Introduction. We report cause of death and care-seeking prior to death in neonates based on interviews with relatives using a Verbal Autopsy questionnaire. Materials and Methods. We identified neonatal deaths between 2004 and 2007 through a large household survey in 2007 in five rural districts of southern Tanzania. Results. Of the 300 reported deaths that were sampled, the Verbal Autopsy (VA) interview suggested that 11 were 28 days or older at death and 65 were stillbirths. Data was missing for 5 of the reported deaths. Of the remaining 219 confirmed neonatal deaths, the most common causes were prematurity (33%), birth asphyxia (22%) and infections (10%). Amongst the deaths, 41% (90/219) were on the first day and a further 20% (43/219) on day 2 and 3. The quantitative results matched the qualitative findings. The majority of births were at home and attended by unskilled assistants. Conclusion. Caregivers of neonates born in health facility were more likely to seek care for problems than caregivers of neonates born at home. Efforts to increase awareness of the importance of early care-seeking for a premature or sick neonate are likely to be important for improving neonatal health. 1. Background The Millennium Development Goal 4 aims at reducing child mortality by two-thirds by the year 2015. There are an estimated 3.6 million neonatal deaths around the world each year [1, 2]. Although simple, low-cost tools and strategies could prevent many of these deaths, the neonatal period now accounts for 41% of under-five deaths [1, 3]. Besides looking at overall child mortality and infant mortality in the first year of life, neonatal deaths are of great importance and causes of neonatal deaths and care-seeking for the neonates have been neglected in the past. The distribution of causes of neonatal deaths varies substantially between and within countries [1, 3]. About two-thirds of neonatal deaths occur in the African and southeast-asian regions. Although south-asian countries have the largest absolute number of deaths, Sub-Saharan Africa generally has higher rates of neonatal mortality. Less than 3% of neonatal deaths take place in countries with reliable vital registration data for cause of death analysis [3]. Although most studies estimate only the cause of death among neonates, for health programming, it is equally important to understand the care-seeking processes and treatment actions that occurred before each death [4, 5]. A functioning continuum of care between home and hospital is required to minimize potential delays and effectively link women and
References
[1]
R. E. Black, S. Cousens, H. L. Johnson et al., “Global, regional, and national causes of child mortality in 2008: a systematic analysis,” The Lancet, vol. 375, no. 9730, pp. 1969–1987, 2010.
[2]
UNICEF, The State of the World's Children 2009, UNICEF, New York, NY, USA, 2008.
[3]
J. E. Lawn, S. Cousens, and J. Zupan, “4 Million neonatal deaths: When? Where? Why?” The Lancet, vol. 365, no. 9462, pp. 891–900, 2005.
[4]
R. Bojalil, B. R. Kirkwood, M. Bobak, and H. Guiscafre, “The relative contribution of case management and inadequate care-seeking behaviour to childhood deaths from diarrhoea and acute respiratory infections in Hidalgo, Mexico,” Tropical Medicine and International Health, vol. 12, no. 12, pp. 1545–1552, 2007.
[5]
P. Waiswa, K. Kallander, S. Peterson, G. Tomson, and G. W. Pariyo, “Using the three delays model to understand why newborn babies die in eastern Uganda,” Tropical Medicine and International Health, vol. 15, no. 8, pp. 964–972, 2010.
[6]
K. J. Kerber, J. E. de Graft-Johnson, Z. A. Bhutta, P. Okong, A. Starrs, and J. E. Lawn, “Continuum of care for maternal, newborn, and child health: from slogan to service delivery,” The Lancet, vol. 370, no. 9595, pp. 1358–1369, 2007.
[7]
J. R. M. A. Schellenberg, R. Nathan, S. Abdulla et al., “Risk factors for child mortality in rural Tanzania,” Tropical Medicine and International Health, vol. 7, no. 6, pp. 506–511, 2002.
[8]
D. R. Marsha, S. Sadruddin, F. F. Fikree, C. Krishnan, and G. L. Darmstadt, “Validation of verbal autopsy to determine the cause of 137 neonatal deaths in Karachi, Pakistan,” Paediatric and Perinatal Epidemiology, vol. 17, no. 2, pp. 132–142, 2003.
[9]
W. H. Mosley, Population Laboratories for Community Health Research, Department of Population Dynamics, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Md, USA, 1989.
[10]
L. C. Chen and D. E. Bell, “Responding to health transitions: from research to action,” in Health Social Change in International Perspective, L. C. Chen, A. Kleinman, and N. C. Ware, Eds., Harvad Series on Population and International Health, pp. 491–501, Harvard University Press, Boston, Mass, USA, 1994.
[11]
K. Kahn, S. M. Tollman, M. Garenne, and J. S. S. Gear, “Who dies from what? Determining cause of death in South Africa's rural north-east,” Tropical Medicine and International Health, vol. 4, no. 6, pp. 433–441, 1999.
[12]
NBS [Tanzania] and ORC Macro, Tanzania Demographic and Health Survey 2004—2005—Key Findings, NBS-Tanzania and ORC Macro, Calverton, Md, USA, 2005.
[13]
NBS [Tanzania] and ORC Macro, Tanzania Demographic and Health Survey 2010, NBS-Tanzania and ORC Macro, Calverton, Md, USA, 2011.
[14]
J. R. M. A. Schellenberg, M. Mrisho, F. Manzi et al., “Health and survival of young children in southern Tanzania,” BMC Public Health, vol. 8, p. 194, 2008.
[15]
M. A. Quigley, J. R. M. A. Schellenberg, and R. W. Snow, “Algorithms for verbal autopsies: a validation study in Kenyan children,” Bulletin of the World Health Organization, vol. 74, no. 2, pp. 147–154, 1996.
[16]
R. W. Snow, J. R. M. Armstrong, D. Forster et al., “Childhood deaths in Africa: uses and limitations of verbal autopsies,” The Lancet, vol. 340, no. 8815, pp. 351–355, 1992.
[17]
C. E. Taylor, “Surveillance for equity in primary health care: policy implications from international experience,” International Journal of Epidemiology, vol. 21, no. 6, pp. 1043–1049, 1992.
[18]
B. Greenwood, “Maternal immunisation in developing countries,” Vaccine, vol. 21, no. 24, pp. 3436–3441, 2003.
[19]
F. Baiden, A. Hodgson, and F. N. Binka, “Demographic surveillance sites and emerging challenges in international health,” Bulletin of the World Health Organization, vol. 84, no. 3, pp. 161–256, 2006.
[20]
M. Adjuik, T. Smith, S. Clark et al., “Cause-specific mortality rates in sub-Saharan Africa and Bangladesh,” Bulletin of the World Health Organization, vol. 84, no. 3, pp. 181–188, 2006.
[21]
M. Mrisho, B. Obrist, J. A. Schellenberg et al., “The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania,” BMC Pregnancy and Childbirth, vol. 9, p. 10, 2009.
[22]
NBS, Population and Housing Census: Regional Profiles, vol. 6, Dar es Salaam, Tanzania, 2004, http://www.tanzania.go.tz/.
[23]
M. Mrisho, J. A. Schellenberg, A. K. Mushi et al., “Factors affecting home delivery in rural Tanzania,” Tropical Medicine and International Health, vol. 12, no. 7, pp. 862–872, 2007.
[24]
S. Penfold, Z. Hill, M. Mrisho et al., “A large cross-sectional community-based study of newborn care practices in Southern Tanzania,” PLoS ONE, vol. 5, no. 12, Article ID e15593, 2010.
[25]
International Classification of Diseases, Manual of the International Statistical Classification of Diseases, Injuries and Causes of Death. Based on the Recommendations of the Tenth Revision Conference, World Health Organization, Geneva, Switzerland, 1992.
[26]
The IPTi Consortium, http://www.ipti-malaria.org/.
[27]
G. L. Darmstadt, A. C. Lee, S. Cousens, et al., “60 Million non-facility births: who can deliver in community settings to reduce intrapartum-related deaths?” International Journal of Gynaecology and Obstetrics, vol. 107, supplement 1, pp. S89–S112, 2009.
[28]
R. L. Goldenberg and E. M. McClure, “Reducing intrapartum stillbirths and intrapartum-related neonatal deaths,” International Journal of Gynaecology and Obstetrics, vol. 107, supplement 1, pp. S1–S3, 2009.
[29]
A. C. Lee, J. E. Lawn, S. Cousens et al., “Linking families and facilities for care at birth: what works to avert intrapartum-related deaths?” International Journal of Gynaecology and Obstetrics, vol. 107, supplement 1, pp. S65–S85, 2009.
[30]
M. Mrisho, J. A. Schellenberg, A. K. Mushi et al., “Understanding home-based neonatal care practice in rural southern Tanzania,” Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 102, no. 7, pp. 669–678, 2008.
[31]
A. H. Baqui, G. L. Darmstadt, E. K. Williams et al., “Rates, timing and causes of neonatal deaths in rural India: implications for neonatal health programmes,” Bulletin of the World Health Organization, vol. 84, no. 9, pp. 706–713, 2006.
[32]
M. Anker, R. E. Black, C. Coldham, H. D. Kalter, M. A. Quigley, and D. Ross, A Standard Verbal Autopsy Method for Investigating Causes of Death in Infants and Children, WHO/CDS/CSR/ISR/99.4, World Health Organization, Geneva, Switzerland, 1999.
[33]
H. D. Kalter, R. H. Gray, R. E. Black, and S. A. Gultiano, “Validation of postmortem interviews to ascertain selected causes of death in children,” International Journal of Epidemiology, vol. 19, no. 2, pp. 380–386, 1990.
[34]
C. Coldham, D. Ross, M. Quigley, Z. Segura, and D. Chandramohan, “Prospective validation of a standardized questionnaire for estimating childhood mortality and morbidity due to pneumonia and diarrhoea,” Tropical Medicine and International Health, vol. 5, no. 2, pp. 134–144, 2000.
[35]
H. D. Kalter, M. Hossain, G. Burnham et al., “Validation of caregiver interviews to diagnose common causes of severe neonatal illness,” Paediatric and Perinatal Epidemiology, vol. 13, no. 1, pp. 99–113, 1999.
[36]
A. H. Baqui, R. E. Black, S. E. Arifeen, K. Hill, S. N. Mitra, and A. Al Sabir, “Causes of childhood deaths in Bangladesh: results of a nationwide verbal autopsy study,” Bulletin of the World Health Organization, vol. 76, no. 2, pp. 161–171, 1998.
[37]
J. V. Freeman, P. Christian, S. K. Khatry et al., “Evaluation of neonatal verbal autopsy using physician review versus algorithm-based cause-of-death assignment in rural Nepal,” Paediatric and Perinatal Epidemiology, vol. 19, no. 4, pp. 323–331, 2005.
[38]
J. E. Todd, A. de Francisco, T. J. D. O'Dempsey, and B. M. Greenwood, “The limitations of verbal autopsy in a malaria-endemic region,” Annals of Tropical Paediatrics, vol. 14, no. 1, pp. 31–36, 1994.
[39]
M. A. Quigley, D. Chandramohan, and L. C. Rodrigues, “Diagnostic accuracy of physician review, expert algorithms and data-derived algorithms in adult verbal autopsies,” International Journal of Epidemiology, vol. 28, no. 6, pp. 1081–1087, 1999.
[40]
K. M. Edmond, M. A. Quigley, C. Zandoh et al., “Diagnostic accuracy of verbal autopsies in ascertaining the causes of stillbirths and neonatal deaths in rural Ghana,” Paediatric and Perinatal Epidemiology, vol. 22, no. 5, pp. 417–429, 2008.
[41]
M. A. Koenig, K. Jamil, P. K. Streatfield et al., “Maternal health and care-seeking behavior in Bangladesh: findings from a national survey,” International Family Planning Perspectives, vol. 33, no. 2, pp. 75–82, 2007.
[42]
U. Syed, N. Khadka, A. Khan, and S. Wall, “Care-seeking practices in South Asia: using formative research to design program interventions to save newborn lives,” Journal of Perinatology, vol. 28, no. 2, pp. S9–S13, 2008.
[43]
B. Sutrisna, A. Reingold, S. Kresno, G. Harrison, and B. Utomo, “Care-seeking for fatal illnesses in young children in Indramayu, West Java, Indonesia,” The Lancet, vol. 342, no. 8874, pp. 787–789, 1993.
[44]
M. Nitcher, “Acute respiratory illness: popular health culture and mother's knowledge in the Phillipines,” Medical Anthropology, vol. 15, no. 4, pp. 353–375, 1994.
[45]
R. Pérez-Cuevas, H. Guiscafré, G. Romero, L. Rodríguez, and G. Gutiérrez, “Mothers' health-seeking behaviour in acute diarrhoea in Tlaxcala, Mexico,” Journal of Diarrhoeal Diseases Research, vol. 14, no. 4, pp. 260–268, 1996.
[46]
S. Awasthi, T. Verma, and M. Agarwal, “Danger signs of neonatal illnesses: perceptions of caregivers and health workers in northern India,” Bulletin of the World Health Organization, vol. 84, no. 10, pp. 819–826, 2006.
[47]
B. R. Kirkwood, “Developing community-based intervention strategies to save newborn lives: lessons learned from formative research in five countries,” Journal of Perinatology, vol. 28, supplement 2, pp. S2–S8, 2008.
