Establishing the causes of childhood mortality in Ghana: the 'spirit child'.

Communities in remote regions of northeast Ghana record some of the highest rates of under five mortality in West Africa (23.9 per 1000 children/year (Binka, Maude et al. (1995). International Journal of Epidemiology, 24(1), 127-135). The communities, isolated geographically and culturally from the main tribal groups in Ghana continue to adhere very strongly to traditional beliefs and practices. A qualitative study of both traditional and modern maternal and child health care systems in the area, demonstrated that almost 15% of deaths of infants under 3 months of age were due to a belief in chichuru or spirit children, resulting in infanticide. It is therefore a significant public health problem, which has to be addressed in programs for the control of child mortality. A modification of the verbal autopsy method is proposed to assist in the identification of non-biomedical causes of death.