Transcript 2009 Svay Rieng verbal autopsy preliminary findings

Svay Rieng Child Verbal
Autopsy Study
Preliminary Findings
Child Health Review Workshop
September 27-29, 2010
Why do this study?

Actual causes of death for children in Cambodia
are not known clearly
 No vital registration with cause of death
assigned
 WHO causes are based on modeling from
surrounding countries
 No recent data was available
Study Design & Population

Conducted in Svay Rieng Operational District

Child deaths were first identified through the
records of the Svay Rieng Operational District
office, the Health Centres in the Svay Rieng OD
and through VHSG’s and village chiefs in the
352 villages
Cause of Death (Physician Review)
Two pediatricians from the National
Pediatric Hospital in Phnom Penh
independently reviewed the data
 For each case the primary cause of death,
was assigned and recorded by each
physician.

Limitations of the Study


Recall bias due to interviews being conducted up
to 15 months after the death
Under reporting of neonatal deaths



Only 10% of deaths reported were neonatal
compared to an expected 34%
No Gold Standard to compare or validate data
for cause of death (e.g. hospital records,
autopsy)
Only one cause of death assigned but in many
cases there were overlapping symptoms that
could be attributed to more than one illness
Findings

The study reviewed a total of 367
childhood deaths from 0-59 months from
August 2008 – October 2009.
 37
were neonatal deaths 0-28 days
(approximately 10%)
 337 were post neonatal deaths 1-59 months
(approximately 90%)
Findings

Neonates (0-28 days)
All mothers had ANC care
 95% had TT, most with 3 or more doses
 54% of babies were born at health centre or hospital
 65% had skilled birth attendance
 24% were less than 2.5kg at birth
 62% of children died at home; 30% died in hospital
 Only one third of caregivers received treatment for
their sick baby

31% at health centre
 69% at Referral Hospital
 15% from drug sellers

Findings

Post neonates (1mo-59mo)
13% reported to be small at birth
 58% died at home, 40% died at hospital and 1% at
health centre
 11% did not seek care at all; 35% had at least one
contact and 54% had two or more contacts for
treatment

57% went to health centre
 56% went to Referral Hospital
 28% went to private clinic (4% to Vietnam)
 20% to traditional healer

Age at death
Neonates
Post Neonates
Age of Deceased
Deceased by agegroup
200
25
20
15
Number
10
5
0
< 7 Days
150
7-13 Days
100
14-20 Days
Male
50
Over 20 Days
0
Agegroup
%
Female
100
90
80
70
60
50
40
30
20
10
0
1-11 Mon
Boys
Girls
Neonatal deaths
12-59 Mons
Age at death 0-59 months
Figure 1: Distribution of childhood deaths (0-59 months) n=367
Number of deaths
120
111
100
87
80
60
40
43
37
21 21
20
8
0
0
2
4
6
8
3
8
2
3
1
10
6
12
5
1
2
14
Age (months)
0
16
0
2
18
1
0
20
0
0
22
0
5
2459
0
Age at death for Neonates (0-28days)
Figure 2: Distribution of neonatal deaths (0-28 days) n=37
Number of deaths
14
12
10
8
6
4
2
0
1
3
5
7
9
11
13
15
Age (days)
17
19
21
23
25
27
Age at death for Post Neonates and
Children(1-59 months
Figure: Distribution of post neonatal deaths (1-59 months) n=330
Number of deaths
120
100
111
87
80
60
43
40
21
20
21
17
8
8
3
2
0
1
2
3
4
5
6
7
8
Age (months)
9
3
1
10
11
5
12- 2423 59
Causes of Neonatal Deaths
(0-28 days)
Diarrheal diseases
3%
Congenital
malformation
Tentanus neonatorum
3%
0%
Meningitis
3%
Low birth
w eight/premature
14%
Birth trauma
0%
Bacterial sepsis of
new born
40%
Pneumonia
14%
Birth asphyxia
23%
Causes of Post Neonatal & Child deaths
Figure: Primary causes of post neonatal deaths as determined by physician
review
Malnutrition
1%
Dengue
2%
Other conditions
3%
Measles
0%
Injury
1%
Uncertain/Unknow n
7%
Beriberi
4%
Sepsis
6%
Meningitis
7%
Diarrheal diseases
12%
undernutrition
Pneumonia
57%
Conclusions

Children are dying at a young age – neonates
and young infants <6mo

Most neonates are dying from infection (sepsis
or pneumonia) followed by birth asphyxia and
prematurity/low birth weight

Pneumonia is the leading cause of death for
post-neonates followed by diarrhoea, meningitis,
sepsis and beriberi