Sociodemographic, behavioral, and environmental factors of child mortality in Eastern Region of Cameroon: results from a social autopsy study
Sociodemographic, behavioral, and environmental factors of child mortality in Eastern Region of Cameroon: results from a social autopsy study
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DOI：
10.7189/jogh.07.010601
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发表时间：
2017-06-01
影响因子：
7.2
通讯作者：
Kalter, Henry D.
中科院分区：
文献类型：
--
作者：
Koffi, Alain K.;Wounang, Romain S.;Kalter, Henry D.
虽然大多数儿童死亡是由肺炎、腹泻和疟疾等高度可预防和可治疗的疾病引起的，但一些社会人口、文化和卫生系统因素不利于儿童从这些疾病中存活下来。方法2012年开展回顾性口头/社会尸检调查，对喀麦隆东部地区多梅、恩圭莱-门杜卡和阿邦-姆邦卫生区2007 - 2010年5岁以下儿童死亡的生物学原因和社会决定因素进行调查。本研究旨在确定1-59个月大婴儿死亡的重要社会人口和家庭特征，包括正常儿童保育的关键预防指标的覆盖范围，以及儿童在“生存之路”模式下的疾病识别和求医情况。在完成访谈的635名死亡儿童中，分别只有26.8%和11.2%的儿童生活在饮用水和卫生设施得到改善的家庭。几乎所有的家庭（96.1%）都使用柴火做饭，在236名在家做饭的母亲中，79.2% （n = 187）在做饭时通常有孩子在身边。当614名儿童患上致命疾病时，大多数（83.7%）照顾者寻求或试图寻求正规卫生保健，但从发病到决定寻求正规保健的中位延迟为2天。结果，许多（n = 111）儿童在病情从轻度或中度发展到重度后才接受治疗。进入正规卫生系统的主要障碍是交通、卫生保健和其他相关费用。结论：在研究环境中，导致1-59月龄儿童死亡的最常见社会因素包括恶劣的生活条件、导致暴露于室内烟雾的流行习俗以及延迟就医决定等与健康相关的行为。提高照顾者认识儿童疾病危险迹象的能力，促进及时和适当的求医，提高生活水平，使父母或照顾者能够克服经济障碍，这些措施可以改变研究地区患病儿童的生存状况。
Background While most child deaths are caused by highly preventable and treatable diseases such as pneumonia, diarrhea, and malaria, several sociodemographic, cultural and health system factors work against children surviving from these diseases.Methods A retrospective verbal/social autopsy survey was conducted in 2012 to measure the biological causes and social determinants of under-five years old deaths from 2007 to 2010 in Doume, Nguele-mendouka, and Abong-Mbang health districts in the Eastern Region of Cameroon. The present study sought to identify important sociodemographic and household characteristics of the 1-59 month old deaths, including the coverage of key preventive indicators of normal child care, and illness recognition and care-seeking for the children along the Pathway to Survival model.Findings Of the 635 deceased children with a completed interview, just 26.8% and 11.2% lived in households with an improved source of drinking water and sanitation, respectively. Almost all of the households (96.1%) used firewood for cooking, and 79.2% (n = 187) of the 236 mothers who cooked inside their home usually had their children beside them when they cooked. When 614 of the children became fatally ill, the majority (83.7%) of caregivers sought or tried to seek formal health care, but with a median delay of 2 days from illness onset to the decision to seek formal care. As a result, many (n = 111) children were taken for care only after their illness progressed from mild or moderate to severe. The main barriers to accessing the formal health system were the expenses for transportation, health care and other related costs.Conclusions The most common social factors that contributed to the deaths of 1-59-month old children in the study setting included poor living conditions, prevailing customs that led to exposure to indoor smoke, and health-related behaviors such as delaying the decision to seek care. Increasing caregivers' ability to recognize the danger signs of childhood illnesses and to facilitate timely and appropriate health care-seeking, and improving standards of living such that parents or caregivers can overcome the economic obstacles, are measures that could make a difference in the survival of the ill children in the study area.