated that support for MITS was possible only if the procedure did not interfere with burial practices and rituals.

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