Home deaths of children under 5 years in rural South Africa: a population-based longitudinal study
Jessica Price1, Merlin Willcox2, Chodziwadziwa Whiteson Kabudula3
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Insights
Over half of child deaths in rural South Africa occur at home, even when healthcare is sought. Interventions must address socioeconomic factors contributing to these home deaths.
Area of Science:
- Public Health
- Epidemiology
- Demography
Background:
- Child mortality remains a significant public health challenge in many low-income settings.
- Understanding the place of death and care-seeking behaviors is crucial for effective child survival strategies.
Purpose of the Study:
- To determine the proportion of under-5 deaths occurring at home in rural South Africa.
- To investigate whether healthcare was sought prior to death.
- To identify determinants of home deaths among children who sought care.
Main Methods:
- Utilized verbal autopsy data from 2000-2015 for under-5 deaths in two South African health and demographic surveillance sites.
- Assessed trends in place of death and care-seeking behaviors.
- Employed multivariate logistic regressions to analyze associations between sociodemographic factors and home deaths despite care-seeking.
Main Results:
- Out of 3760 under-5 deaths, 53% occurred at home and 41% in health facilities.
- Eighty-four percent of children who died at home had accessed healthcare during their final illness.
- Factors associated with home death despite seeking care included lower maternal education, larger household size, traditional medicine use, and Mozambican descent. Neonates aged 8-27 days were more likely to die at home than those aged 0-7 days.
Conclusions:
- More than half of under-5 deaths in rural South Africa occur at home, with most children having sought healthcare.
- Home deaths are not solely due to poor care-seeking behaviors.
- Interventions should be targeted towards high-risk sociodemographic groups to reduce in-home mortality.
Objectives:
To determine the proportion of under-5 deaths that occurred at home in rural South Africa, whether care was sought prior to death, and determinants of home deaths amongst those who sought care.
Methods:
Verbal autopsy data were used for all under-5 deaths, 2000-2015, in two health and demographic surveillance system sites. Trends in place of death and care-seeking were assessed. Associations between sociodemographic factors and home death despite seeking care were assessed by multivariate logistic regressions.
Results:
There were 3760 under-5 deaths; 1954 (53%) at home and 1510 (41%) in health facilities. Eighty-four per cent of children who died at home accessed healthcare during their final illness. Amongst neonates for whom care was sought, those who were 8-27 days old were more likely to die at home than those who were 0-7 days old (OR = 5.56, 95%CI 2.69-11.55, P < 0.001). Factors associated with home death of infants and young children despite seeking care included low maternal education (OR = 1.71, 95%CI 1.31-2.24, P < 0.001), larger household size (OR = 1.56, 95%CI 1.17-2.06, P = 0.002), traditional medicine use (OR = 2.33, 95%CI 1.75-3.12, P < 0.001) and Mozambican descent (OR = 1.47, 95%CI 1.06-2.03, P = 0.020). The proportion of HIV-related deaths that occurred at home fell from 60% in 2008-2011 to 39% in 2012-2015 ( χ2 = 13.86, P < 0.001).
Conclusion:
More than half of under-5 deaths in rural South Africa occurred at home although healthcare was sought for most children, highlighting that home deaths are not simply a function of poor care-seeking. Interventions should target high-risk sociodemographic groups.
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