Confidential enquiry into child deaths in two contrasting settings in Africa

• Main Author: Willcox, Merlin
• Other Authors: Mant, David ; Harnden, Anthony
• Published: University of Oxford 2016
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.730026

<b>Background</b>: There is evidence that in-facility death reviews can lead to reductions in hospital-based maternal and perinatal mortality, but there are no studies of child death reviews in sub-Saharan Africa. The aim was to adapt the UK confidential enquiry (CE) methodology to the context in sub-Saharan Africa, to evaluate its implementation and impact. <b>Methods</b>: The CE process was adapted in consultation with health workers and researchers in Mali and Uganda, and was piloted in five sites in each country from 2011 to 2014. Village Health Teams reported all deaths within their area to fieldworkers, who then attempted to interview the family and any health workers involved. Cases were summarised and discussed by a multidisciplinary panel, who determined the most likely cause of death, identified avoidable factors and made recommendations to avoid similar deaths. The process was evaluated both by measuring quantitative indicators (number of child deaths per year in the study areas) and by qualitative observation and interviews. <b>Results</b>: It was usually possible to interview the families of children who had died (over 75% in all sites) although interviewing health workers and finding medical records often proved difficult. Nevertheless, in almost all cases, review meetings were able to assign a cause of death, identify avoidable factors, and make recommendations, many of which were implemented. Between the first and second years of the CE, estimated child mortality declined by -27.0% (95% CI -40.2% to -11.4%), compared to -4.4% at the national level in Uganda, and by -18.2% (95% CI -30.2% to -4.3%) compared to -3.9% at the national level in Mali. <b>Conclusion</b>: It was feasible to implement a community-based CE into child deaths in Mali and Uganda. This was associated with a faster reduction in under-five mortality in most study sites than at the national level.