Svay Rieng Child Verbal Autopsy Study Preliminary Findings

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Svay Rieng Child Verbal Autopsy StudyPreliminary
Findings

• Child Health Review Workshop
• September 27-29, 2010

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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

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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 VHSGs and village chiefs in the 352
  villages

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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.

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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

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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)

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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

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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

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Age at death
Neonates
Post Neonates
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Age at death 0-59 months
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Age at death for Neonates (0-28days)
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Age at death for Post Neonates and Children(1-59
months
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Causes of Neonatal Deaths (0-28 days)
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Causes of Post Neonatal Child deaths
under- nutrition
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Conclusions

• Children are dying at a young age neonates and
  young infants lt6mo
• 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