Confidential enquiry into child deaths is associated with a reduction in child mortality in Africa
Child mortality remains unacceptably high in sub-Saharan Africa. The majority of children die outside of any health facility, from causes which are easily preventable or treatable. There are no published attempts to implement a community-based confidential enquiry into child deaths in Africa. The aim of this study was to evaluate whether this approach could be adapted to the African context, and whether it would lead to a reduction in child mortality.
The UK confidential enquiry process was adapted to the context in sub-Saharan Africa, and piloted in 8 sub-districts in Uganda and Mali. Deaths were ascertained by reports from community health workers, and were investigated by fieldworkers interviewing families and any health workers involved. Each case was reviewed by a local panel, which identified the most likely causes, discussed the avoidable factors, and made recommendations for avoiding future similar deaths. The decline in child mortality in the study areas was compared with that in the country according to official statistics.
It was feasible to interview the families of over 95% of the deceased children. Of those who had consulted a health worker, 50-80% of the health workers could be interviewed. Almost all of the child deaths had at least one avoidable factor. The commonest avoidable factors were delay in treatment-seeking, and poor quality of primary health care. The panels made a number of recommendations, several of which were implemented, including continuing professional development for primary health care workers and involvement of leaders in problem solving, targeted at the most important quality of care issues identified by the confidential enquiry. Child mortality declined in 6 of the 8 study sites, by 11-44% per year, which is significantly greater than the decline at national level (around 4% per year).
The confidential enquiry was successfully adapted to the African context and seems to have been associated with an accelerated decline in child mortality in most of the study sites. A cluster-randomised trial is needed to confirm its effectiveness.
- Merlin Willcox, Mbarara University of Science and Technology, Mbarara, Uganda
- Elias Kumbakumba, Université des Sciences, Techniques et Technologies de Bamako, Bamako, Mali
- Vincent Mubangizi, Université des Sciences, Techniques et Technologies de Bamako, Bamako, Mali
- Drissa Diallo, Institut National de Recherche en Santé Publique, Bamako, Mali
- Chiaka Diakité, International Health Sciences University, Kampala, Uganda
- Pierre Daou, International Health Sciences University, Kampala, Uganda
- Eugene Dembélé, International Health Sciences University, Kampala, Uganda
- Peter Kirabira, Bwindi Community Hospital, Buhoma, Uganda
- Florence Nakaggwa, Bwindi Community Hospital, Buhoma, Uganda
- Nick Wooding, Bwindi Community Hospital, Buhoma, Uganda
- Jeremiah Nahamya
- Mutahunga Birungi
- Leonard Tutaryebwa
- Kieran Dinwoodie
- Sarah Capewell
- Anthony Harnden, Mbarara University of Science and Technology, Mbarara, Uganda
- David Mant, Mbarara University of Science and Technology, Mbarara, Uganda