Willcox ML, et al. - Experts evaluated if a community enquiry into the circumstances of death could improve intervention effectiveness by identifying local avoidable factors and explaining implementation failures. Findings suggested a likeness of local investigation and review of circumstances of death of children in sub-Saharan Africa to lead to more effective interventions than simple consideration of the biomedical causes of death. Local public health priorities and implementable solutions were discerned by this approach to address the avoidable factors identified.

Methods

• Authors ascertained the deaths of children younger than 5 years by community informants in 2 districts in Mali (762 deaths) and 3 districts in Uganda (442 deaths) in 2011-15.
• They investigated the deaths by interviewing parents and health workers.
• A panel of local health-care workers and community representatives who formulated recommendations to address avoidable factors and, subsequently, oversaw their implementation reviewed the investigation findings.

Results

• Data suggested that at least 1 avoidable factor was identified in 97% (95% CI 96-98, 737 of 756) of deaths in children younger than 5 years in Mali and 95% (93-97, 389 of 409) in Uganda.
• In 76% (146 of 194) of neonatal deaths in Mali, suboptimal newborn care was a factor and 64% (134 of 194) in Uganda.
• As per data, in postneonatal deaths the most frequent avoidable factor was inadequate child protection (mainly child neglect) in Uganda (29%, 63 of 215) and malnutrition in Mali (22%, 124 of 562). 84% (618 of 736 in Mali, 328 of 391 in Uganda) of families had consulted a health-care provider for the fatal illness, but the quality of care was often inadequate.
• Findings suggested that even in official primary care clinics, danger signs were often missed (43% of cases in Mali [135 of 396], 39% in Uganda [30 of 78]), essential treatment was not given (39% in Mali [154 of 396], 35% in Uganda [27 of 78]), and patients who were seriously ill were not referred to a hospital in time (51% in Mali [202 of 396], 45% in Uganda [35 of 78]).
• Results demonstrated that the focus of local recommendations was on quality of care in health-care facilities and on community issues influencing treatment-seeking behaviour.