The relative contribution of case management and inadequate care‐seeking behaviour to childhood deaths from diarrhoea and acute respiratory infections in Hidalgo, Mexico

Abstract

Summaryobjective To investigate the contribution of poor case management and care-seeking behaviour to childhood deaths from acute respiratory infections (ARI) and diarrhoeal diseases in rural Mexico.methods Eighty-nine deaths from ARI and diarrhoea in under-fives from Hidalgo over a 7-month period were identified from registered death certificates. We interviewed the carers of 75 of these children, eliciting what happened before death, including signs and symptoms, contact with health services, details on treatments and details of doctors. These death narratives were used to assess the contributions of care seeking and case management to the childhood deaths. We conducted an independent investigation of the clinical competence of doctors mentioned in the death narratives using standard case scenarios and compared this with results obtained from neighbourhood control doctors.results Late care seeking and ⁄ or poor case management contributed to 68% of deaths. The estimated contribution of care seeking alone was 32%, of case management alone 17% and of both care seeking and case management 18% of deaths. Doctors implicated as having contributed to a child's death had significantly lower clinical competence scores than those who were not. Private doctors accounted for 1.4 times more consultations prior to death than public doctors, but were implicated in 1.8 times the number of deaths.conclusion Efforts to reduce child mortality need to improve both care seeking for childhood illnesses and quality of case management. It is essential that doctors in the private sector be included, as in Mexico and many other countries they provide a large proportion of care, often with adverse outcomes.

Social autopsy: INDEPTH Network experiences of utility, process, practices, and challenges in investigating causes and contributors to mortality

“…Our results are consistent with earlier studies of the possible contribution of inadequate care seeking and poor case management to childhood deaths [10,11,19]. An ethnographic study in Ghana found that mothers may not be able to recognize serious illness in their babies, and they often do not seek care outside the home even when they do realize that their child is seriously ill [29].…”

“…With more programming, these tools could potentially adopt the structure of the Tanzania Essential Health Interventions Project (TEHIP) District Health Intervention Profile, which not only displays the local disease burden but also links the data to displays of health systems actions that can be implemented to address the most common problems and barriers [39]. Another option used in other studies [10,11] is to have an expert panel review each death using standard checklists and frameworks, which is a model commonly used for the interpretation of VA data.…”

Care-seeking in the development of severe community acquired pneumonia in Ugandan children

“…Cough was the most commonly reported first symptom of illness (103, 74%) and one caretaker reported that difficult breathing was the first symptom to be recognised. The first symptom had been noted a median of 7 days before arrival at hospital (interquartile range [4][5][6][7][8][9][10][11][12][13][14]. Fever had reportedly been noted by 88% of caretakers a median of 3 days previously.…”

“…12 Despite the risk of misdiagnosis and delay, there is limited knowledge of the time taken to develop severe pneumonia and of how quickly caretakers and health-care workers respond to the key symptoms. 13,14 In this study therefore, we report the time it takes from caretakers' first recognition of illness until pneumonia is radiologically verified. We also describe the treatment given before arrival at hospital during the development of severe pneumonia in Ugandan children under 5 years of age in a setting with a high incidence of childhood pneumonia and malaria.…”

Neonatal Deaths in Rural Southern Tanzania: Care-Seeking and Causes of Death

“…Less than 3% of neonatal deaths take place in countries with reliable vital registration data for cause of death analysis [3]. Although most studies estimate only the cause of death among neonates, for health programming, it is equally important to understand the care-seeking processes and treatment actions that occurred before each death [4, 5]. A functioning continuum of care between home and hospital is required to minimize potential delays and effectively link women and newborns with care [6].…”