Social autopsy study identifies determinants of neonatal mortality in Doume, Nguelemendouka and Abong-Mbang health districts, Eastern Region of Cameroon

Abstract

Background: Reducing preventable medical causes of neonatal death for faster progress toward the MGD4 will require Cameroon to adequately address the social factors contributing to these deaths. The objective of this paper is to explore the social, behavioral and health systems determinants of newborn death in Doume, Nguelemendouka and Abong-Mbang health districts, in Eastern Region of Cameroon, from 2007-2010.

Methods: Data come from the 2012 Verbal/Social Autopsy (VASA) study, which aimed to determine the biological causes and social, behavioral and health systems determinants of under-five deaths in Doume, Nguelemendouka and Abong-Mbang health districts in Eastern Region of Cameroon. The analysis of the data was guided by the review of the coverage of key interventions along the continuum of normal maternal and newborn care and by the description of breakdowns in the care provided for severe neonatal illnesses within the Pathway to Survival conceptual framework.

Results: One hundred sixty-four newborn deaths were confirmed from the VASA survey. The majority of the deceased newborns were living in households with poor socio-economic conditions. Most (60-80%) neonates were born to mothers who had one or more pregnancy or labor and delivery complications. Only 23% of the deceased newborns benefited from hygienic cord care after birth. Half received appropriate thermal care and only 6% were breastfed within one hour after birth. Sixty percent of the deaths occurred during the first day of life. Fifty-five percent of the babies were born at home. More than half of the deaths (57%) occurred at home. Of the 64 neonates born at a health facility, about 63% died in the health facility without leaving. Careseeking was delayed for several neonates who became sick after the first week of life and whose illnesses were less serious at the onset until they became more severely ill. Cost, including for transport, health care and other expenses, emerged as main barriers to formal care-seeking both for the mothers and their newborns.

Conclusions: This study presents an opportunity to strengthen maternal and newborn health by increasing the coverage of essential and low cost interventions that could have saved the lives of many newborns in eastern Cameroon.

Figure 1

Maternal complications syndromes and care-seeking during the pregnancy and delivery (N = 164). *Maternal complications: Antepartum hemorrhage (APH) – Any vaginal bleeding before labor; Preeclampsia/eclampsia – Puffy face and [blurred vision or severe headache or high blood pressure] and /or Convulsions and no fever and no history of convulsions; Maternal sepsis – Fever and (severe abdominal pain or smelly vaginal discharge or foul smelling liquor); Maternal anemia – (Severe anemia or pallor and shortness of breath) and (too weak to get out of bed or fast or difficult breathing); Intrapartum hemorrhage (IPH) – Excessive bleeding during labor or delivery; Preterm delivery – Less than 9 months; Prolonged labor – Labor for 12 hours or more

Figure 2

Quality gap for at least one antenatal care visit (N = 125). For women who went to at least one antenatal care (ANC) visit (N = 125), a quality gap (or missed opportunity) exists and represents the difference between the expected maximum coverage and the actual coverage proportion. *Quality ANC includes blood pressure checked, urine and blood tested, nutrition counsels, and counsels about danger signs.

Figure 3

Preventive care of the mothers and newborns (N = 164).

Figure 4

The “Pathway to Survival” for 123 neonatal deaths (born at home or left the delivery facility alive). ^§Illness severity at onset; ^§§Illness severity at onset and when caregiver decided to seek formal care; N/M – normal/mild, Mod – moderate, Svr – severe; *CHW – Community Health Worker, **NGO – Non-governmental organization.

Figure 5

Main care–seeking constraints for the delivery and for the neonatal illness.