Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
INDEPTH Network, Accra, Ghana.
BMJ Open. 2017 Aug 11;7(8):e012856. doi: 10.1136/bmjopen-2016-012856.
To identify the medical causes of death and contribution of non-biological factors towards infant mortality by a retrospective analysis of routinely collected data using verbal and social autopsy tools.
The study site was Health and Demographic Surveillance System (HDSS), Ballabgarh, North India PARTICIPANTS: All infant deaths during the years 2008-2012 were included for verbal autopsy and infant deaths from July 2012 to December 2012 were included for social autopsy.
Cause of death ascertained by a validated verbal autopsy tool and level of delay based on a three-delay model using the INDEPTH social autopsy tool were the main outcome measures. The level of delay was defined as follows: level 1, delay in identification of danger signs and decision making to seek care; level 2, delay in reaching a health facility from home; level 3, delay in getting healthcare at the health facility.
The infant mortality rate during the study period was 46.5/1000 live births. Neonatal deaths contributed to 54.3% of infant deaths and 39% occurred on the first day of life. Birth asphyxia (31.5%) followed by low birth weight (LBW)/prematurity (26.5%) were the most common causes of neonatal death, while infection (57.8%) was the most common cause of post-neonatal death. Care-seeking was delayed among 50% of neonatal deaths and 41.2% of post-neonatal deaths. Delay at level 1 was most common and occurred in 32.4% of neonatal deaths and 29.4% of post-neonatal deaths. Deaths due to LBW/prematurity were mostly followed by delay at level 1.
A high proportion of preventable infant mortality still exists in an area which is under continuous health and demographic surveillance. There is a need to enhance home-based preventive care to enable the mother to identify and respond to danger signs. Verbal autopsy and social autopsy could be routinely done to guide policy interventions aimed at reduction of infant mortality.
通过使用口头和社会尸检工具对常规收集的数据进行回顾性分析，确定导致婴儿死亡的医学原因和非生物因素对婴儿死亡率的影响。
本研究地点为印度北部巴拉加尔健康和人口监测系统（HDSS）。
纳入 2008-2012 年期间所有的婴儿死亡进行口头尸检，纳入 2012 年 7 月至 12 月期间的婴儿死亡进行社会尸检。
主要结局指标为通过验证后的口头尸检工具确定死因和使用 INDEPTH 社会尸检工具基于三级延误模型确定的延误程度。延误程度定义如下：一级，识别危险信号和决定寻求医疗的延误；二级，从家到医疗机构的延误；三级，在医疗机构获得医疗保健的延误。
研究期间婴儿死亡率为 46.5/1000 活产儿。新生儿死亡占婴儿死亡的 54.3%，39%发生在生命的第一天。出生窒息（31.5%）后为低出生体重/早产（26.5%）是新生儿死亡的最常见原因，而感染（57.8%）是新生儿后死亡的最常见原因。50%的新生儿死亡和 41.2%的新生儿后死亡存在寻求医疗护理的延误。一级延误最常见，发生在 32.4%的新生儿死亡和 29.4%的新生儿后死亡。低出生体重/早产导致的死亡大多存在一级延误。
在一个持续进行健康和人口监测的地区，仍存在相当比例的可预防婴儿死亡。需要加强家庭为基础的预防保健，使母亲能够识别和应对危险信号。应常规进行口头尸检和社会尸检，以指导旨在降低婴儿死亡率的政策干预。
