School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
mothers2mothers, Cape Town, South Africa.
BMC Pregnancy Childbirth. 2020 Nov 26;20(1):736. doi: 10.1186/s12884-020-03419-4.
Engaging community health workers in a formalised death review process through verbal and social autopsy has been utilised in different settings to estimate the burden and causes of mortality, where civil registration and vital statistics systems are weak. This method has not been widely adopted. We piloted the use of trained community health workers (CHW) to investigate the extent of unreported maternal and infant deaths in Khayelitsha and explored requirements of such a programme and the role of CHWs in bridging gaps.
This was a mixed methods study, incorporating both qualitative and quantitative methods. Case identification and data collection were done by ten trained CHWs. Quantitative data were collected using a structured questionnaire. Qualitative data were collected using semi-structured interview guides for key informant interviews, focus group discussions and informal conversations. Qualitative data were analysed thematically using a content analysis approach.
Although more than half of the infant deaths occurred in hospitals (n = 11/17), about a quarter that occurred at home (n = 4/17) were unreported. Main causes of deaths as perceived by family members of the deceased were related to uncertainty about the quality of care in the facilities, socio-cultural and economic contexts where people lived and individual factors. Most unreported deaths were further attributed to weak facility-community links and socio-cultural practices. Fragmented death reporting systems were perceived to influence the quality of the data and this impacted on the number of unreported deaths. Only two maternal deaths were identified in this pilot study.
CHWs can conduct verbal and social autopsy for maternal and infant deaths to complement formal vital registration systems. Capacity development, stakeholder's engagement, supervision, and support are essential for a community-linked death review system. Policymakers and implementers should establish a functional relationship between community-linked reporting systems and the existing system as a starting point. There is a need for more studies to confirm or build on our pilot findings.
在民事登记和生命统计系统薄弱的情况下，通过口头和社会尸检让社区卫生工作者参与正式的死亡审查过程，已在不同环境中用于估计死亡率的负担和原因。这种方法尚未得到广泛采用。我们在科萨塔试点使用经过培训的社区卫生工作者（CHW）来调查未报告的母婴死亡程度，并探讨了此类计划的要求以及 CHW 在弥合差距方面的作用。
这是一项混合方法研究，结合了定性和定量方法。十名经过培训的 CHW 进行了病例识别和数据收集。定量数据使用结构化问卷收集。定性数据使用半结构化访谈指南，对关键知情人进行访谈、焦点小组讨论和非正式对话进行收集。使用内容分析方法对定性数据进行主题分析。
尽管超过一半的婴儿死亡发生在医院（n=11/17），但约四分之一发生在家庭（n=17/17）的死亡未报告。死者家属认为死亡的主要原因与对设施护理质量的不确定性、人们生活的社会文化和经济背景以及个人因素有关。大多数未报告的死亡进一步归因于医疗机构与社区联系薄弱和社会文化习俗。碎片化的死亡报告系统被认为会影响数据质量，从而影响未报告死亡的数量。在这项试点研究中仅发现两例产妇死亡。
CHW 可以对母婴死亡进行口头和社会尸检，以补充正式的生命登记系统。能力建设、利益相关者的参与、监督和支持对于社区关联的死亡审查系统至关重要。政策制定者和执行者应建立社区报告系统与现有系统之间的功能性关系，作为起点。需要进行更多研究来证实或建立在我们的试点研究结果之上。
