Cause of death in under 5 children in a demographic surveillance site in Pakistan

Abstract

ObjectiveTo identify Cause of deaths among children below age of 5yearsfrom a prospective cohort of women in one urban and four peri-urbansettings of Karachi, PakistanIntroductionPakistan ranks 26th in Childhood mortality rates, globally. Pakistan,with other 4 countries is responsible for about half of the deaths ofchildren age under 5. Despite such burden vital registration systemis not well established, health facilities are not easily accessible andmostly deaths occur at home, making identification of cause of death(COD) difficultMethodsFrom Jan 2007-Dec 2012 under-5 mortality was identifiedby CHWs during their 3-monthly visits. A Research Assistantconducted Verbal Autopsies (VA). Each VA form was analyzed by2 physicians, independently, and assigned a cause. VA is analyzedby a third physician in case two physicians do not agree on a cause.Cause Specific Mortality Fractions (CSMF) were calculated for eachidentified COD.Results833(58%) neonatal deaths and 591(42%) Under-5 deaths (excludingneonates) were identified. Among neonates most common CODswere perinatal asphyxia(30.4%), neonatal sepsis/meningitis(28%),pre-term birth complication(11%) and neonatal pneumonia(6%).For Post-neonatal deaths most common CODs were sepsis (19%),diarrheal disease (17%), Pneumonia (17%) and meningitis (8%).ConclusionsWe describe the CSMF for different CODs among neonated andchildren under 5. Strategies for prevention of most common causesand making health facilities easily accessible will decrease thisburden.