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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Etiology of child mortality in Goroka, Papua New Guinea: a prospective two-year study
Trevor Duke1, Audrey Michael, Joyce Mgone
1Goroka Base Hospital, Goroka, Papua New Guinea. duket@cryptic.rch.unimelb.edu.au
Insights
Child deaths in developing countries are often caused by infections and preventable factors like poor maternal care and delayed treatment. Addressing these issues through systematic audits can improve child survival rates.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Child mortality remains a significant challenge in developing nations.
- Understanding the specific causes of death is crucial for effective intervention.
Purpose of the Study:
- To gather precise data on disease-specific and microbial causes of child deaths.
- To identify avoidable factors contributing to child mortality in a developing country.
Main Methods:
- A prospective audit of 353 child deaths over 24 months at Goroka Hospital, Papua New Guinea.
- Data collected on neonates, and children aged 1-59 months and 5-12 years.
Main Results:
- Common causes included low birth weight, sepsis, birth asphyxia, pneumonia, and malnutrition.
- Microbial pathogens were identified in 50.7% of deaths; nine pathogens caused 41% of all deaths.
- Avoidable factors, such as lack of antenatal care and delayed presentation, were present in 50% of deaths.
Conclusions:
- Reducing child mortality requires addressing diseases, infections, social factors, and health system weaknesses.
- Systematic mortality audits are valuable for prioritizing interventions and monitoring healthcare quality.
Objective:
To collect accurate data on disease- and microbial-specific causes and avoidable factors in child deaths in a developing country.
Methods:
A systematic prospective audit of deaths of children seen at Goroka Hospital in the highlands of Papua New Guinea was carried out. Over a 24-month period, we studied 353 consecutive deaths of children: 126 neonates, 186 children aged 1-59 months, and 41 children aged 5-12 years.
Findings:
The most frequent age-specific clinical diagnoses were as follows: for neonates--very low birth weight, septicaemia, birth asphyxia and congenital syphilis; for children aged 1-59 months--pneumonia, septicaemia, marasmus and meningitis; and for children aged 5-12 years--malignancies and septicaemia. At least one microbial cause of death was identified for 179 (50.7%) children and two or more were identified for 37 (10.5%). Nine microbial pathogens accounted for 41% of all childhood deaths and 76% of all deaths that had any infective component. Potentially avoidable factors were identified for 177 (50%) of deaths. The most frequently occurring factors were as follows: no antenatal care in high-risk pregnancies (8.8% of all deaths), very delayed presentation (7.9%), vaccine-preventable diseases (7.9%), informal adoption or child abandonment leading to severe malnutrition (5.7%), and lack of screening for maternal syphilis (5.4%). Sepsis due to enteric Gram-negative bacilli occurred in 87 (24.6%). The strongest associations with death from Gram- negative sepsis were adoption/abandonment leading to severe malnutrition, village births, and prolonged hospital stay.
Conclusions:
Reductions in child mortality will depend on addressing the commonest causes of death, which include disease states, microbial pathogens, adverse social circumstances and health service failures. Systematic mortality audits in selected regions where child mortality is high may be useful for setting priorities, estimating the potential benefit of specific and non-specific interventions, and providing continuous feedback on the quality of care provided and the outcome of health reforms.
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