Causes of infant deaths and patterns of associated factors in Eastern Ethiopia: Results of verbal autopsy (InterVA-4) study

Abstract

Background In a range of setting, detecting and generate empirical information on the cause of infant death and contributing risk factors at population level is basically utmost essential to take evidence-based measures in reducing infant morbidity and mortality. An electronic verbal autopsy is suitable tool and best alternative solution to determine individuals’ cause of death in a setting where the majority of deaths occur at home and civil registration systems do not exist. The present study was undertaken to find out cause of infant death, applying computer-based probabilistic model (InterVA-4) and analyze the patterns of association factors of mother’s and the deceased infant’s characteristics to the leading cause-specific infant mortality in Eastern Ethiopia. Methods The study employed a community-based prospective longitudinal survey, which was conducted with routinely enumeration of reported infant deaths for a period of two years (from September 2016 to August 2018) in Eastern part of Ethiopia. Using the two-stage cluster sampling technique, the study was undertaken in four randomly selected districts of West Hararghe zone and two districts of zone 3 in Oromia and Afar regional state, respectively. The study included a total of 362 infants who were deceased during the study period. Data was collected by trained enumerators by interviewing the mothers or guardians of the deceased infant using a 2014 standardize World Health Organization (WHO) Verbal Autopsy questionnaire. InterVA-4 model were used for processing and interpreting verbal autopsy data in order to arrive at the most likely causes of infant death. SPSS version 23 was also used for statistical analysis of frequency distribution and logistic regression for the association between covariates and outcomes. Findings Of the overall (362) deceased infants’ during the study period, 53.0% of deaths occurred during neonatal time while 47.0% died in the post-neonatal period. Acute respiratory infection including neonatal and post-neonatal pneumonia (38.4%), birth asphyxia (16.4%), diarrheal diseases (16.3%), prematurity (7.4%) and malaria (4.3%) were found to be the leading causes of infant mortality in the study area. The independent factors strongly associated with probable ARI, including pneumonia related mortality as compared to all-causes of death were infants with maternal age lower than 20 years old (p = 0.001, AOR: 4.82, 95% CI: 1.88, 12.3) and infant being died outside of heath facilities (P = 0.007, AOR: 2.85, 95% CI: 1.33, 6.12). The post-neonatal period (P = 0.000, AOR: 15.5, 95% CI: 6.35, 37.8) and infant died in the wet season (P = 0.006, AOR: 2.38, 95% CI: 1.28, 4.44) had strong relationship with dying from diarrhea-related death than those infants died from all non-diarrhea. The death due to malaria robustly associated with infants whose mothers age between 20–35 years old (P = 0.024, AOR: 4.44, 95% CI: 1.22, 16.2) and infant who was dwelled in the districts of Afar region (P = 0.013, AOR: 4.08, 95% CI: 1.35, 12.4). Conclusion The highest cause of infant mortality was associated with disease of respiratory system, particularly acute respiratory infection, including both neonates and post-neonatal pneumonia. Most of the infant deaths existed are as a result of diseases and conditions that are readily preventable or treatable cause, similar to those reported in worldwide, which have needs of further attention. The patterns of significant associated factors across cause-specific mortality against all-cause of death were dissimilar. Therefore, strengthen maternal and child health program with effective preventive interventions emphasizing on the most common cause of infant deaths and those factors contributing in raising mortality risk are required.

Verbal autopsy analysis of childhood deaths in rural Gambia

“…Severe malnutrition and ARIP were the commonest underlying and primary causes of death respectively. This is similar to verbal autopsy studies in Ethiopia and Bangladesh where acute lower respiratory infection was the commonest cause of death [ 30 , 33 ]. In the latter study, childhood wasting was additionally identified as the leading risk factor for lower respiratory infections.…”

“…However, in this study, only a few caretakers reported seeking care from traditional healers or pharmacies. Other studies in Ghana, Rwanda and Ethiopia found a similarly high number of home deaths [29][30][31]. With substantial proportions of deaths occurring at home, mortality data generated through the use of VA should be considered as an adjunct to data from health facilities in characterizing under-5 deaths.…”

Causes of sudden neonatal mortality disclosed by autopsy and histopathological examination

“…The most frequently reported causes of neonatal deaths are infections, perinatal asphyxia, metabolic diseases, and congenital malformations. [9][10][11][12] In this study, natural deaths were responsible for 74.5% (n = 91) of total deaths. As a natural cause, the most common one in the group was pneumonia (n = 66), representing 54% of all the neonatal deaths.…”

“…The most frequently reported causes of neonatal deaths are infections, perinatal asphyxia, metabolic diseases, and congenital malformations. [9–12]…”

Mothers’ experience of losing infants by death and its predictors in Ethiopia

“…Approximately, 12.2% of newborns die daily, and 37 neonates die per 1,000 live births [ 15 , 16 ]. High infant mortality occurred in the Afar and Oromia regional states of Ethiopia [ 17 ]. Studies done in Eastern Ethiopia show that 53.0% and 47.0% of infants’ deaths occur in the neonatal and post-neonatal periods respectively [ 17 ].…”