Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda
Introduction Neonatal mortality remains a formidable challenge in low-resource settings, such as Uganda, despite global health initiatives. This study employs a social and verbal autopsy approach to identify the causes, settings and health accessibility challenges surrounding neonatal deaths in the...
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BMJ Publishing Group
2024-04-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/2/1/e000682.full |
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| author | Peter Waiswa Rornald Muhumuza Kananura Dinah Amongin Joseph Akuze Jacquellyn Nambi Ssanyu Felix Kizito |
| author_facet | Peter Waiswa Rornald Muhumuza Kananura Dinah Amongin Joseph Akuze Jacquellyn Nambi Ssanyu Felix Kizito |
| author_sort | Peter Waiswa |
| collection | DOAJ |
| description | Introduction Neonatal mortality remains a formidable challenge in low-resource settings, such as Uganda, despite global health initiatives. This study employs a social and verbal autopsy approach to identify the causes, settings and health accessibility challenges surrounding neonatal deaths in the Luuka district from 1 January 2017 to 31 December 2019.Methods We analysed data from 172 neonatal verbal and social autopsies (VASA) conducted over 3 years, as part of a maternal and neonatal demand and supply health system strengthening intervention. Cause-of-death coding was done by two independent medical officers using WHO-ICD-10 guidelines to ascertain the causes of death. VASA-coded data analysis of the causes of death was done in STATA V.14.0. In addition, 16 key informant interviews were conducted, including 2 community health workers,6 household members and 8 health workers, with qualitative data analysed through thematic content analysis.Results Among the 172 neonate deaths, 95.9% occurred in the early neonatal period (0–6 days) and 4.1% in the late neonatal period (7–27 days). The primary causes of death were birth asphyxia (42.4%), low birth weight/prematurity (18.6%), other perinatal causes (12.8%) and neonatal sepsis (9.3%). Delays in getting appropriate care at the facility (delay 3) and delays in seeking care (delay 1) (51.2% and 44.2%, respectively) were linked to newborn mortality. Qualitative insights underscored inadequate awareness of neonatal danger signs, deficient referral systems, drug shortages, reliance on unskilled traditional birth attendants and insufficient neonatal care facilities as significant contributors.Conclusion Addressing delays in both home-based care (delay 1) and timely access to appropriate care in healthcare facilities (delays 2 and 3) is pivotal in mitigating neonatal mortality. Comprehensive interventions targeting improved access to maternal services and enhanced quality of care in health facilities are imperative for advancing newborn survival in rural settings. |
| format | Article |
| id | doaj-art-8e3e94ef805143319d67bbf068eb907b |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Public Health |
| spelling | doaj-art-8e3e94ef805143319d67bbf068eb907b2025-01-28T22:30:09ZengBMJ Publishing GroupBMJ Public Health2753-42942024-04-012110.1136/bmjph-2023-000682Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in UgandaPeter Waiswa0Rornald Muhumuza Kananura1Dinah Amongin2Joseph Akuze3Jacquellyn Nambi Ssanyu4Felix Kizito52 Makerere University Center of Excellence for Maternal and Newborn Health, Kampala, UgandaAfrican Population and Health Research Center, Nairobi, KenyaDepartment of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, UgandaAdvance Innovations for Transforming Health, Kampala, UgandaDepartment of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, UgandaDepartment of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, UgandaIntroduction Neonatal mortality remains a formidable challenge in low-resource settings, such as Uganda, despite global health initiatives. This study employs a social and verbal autopsy approach to identify the causes, settings and health accessibility challenges surrounding neonatal deaths in the Luuka district from 1 January 2017 to 31 December 2019.Methods We analysed data from 172 neonatal verbal and social autopsies (VASA) conducted over 3 years, as part of a maternal and neonatal demand and supply health system strengthening intervention. Cause-of-death coding was done by two independent medical officers using WHO-ICD-10 guidelines to ascertain the causes of death. VASA-coded data analysis of the causes of death was done in STATA V.14.0. In addition, 16 key informant interviews were conducted, including 2 community health workers,6 household members and 8 health workers, with qualitative data analysed through thematic content analysis.Results Among the 172 neonate deaths, 95.9% occurred in the early neonatal period (0–6 days) and 4.1% in the late neonatal period (7–27 days). The primary causes of death were birth asphyxia (42.4%), low birth weight/prematurity (18.6%), other perinatal causes (12.8%) and neonatal sepsis (9.3%). Delays in getting appropriate care at the facility (delay 3) and delays in seeking care (delay 1) (51.2% and 44.2%, respectively) were linked to newborn mortality. Qualitative insights underscored inadequate awareness of neonatal danger signs, deficient referral systems, drug shortages, reliance on unskilled traditional birth attendants and insufficient neonatal care facilities as significant contributors.Conclusion Addressing delays in both home-based care (delay 1) and timely access to appropriate care in healthcare facilities (delays 2 and 3) is pivotal in mitigating neonatal mortality. Comprehensive interventions targeting improved access to maternal services and enhanced quality of care in health facilities are imperative for advancing newborn survival in rural settings.https://bmjpublichealth.bmj.com/content/2/1/e000682.full |
| spellingShingle | Peter Waiswa Rornald Muhumuza Kananura Dinah Amongin Joseph Akuze Jacquellyn Nambi Ssanyu Felix Kizito Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda BMJ Public Health |
| title | Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda |
| title_full | Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda |
| title_fullStr | Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda |
| title_full_unstemmed | Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda |
| title_short | Using verbal and social autopsy approaches to understand why neonates die in rural settings: a case study of a remote rural district in Uganda |
| title_sort | using verbal and social autopsy approaches to understand why neonates die in rural settings a case study of a remote rural district in uganda |
| url | https://bmjpublichealth.bmj.com/content/2/1/e000682.full |
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