BackgroundEffective implementation of child survival interventions depends on improved understanding of cultural, social, and health system factors affecting utilization of health care. Never the less, no standardized instrument exists for collecting and interpreting information on how to avert death and improve the implementation of child survival interventions.ObjectiveTo describe the methodology, development, and first results of a standard social autopsy tool for the collection of information to understand common barriers to health care, risky behaviors, and missed opportunities for health intervention in deceased children under 5 years old.MethodsUnder the INDEPTH Network, a social autopsy working group was formed to reach consensus around a standard social autopsy tool for neonatal and child death. The details around 434 child deaths in Iganga/Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda and 40 child deaths in Dodowa HDSS in Ghana were investigated over 12 to 18 months. Interviews with the caretakers of these children elicited information on what happened before death, including signs and symptoms, contact with health services, details on treatments, and details of doctors. These social autopsies were used to assess the contributions of delays in care seeking and case management to the childhood deaths.ResultsAt least one severe symptom had been recognized prior to death in 96% of the children in Iganga/Mayuge HDSS and in 70% in Dodowa HDSS, yet 32% and 80% of children were first treated at home, respectively. Twenty percent of children in Iganga/Mayuge HDSS and 13% of children in Dodowa HDSS were never taken for care outside the home. In both countries most went to private providers. In Iganga/Mayuge HDSS the main delays were caused by inadequate case management by the health provider, while in Dodowa HDSS the main delays were in the home.ConclusionWhile delay at home was a main obstacle to prompt and appropriate treatment in Dodowa HDSS, there were severe challenges to prompt and adequate case management in the health system in both study sites in Ghana and Uganda. Meanwhile, caretaker awareness of danger signs needs to improve in both countries to promote early care seeking and to reduce the number of children needing referral. Social autopsy methods can improve this understanding, which can assist health planners to prioritize scarce resources appropriately.
ObjectiveAccess to improved sanitation facilities is critical to the health and well-being of individuals and communities. However, globally, over 2.5 billion people live without access to safe sanitation facilities and more than 40% of the world population, do not use a toilet, but defecate in the open or in unsanitary places. In Ghana, only 14% of the population have access to improved sanitation facilities with great disparities between rural (8%) and urban (19%) dwellers. This paper sought to examine the determinants of access to improved sanitation facilities by households among rural dwellers in two districts in southern Ghana.ResultsThis study, which involved 16,353 household heads from the Dodowa Health and Demographic Surveillance System, found that sanitation facilities used by households were significantly influenced by age, gender, level of education, occupation, marital and socioeconomic status of household heads. It further revealed that a large proportion (85.94%) of the study participants did not have access to improved sanitation facilities. The study therefore recommends that the national sanitation laws must strictly be enforced to ensure each household in Ghana has decent and hygienic toilet facility.
CHWs' adherence to dosing guidelines was high. Adherence to referral guidelines was inadequate. More effort needs to be put into strengthening referral practices of CHWs within comparable community programmes.
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