caa a22 4500 397520069 CHVBK 20180308164630.0 cr unu---uuuuu 161202e199512 xx s 000 0 eng 10.1093/heapol/10.4.395 doi (NATIONALLICENCE)oxford-10.1093/heapol/10.4.395 Verbal autopsy in Karachi slums: comparing single and multiple cause of child deaths [Elektronische Daten] [DAVID MARSH, KHATIDJA HUSEIN, MELVYN LOBO, MEHBOOB ALI SHAH, STEPHEN LUBY] Background: Children dying in developing countries often have more than one serious disease process. Identifying the single most important is difficult and risks omitting valuable information. We report patterns of childhood death in Karachi slums comparing single and multiple cause analysis. Methods: The Aga Khan University has developed primary health care programmes in Karachi slums where community health workers maintain monthly surveillance of families with children aged under five years. We investigated all deaths among children under five from 1990 to 1992 when the overall IMR was 78. We used a structured verbal autopsy questionnaire comprised of verbatim and symptom check-list sections. Reviewers assigned up to four diagnoses per death. We compared analysis by single (main) cause and multiple (consolidated) causes per case. Results: Overall, the 431 cases had 627 causes of death; 156 cases (36%) had more than one cause of death. By consolidated analysis, diarrhoea, malnutrition, low birth weight (LBW), acute respiratory infection (ARI), and vaccine preventable diseases played roles in 41%, 24%, 22%, 13%, and 2% of deaths, respectively. Proportionate mortality ratios by main cause (1 diagnosis per child) analysis for the same diagnoses were: 39%, 1%, 8%, 11%, and 1%, respectively. Half of all child death occurred by age 3 months. Eighty-three per cent (146/176) of fatal diarrhoea syndromes were due to acute watery diarrhoea, and 41% (72/176) were associated with severe malnutrition (vs 21% [12/56] of fatal ARI cases). Each verbal autopsy cost an estimated US$4.00, an annual cost of US$0.08 per programme child. Implications: Compared to single main cause analysis, consolidated analysis more completely assesses reasons for child death to guide programme response. We propose that health planning for populations with low vaccine coverage or common co-morbid conditions, such as malaria and anaemia, would particularly benefit from analysis of death seeking multiple causes. © Oxford University Press Review paper nationallicence MARSH DAVID Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan aut HUSEIN KHATIDJA Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan aut LOBO MELVYN Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan aut SHAH MEHBOOB ALI Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan aut LUBY STEPHEN Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan aut Health Policy and Planning Oxford University Press 10/4(1995-12), 395-403 0268-1080 10:4<395 1995 10 heapol https://doi.org/10.1093/heapol/10.4.395 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/heapol/10.4.395 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- MARSH DAVID Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan aut NATIONALLICENCE 700 1- HUSEIN KHATIDJA Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan aut NATIONALLICENCE 700 1- LOBO MELVYN Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan aut NATIONALLICENCE 700 1- SHAH MEHBOOB ALI Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan aut NATIONALLICENCE 700 1- LUBY STEPHEN Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan aut NATIONALLICENCE 773 0- Health Policy and Planning Oxford University Press 10/4(1995-12), 395-403 0268-1080 10:4<395 1995 10 heapol Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford