Under 10 mortality patterns, risk factors, and mechanisms in low resource settings of Eastern Uganda: An analysis of event history demographic and verbal social autopsy data

Abstract

Background Globally, the under-10 years of age mortality has not been comprehensively studied. We applied the life-course perspective in the analysis and interpretation of the event history demographic and verbal autopsy data to examine when and why children die before their 10 th birthday. Methods We analysed a decade (2005-2015) of event histories data on 22385 and 1815 verbal autopsies data collected by Iganga-Mayuge HDSS in eastern Uganda. We used the lifetable for mortality estimates and patterns, and Royston-Parmar survival analysis approach for mortality risk factors' assessment. Results The under-10 and 5-9 years of age mortality probabilities were 129 (95% Confidence Interval [CI] = 123-370) per 1000 live births and 11 (95% CI = 7-26) per 1000 children aged 5-9 years, respectively. The top four causes of newborn mortality and stillbirth were antepartum maternal complications (31%), intrapartum-related causes including birth injury, asphyxia and obstructed labour (25%), Low Birth Weight (LBW) and prematurity (20%), and other unidentified perinatal mortality causes (18%). Malaria, protein deficiency including anaemia, diarrhoea or gastrointestinal, and acute respiratory infections were the major causes of mortality among those aged 0-9 years-contributing 88%, 88% and 46% of all causes of mortality for the post-neonatal, child and 5-9 years of age respectively. 33% of all causes of mortality among those aged 5-9 years was a share of Injuries (22%) and gastrointestinal

Excessive premature mortality among children with cerebral palsy in rural Uganda: A longitudinal, population-based study

“…These CODs were not seen in the CP cohort since deceased children were unable to walk. Instead, they retained a similar COD pattern as children below 5 years in the general population, i.e., malaria, malnutrition and infections [5]. In regions where these risks are prevalent, for example the endemic spread of Malaria, children with CP are more vulnerable and more likely to die.…”

“…Families of children with CP, who had been identified in 2015, were contacted by phone or home visit in September 2019 to inquire whether the child was alive and to obtain consent for participating in the study. If the child was deceased, an experienced IM-HDSS field worker with counselling skills conducted a verbal autopsy audit following standard HDSS procedures [5,19]. Surviving children were subjected to follow-up assessments, which will be reported elsewhere.…”

“…For children in the general population, information was collected from IM-HDSS annual censuses. For details see [5]. We identified deceased children and recorded their dates of birth and death and immediate COD.…”

“…Malaria is endemic in the area and malaria and anaemia/malnutrition were also the most common CODs in the general population, while half of the children in the general population had other CODs such as gastrointestinal disorders and injuries. In a previous study on the under-10-mortality in the IM-HDSS in 2005-2015, the investigators described a shift of COD between 0-5 and 5-9 years, in which gastrointestinal disorders and injuries emerged after 4 years of age [5]. They suggested this resulted from new behaviours, curiosity and limited supervision exposing the children to injuries such as poisoning, falls, drowning and suffocation, or to ingestion of unhealthy items, such as worms or typhoid, leading to diarrhoea and gastrointestinal disorders.…”

“…This decrease has been attributed to antimalarial interventions and breastfeeding, in addition to general socioeconomic development [3]. Nevertheless, child mortality remains high in sub-Saharan Africa [5], especially among children with neurodevelopmental disorders or epilepsy, whose mortality rate was reportedly 3-4 times higher than that of typically developing children [6].…”