Cause-specific child mortality in a mountainous community in Pakistan by verbal autopsy

In Pakistan's rural areas population-based cause of death data from systematic verbal autopsies are rare. Using verbal autopsy algorithms with multiple coding and decision rules, we assigned causes of death among 79% of children under age five years dying between July, 1988 and December, 1991 in Oshikhandass, a remote mountainous community in Pakistan's Northern Areas. Main causes of death were pneumonia (44%), diarrhoea (35%), and neonatal sepsis (6%). Combined (main plus associated) analysis revealed 48% died with diarrhoea, 46% with malnutrition, 44% with pneumonia, 15% with neonatal sepsis, and 15% with low birth weight. Median age of death with pneumonia was 2 months, with diarrhoea 8 months. Half died by month 4. The inquiry was well received by villagers. Population-based verbal autopsy surveillance is a cost-effective strategy to guide health managers. Plans are underway to institute it for the surrounding population of 400,000. Creative ways to access, treat and reduce risk among young infants are needed.