Institute for International Programs, Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland, USA.
National Bureau of Statistics, Dodoma, Tanzania.
J Glob Health. 2020 Dec;10(2):020901. doi: 10.7189/jogh.10.020901.
Tanzania has decreased its child mortality rate by more than 70 percent in the last three decades and is striving to develop a nationally-representative sample registration system with verbal autopsy to help focus health policies and programs toward further reduction. As an interim measure, a verbal and social autopsy study was conducted to provide vital information on the causes and social determinants of neonatal and child deaths.
Causes of neonatal and 1-59 month-old deaths identified by the 2015-16 Tanzania Demographic and Health Survey were assessed using the expert algorithm verbal autopsy method. The social autopsy examined prevalence of key household, community and health system indicators of preventive and curative care provided along the continuum of care and Pathway to Survival models. Careseeking for neonates and 1-59 month-olds was compared, and tests of associations of age and cause of death to careseeking indicators and place of death were conducted.
The most common causes of death of 228 neonates and 351 1-59 month-olds, respectively, were severe infection, intrapartum related events and preterm delivery, and pneumonia, diarrhea and malaria. Coverage of early initiation of breastfeeding (24%), hygienic cord care (29%), and full immunization of 12-59 month-olds (33%) was problematic. Most (88.8%) neonates died in the first week, including 44.3% in their birth facility before leaving. Formal care was sought for just 41.9% of newborns whose illness started at home and was delayed by 5.3 days for 1-59 month-olds who sought informal care. Care was less likely to be sought for the youngest neonates and infants and severely ill children. Although 70.3% of 233 under-5 year-olds were moderately or severely ill on discharge from their first provider, only 29.0%-31.2% were referred.
The study highlights needed actions to complete Tanzania's child survival agenda. Low levels of some preventive interventions need to be addressed. The high rate of facility births and neonatal deaths requires strengthening of institutionally-based interventions targeting maternal labor and delivery complications and neonatal causes of death. Scale-up of Integrated Community Case Management should be considered to strengthen careseeking for the youngest newborns, infants and severely ill children and referral practices at first level facilities.
在过去的三十年里，坦桑尼亚将儿童死亡率降低了 70%以上，并正在努力建立一个具有代表性的全国样本登记系统，利用死因推断来帮助将卫生政策和项目重点进一步转向降低儿童死亡率。作为一项临时措施，进行了死因推断和社会因素调查研究，以提供有关新生儿和 1-59 月龄儿童死亡原因和社会决定因素的重要信息。
利用专家算法死因推断方法，对 2015-16 年坦桑尼亚人口与健康调查中确定的新生儿和 1-59 月龄儿童死亡原因进行评估。社会因素调查检查了预防和治疗性护理的关键家庭、社区和卫生系统指标在整个护理过程中的流行情况，以及生存途径模型。比较了新生儿和 1-59 月龄儿童的就诊情况，并对年龄和死因与就诊指标和死亡地点的关系进行了检验。
228 名新生儿和 351 名 1-59 月龄儿童的主要死亡原因分别为严重感染、分娩相关事件和早产，以及肺炎、腹泻和疟疾。早期开始母乳喂养（24%）、脐带卫生护理（29%）和 12-59 月龄儿童的全面免疫接种（33%）覆盖率存在问题。大多数（88.8%）新生儿在第一周死亡，其中 44.3%在离开前死于出生机构。只有 41.9%的在家中发病并延误 5.3 天的新生儿和 1-59 月龄儿童寻求了正规医疗。对于年龄最小的新生儿和婴儿以及重病儿童，寻求医疗护理的可能性较小。尽管 233 名 5 岁以下儿童中有 70.3%在首次就诊时病情中度或重度，但只有 29.0%-31.2%的儿童被转诊。
该研究强调了完成坦桑尼亚儿童生存议程所需的行动。一些预防措施的水平较低，需要加以解决。高比例的机构分娩和新生儿死亡需要加强以机构为基础的干预措施，以解决孕产妇分娩和分娩并发症以及新生儿死亡原因。应考虑扩大综合社区病例管理，以加强对最年幼的新生儿、婴儿和重病儿童的医疗保健服务，并改善第一级医疗机构的转诊实践。
