Patel Monika, Khandhar Bhavesh J, Satapara Niketkumar D, Yogesh M, Rabadiya Samarth, Sharma Soumya
Department of Community Medicine, Shri MP Shah Medical College Gujarat, India.
Department of Pediatrics, MP Shah Medical College, Gujarat, India.
J Educ Health Promot. 2024 Dec 28;13:501. doi: 10.4103/jehp.jehp_442_24. eCollection 2024.
Accurate determination of infant mortality causes and understanding sociocultural factors influencing care-seeking behaviors are crucial for targeted interventions in resource-limited settings. This mixed-methods study aimed to assess the accuracy of verbal autopsy (VA) in ascertaining infant death causes and explore sociocultural determinants of infant mortality in Gujarat, India.
It was a mixed-method study with a retrospective cohort component for which data from 661 infant records were extracted from the main health office's database, with a subset of 328 infant deaths selected for verbal autopsy analysis. Delivery characteristics, care-seeking behaviors, access to healthcare, and risk factors were evaluated. Bivariate and multivariate analyses were conducted to identify factors associated with infant mortality. VA diagnostic accuracy was assessed using sensitivity, specificity, predictive values, and receiver operating characteristic curve analysis, with death certificates as the reference standard. Qualitative methods, including in-depth interviews, and focus group discussions were used to explore the sociocultural influences, health system challenges, and stakeholder experiences related to infant deaths and VA implementation. Findings were integrated through triangulation.
Institutional deliveries were 583/661 (88%), and the skilled birth attendance was 397/661 (60%). Care-seeking from health facilities was low at 264/661 (40%), with a mean time of 12 hours. Home deaths accounted for 328/661 (49.6%) cases. Low birth weight (aOR 1.81, 95% CI 1.3-2.4, = 0.002), home delivery (aOR 1.72, 95% CI 1.1-2.8, = 0.01), early complementary feeding (aOR 1.48, 95% CI 1.1-2.0, = 0.01), and acute malnutrition (aOR 1.91, 95% CI 1.3-2.6, = 0.001) were independent risk factors for mortality. Verbal autopsy showed high specificity (87%) but variable sensitivity (70%) in determining causes of death. Qualitative findings revealed barriers to timely care (lack of danger sign recognition, financial constraints, traditional healer reliance), cultural beliefs impacting care practices, gender discrimination, health system constraints (staff shortages, diagnostic limitations), and challenges with VA implementation (recall bias, desire for feedback).
Enhancing antenatal care, skilled birth attendance, optimal breastfeeding, complementary feeding practices, addressing acute malnutrition, overcoming sociocultural barriers through community engagement, health system strengthening, and culturally sensitive interventions could potentially reduce infant mortality rates. While a verbal autopsy is practical for the cause of death determination in resource-limited settings, its effectiveness relies on addressing the identified challenges through policy measures focused on community participation, health system improvements, and culturally appropriate strategies.
准确确定婴儿死亡原因并了解影响就医行为的社会文化因素对于资源有限地区的针对性干预至关重要。这项混合方法研究旨在评估口头尸检（VA）在确定婴儿死亡原因方面的准确性，并探索印度古吉拉特邦婴儿死亡率的社会文化决定因素。
这是一项混合方法研究，包含回顾性队列研究部分，从主要卫生办公室数据库中提取了661份婴儿记录的数据，选择了328例婴儿死亡病例进行口头尸检分析。评估了分娩特征、就医行为、获得医疗保健的机会和风险因素。进行了双变量和多变量分析以确定与婴儿死亡率相关的因素。以死亡证明为参考标准，使用敏感性、特异性、预测值和受试者工作特征曲线分析评估VA诊断准确性。采用定性方法，包括深入访谈和焦点小组讨论，以探讨与婴儿死亡和VA实施相关的社会文化影响、卫生系统挑战和利益相关者的经历。通过三角验证整合研究结果。
机构分娩率为583/661（88%），熟练接生率为397/661（60%）。到卫生机构就医的比例较低，为264/661（40%），平均就医时间为12小时。在家中死亡的病例占328/（49.6%）。低出生体重（调整后比值比1.81，95%置信区间1.3 - 2.4，P = 0.002）、在家分娩（调整后比值比1.72，95%置信区间1.与早期辅食添加（调整后比值比1.48，95%置信区间1.1 - 2.0，P = 0.01）以及急性营养不良（调整后比值比1.91，95%置信区间1.3 - 2.6，P = 0.001）是死亡的独立危险因素。口头尸检在确定死亡原因方面显示出高特异性（87%）但敏感性各异（70%）。定性研究结果揭示了及时就医的障碍（缺乏危险信号识别、经济限制、依赖传统治疗师）、影响护理实践的文化信仰、性别歧视、卫生系统限制（人员短缺、诊断限制）以及VA实施方面的挑战（回忆偏倚、渴望反馈）。
加强产前护理、熟练接生、优化母乳喂养、辅食添加实践、解决急性营养不良问题、通过社区参与克服社会文化障碍、加强卫生系统以及采取文化敏感干预措施可能会降低婴儿死亡率。虽然口头尸检在资源有限地区确定死亡原因方面具有实用性，但其有效性依赖于通过侧重于社区参与、卫生系统改善和文化适宜策略的政策措施来应对已确定的挑战。
