Engaging community health workers in maternal and infant death identification in Khayelitsha, South Africa: a pilot study

BMC Pregnancy and Childbirth

Ademola Ajuwon¹  Rene Phetlhu²  Jude Igumbor³  Edna N. Bosire⁴  Marjorie Mbule⁵  Jocelyn Muller⁵  Kathrin Schmitz⁵  Olatunji Adetokunboh⁵  Agnes Ronan⁵  Fiona Burtt⁵  Esca Scheepers⁵ 

[1] Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan;School of Nursing, University of the Western Cape;School of Public Health, Faculty of Health Sciences, University of the Witwatersrand;South African Medical Research Council Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand;mothers2mothers;

关键词: Verbal autopsy;    Social autopsy;    Death surveillance and response;    Death review;    Infant mortality;    Stillbirth;   

DOI  :  10.1186/s12884-020-03419-4

来源: DOAJ

【 摘 要 】

Abstract Background Engaging community health workers in a formalised death review process through verbal and social autopsy has been utilised in different settings to estimate the burden and causes of mortality, where civil registration and vital statistics systems are weak. This method has not been widely adopted. We piloted the use of trained community health workers (CHW) to investigate the extent of unreported maternal and infant deaths in Khayelitsha and explored requirements of such a programme and the role of CHWs in bridging gaps. Methods This was a mixed methods study, incorporating both qualitative and quantitative methods. Case identification and data collection were done by ten trained CHWs. Quantitative data were collected using a structured questionnaire. Qualitative data were collected using semi-structured interview guides for key informant interviews, focus group discussions and informal conversations. Qualitative data were analysed thematically using a content analysis approach. Results Although more than half of the infant deaths occurred in hospitals (n = 11/17), about a quarter that occurred at home (n = 4/17) were unreported. Main causes of deaths as perceived by family members of the deceased were related to uncertainty about the quality of care in the facilities, socio-cultural and economic contexts where people lived and individual factors. Most unreported deaths were further attributed to weak facility-community links and socio-cultural practices. Fragmented death reporting systems were perceived to influence the quality of the data and this impacted on the number of unreported deaths. Only two maternal deaths were identified in this pilot study. Conclusions CHWs can conduct verbal and social autopsy for maternal and infant deaths to complement formal vital registration systems. Capacity development, stakeholder’s engagement, supervision, and support are essential for a community-linked death review system. Policymakers and implementers should establish a functional relationship between community-linked reporting systems and the existing system as a starting point. There is a need for more studies to confirm or build on our pilot findings.

【 授权许可】

Unknown