Oxford Journals Medicine Health Policy and Planning Volume 10, Issue 4 Pp !"#$40!

Verbal autopsy in Karachi slums: comparing single and multiple cause of child deaths 2008
1. 2. 3. 4. 5. +%uthor 1 1 DAVID MARSH, KHATIDJA HUSEIN, MELVYN LOBO, MEHBOOB ALI SHAH and STEPHEN LUBY

%ffiliations
&epartment of 'ommunity Health (ciences, )he %ga *han +ni,ersity *arachi, Pa-istan &a,id . Marsh, Health +nit, (a,e the 'hildren /ederation 0+(%1, #4 2ilton .oad, 2estport, ') 03440, +(%

Abstract Background5 'hildren dying in de,eloping countries often ha,e more than one serious disease process Identifying the single most important is difficult and ris-s omitting ,alua6le information 2e report patterns of childhood death in *arachi slums comparing single and multiple cause analysis Methods5 )he %ga *han +ni,ersity has de,eloped primary health care programmes in *arachi slums 7here community health 7or-ers maintain monthly sur,eillance of families 7ith children aged under fi,e years 2e in,estigated all deaths among children under fi,e from 1""0 to 1""8 7hen the o,erall IM. 7as 94 2e used a structured ,er6al autopsy :uestionnaire comprised of ,er6atim and symptom chec-$list sections .e,ie7ers assigned up to four diagnoses per death 2e compared analysis 6y single 0main1 cause and multiple 0consolidated1 causes per case Results5 O,erall, the 4!1 cases had 389 causes of death; 1#3 cases 0!3<1 had more than one cause of death =y consolidated analysis, diarrhoea, malnutrition, lo7 6irth 7eight 0>=21, acute respiratory infection 0%.I1, and ,accine pre,enta6le diseases played roles in 41<, 84<, 88<, 1!<, and 8< of deaths, respecti,ely Proportionate mortality ratios 6y main cause 01 diagnosis per child1 analysis for the same diagnoses 7ere5 !"<, 1<, 4<, 11<, and 1<, respecti,ely Half of all child death occurred 6y age ! months ?ighty$three per cent 0143@1931 of fatal diarrhoea syndromes 7ere due to acute 7atery diarrhoea, and 41< 098@1931 7ere associated 7ith se,ere malnutrition 0,s 81< A18@#3B of fatal %.I cases1 ?ach ,er6al autopsy cost an estimated +(C4 00, an annual cost of +(C0 04 per programme child Implications5 'ompared to single main cause analysis, consolidated analysis more completely assesses reasons for child death to guide programme response 2e propose that health planning for populations 7ith lo7 ,accine co,erage or common co$mor6id conditions, such as malaria and anaemia, 7ould particularly 6enefit from analysis of death see-ing multiple causes
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H&oingH health policy analysis5 methodological and conceptual reflections and challenges 'alculating P%>Qs, comparing P%>Q and &%>Q calculations 'onstructing socio$economic status indices5 ho7 to use principal components analysis %n analysis of R%VI, the Rlo6al /und and 2orld =an- support for human resources for health in de,eloping countries Policy to tac-le the social determinants of health5 using conceptual models to understand the policy process G Vie7 all Most .ead articles &isclaimer5 Please note that a6stracts for content pu6lished 6efore 1""3 7ere created through digital scanning and may therefore not exactly replicate the text of the original print issues %ll efforts ha,e 6een made to ensure accuracy, 6ut the Pu6lisher 7ill not 6e held responsi6le for any remaining inaccuracies If you re:uire any further clarification, please contact our 'ustomer (er,ices &epartment Online ISSN 1460-2237 - Print ISSN 0268-1080 'opyright D 801! Oxford University Press

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