TY - JOUR
T1 - Engaging communities in collecting and using results from verbal autopsies for child deaths
T2 - An example from urban slums in Freetown, Sierra Leone
AU - Hutain, Jennifer
AU - Perry, Henry B.
AU - Koffi, Alain K.
AU - Christensen, Megan
AU - O'Connor, Emily Cummings
AU - Jabbi, Sonnia Magba Bu Buakei
AU - Samba, Thomas T.
AU - Kaiser, Reinhard
N1 - Funding Information:
David Pyle contributed to the design of this Child Survival Project and Operations Research Project, and Jennifer Weiss supported the initial stage of implementation of both. The authors acknowledge the support and cooperation of the community members, the community leaders, the CHWs and Peer Supervisors, and the HMCs and WDCs who were part of this study and the child survival project. They generously and tirelessly gave their time and unrelenting efforts, despite enormous adversity, to improve health within their communities. We also acknowledge the efforts of Laura Hastings and Khadijatu Bakarr, Program Managers of the Child Survival Project, as well as the full Child Survival Project team. Erin Nichols provided helpful comments on an earlier draft of this manuscript. Finally, we thank the Freetown City Council, the Ministry of Health and Sanitation, and the District Health Management Team for its full support. This study was generously supported by the American and Irish people through the United States Agency for International Development (USAID), Irish Aid and Concern Worldwide. The content of this report are the responsibility of Concern Worldwide and Johns Hopkins University and do not necessarily reflect the views of USAID, Irish Aid or the United States Government and Irish Government.
Funding Information:
Funding: This study was generously supported by the American and Irish people through the United States Agen-
Publisher Copyright:
© 2019 The Author(s).
PY - 2019
Y1 - 2019
N2 - Background Verbal autopsies (VAs) can provide important epidemiological information about the causes of child deaths. Though studies have been conducted to assess the validity of various types of VAs, the programmatic experience of engaging local communities in collecting and using VA has received little attention in the published literature. Concern Worldwide, an international non-governmental organization (NGO), in collaboration with the Ministry of Health and Sanitation (MOHS), has implemented a VA protocol in five urban slums of Freetown, Sierra Leone. This paper provides VA results and describes lessons learned from the VA process. Methods Under-five child deaths were registered by Community Health Workers (CHWs) in five urban slums between 2014 and 2017, and a specially trained local clinician used a VA protocol to interview caretakers. Symptoms were analysed using InterVA-4 computerized algorithm, a probabilistic expert-driven model to determine the most likely cause of death. Themes in care-seeking were extracted from multiple-choice and open-ended questions. VAs were implemented in collaboration with the community and the results were shared with community stakeholders in participatory review meetings. Results Main challenges included limitations in death notification and capacity to conduct VA for all notified deaths. A total of 215 VA were available for analysis. Among 79 neonatal deaths aged 0-27 days, the most common cause of death was neonatal pneumonia (55%); among 136 children deaths aged 1-4 years, the most common causes were malaria (56%) and pneumonia (41%). Key themes in care-seeking identified included use of traditional medicine (14% of deaths), absence of care-seeking (23% of deaths), and difficultly reaching the health facility (8% of deaths that occurred at home) during fatal illness. Conclusions Conducting VAs as a collaborative process with communities is challenging but can provide valuable data that can be used for local-level decision-making. The findings have practical implications for engaging the community and CHWs in reducing the number of these preventable deaths through expanded efforts at prevention, early and appropriate treatment, and reduction of barriers to care-seeking. A functional end-to-end VA system can enhance meaningful routine vital events monitoring by community, national, and international stakeholders.
AB - Background Verbal autopsies (VAs) can provide important epidemiological information about the causes of child deaths. Though studies have been conducted to assess the validity of various types of VAs, the programmatic experience of engaging local communities in collecting and using VA has received little attention in the published literature. Concern Worldwide, an international non-governmental organization (NGO), in collaboration with the Ministry of Health and Sanitation (MOHS), has implemented a VA protocol in five urban slums of Freetown, Sierra Leone. This paper provides VA results and describes lessons learned from the VA process. Methods Under-five child deaths were registered by Community Health Workers (CHWs) in five urban slums between 2014 and 2017, and a specially trained local clinician used a VA protocol to interview caretakers. Symptoms were analysed using InterVA-4 computerized algorithm, a probabilistic expert-driven model to determine the most likely cause of death. Themes in care-seeking were extracted from multiple-choice and open-ended questions. VAs were implemented in collaboration with the community and the results were shared with community stakeholders in participatory review meetings. Results Main challenges included limitations in death notification and capacity to conduct VA for all notified deaths. A total of 215 VA were available for analysis. Among 79 neonatal deaths aged 0-27 days, the most common cause of death was neonatal pneumonia (55%); among 136 children deaths aged 1-4 years, the most common causes were malaria (56%) and pneumonia (41%). Key themes in care-seeking identified included use of traditional medicine (14% of deaths), absence of care-seeking (23% of deaths), and difficultly reaching the health facility (8% of deaths that occurred at home) during fatal illness. Conclusions Conducting VAs as a collaborative process with communities is challenging but can provide valuable data that can be used for local-level decision-making. The findings have practical implications for engaging the community and CHWs in reducing the number of these preventable deaths through expanded efforts at prevention, early and appropriate treatment, and reduction of barriers to care-seeking. A functional end-to-end VA system can enhance meaningful routine vital events monitoring by community, national, and international stakeholders.
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U2 - 10.7189/jogh.09.010419
DO - 10.7189/jogh.09.010419
M3 - Article
C2 - 30842882
AN - SCOPUS:85062743256
SN - 2047-2978
VL - 9
JO - Journal of global health
JF - Journal of global health
IS - 1
M1 - 010419
ER -