Academic journal article Bulletin of the World Health Organization

Birth Attendants as Perinatal Verbal Autopsy Respondents in Low- and Middle-Income Countries: A Viable alternative?/Les Sages-Femmes Pour Repondre Aux Questions De L'autopsie Verbale Perinatale Dans Les Pays a Revenu Faible et Moyen: Une Alternative viable?/Las Matronas Como Encuestadas En Autopsias Verbales Peri Alternativa viable?/Las Matronas Como Encuestadas En Autopsias Verbales Perinatales En Paises De Ingresos

Academic journal article Bulletin of the World Health Organization

Birth Attendants as Perinatal Verbal Autopsy Respondents in Low- and Middle-Income Countries: A Viable alternative?/Les Sages-Femmes Pour Repondre Aux Questions De L'autopsie Verbale Perinatale Dans Les Pays a Revenu Faible et Moyen: Une Alternative viable?/Las Matronas Como Encuestadas En Autopsias Verbales Peri Alternativa viable?/Las Matronas Como Encuestadas En Autopsias Verbales Perinatales En Paises De Ingresos

Article excerpt

Introduction

Of the approximately 8.8 million deaths that occur annually in children under 5 years of age, 41% occur in neonates. (1) A child is 45 times more likely to die within the first 28 days of life than in the entire period from 28 days to 5 years of age. (2) Three quarters of all neonatal deaths, or approximately 2.7 million deaths annually,, occur during the first seven days of life and are termed early neonatal deaths. (3) In addition, an estimated 2.7 million stillbirths occur annually. (4-6) Early neonatal deaths and stillbirths, which together comprise what are termed perinatal deaths, account for the highest proportion of deaths among children less than 15 years of age. In this age group, they account for twice as many deaths as malaria and human immunodeficiency virus (HIV) infection combined. (7) Over 98% of perinatal deaths occur in low- and middle-income countries and more than two thirds occur in community settings, frequently at homey These deaths that take place outside the formal health-care system are rarely included in the vital registers. (10,11) In fact, vital registration data are unavailable for over 97% of perinatal deaths, yet such data are necessary for designing measures to reduce perinatal mortality.

A coherent health policy based on accurate information needs to be developed to address the most common causes of perinatal death. (7,12)

Verbal autopsy is one of various techniques that have been developed to compensate for the lack of data on the causes of deaths that occur in community settings. (13) It is an indirect method of ascertaining the cause of death where civil registration and health systems are weak. (14) During a verbal autopsy conducted to investigate the causes of a perinatal death, a systematic description of the signs, symptoms and circumstances preceding the death is obtained through an interview with the primary caregiver, traditionally the mother, of a lost fetus or child who has died. (15) In most cases a physician panel uses the data thus obtained to ascertain the cause of death. Less commonly, the cause of death is established by using algorithms, neural networks or probabilistic approaches to interpret these data. (16-18) Verbal autopsy has been validated against more conventional methods for establishing the cause of death and it is used in large surveillance programmes and vital registration systems. (19)

Traditionally, the perinatal verbal autopsy respondent is the mother whose neonate or fetus has died. However, birth attendants could make better verbal autopsy respondents than mothers for several reasons: (i) they may be more aware than mothers of the circumstances surrounding the birth; (ii) they are often the first to attempt resuscitation and often have greater insight than the mother into the events that led to the death. Often the circumstances surrounding such deaths become embedded in the memory of birth attendants who live in the same community as the mother. For these reasons, our group undertook a prospective study to investigate whether birth attendants could be a suitable alternative to mothers as respondents during perinatal verbal autopsies. Our a priori hypothesis was that mothers' and birth attendants' responses to selected close-ended items on the verbal autopsy questionnaire would show more than 80% concordance.

Methods

Study design, setting and subjects

This prospective observational study based on verbal autopsy was an ancillary study to the FIRST BREATH Trial, conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Global Network for Women's and Children's Health Research. 20 The FIRST BREATH Trial was a cluster-randomized, controlled trial that investigated the effects of implementing a package of neonatal care practices and neonatal resuscitation in community settings.

Our verbal autopsy study included 38 communities in the Democratic Republic of the Congo (Equateur province), Guatemala (Chimaltenango province), Pakistan (Thatta district) and Zambia (Kafue district). …

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