Sociodemographic, behavioral, and environmental factors of child mortality in Eastern Region of Cameroon: results from a social autopsy study

Abstract

Background: While most child deaths are caused by highly preventable and treatable diseases such as pneumonia, diarrhea, and malaria, several sociodemographic, cultural and health system factors work against children surviving from these diseases.

Methods: A retrospective verbal/social autopsy survey was conducted in 2012 to measure the biological causes and social determinants of under-five years old deaths from 2007 to 2010 in Doume, Nguelemendouka, and Abong-Mbang health districts in the Eastern Region of Cameroon. The present study sought to identify important sociodemographic and household characteristics of the 1-59 month old deaths, including the coverage of key preventive indicators of normal child care, and illness recognition and care-seeking for the children along the Pathway to Survival model.

Findings: Of the 635 deceased children with a completed interview, just 26.8% and 11.2% lived in households with an improved source of drinking water and sanitation, respectively. Almost all of the households (96.1%) used firewood for cooking, and 79.2% (n = 187) of the 236 mothers who cooked inside their home usually had their children beside them when they cooked. When 614 of the children became fatally ill, the majority (83.7%) of caregivers sought or tried to seek formal health care, but with a median delay of 2 days from illness onset to the decision to seek formal care. As a result, many (n = 111) children were taken for care only after their illness progressed from mild or moderate to severe. The main barriers to accessing the formal health system were the expenses for transportation, health care and other related costs.

Conclusions: The most common social factors that contributed to the deaths of 1-59-month old children in the study setting included poor living conditions, prevailing customs that led to exposure to indoor smoke, and health-related behaviors such as delaying the decision to seek care. Increasing caregivers' ability to recognize the danger signs of childhood illnesses and to facilitate timely and appropriate health care-seeking, and improving standards of living such that parents or caregivers can overcome the economic obstacles, are measures that could make a difference in the survival of the ill children in the study area.

Figure 1

Appropriate feeding for children whose illness started at age 0–23 months. *Child’ illness began before 6 months of age (1-5 months), he/she was being breastfed at the time of fatal illness and was not given anything but breast milk as food. **Breastfed children whose fatal illness started at 6-8 months old and 9-23 months old, and received, respectively, at least two and three complementary non-liquid feedings each day. ***Never-breastfed children whose fatal illness started at 6-8 months old and 9-23 months old, respectively, and received at least four replacement feeds each day (including milk and solid, semi-solid and soft foods). ****Children whose fatal illness started at 0-23 months and satisfied one of the above conditions.

Figure 2

Coverage along the continuum of care for 1-59-month old child deaths in Doume, Nguelemendouka and Abong-Mbang districts, in Eastern Region of Cameroon, from 2007-2010. *Proportion of children who were NOT usually beside or carried by their mother when she cooked inside the home. **Insecticide-treated bed net. ***Information on immunizations was obtained either from the vaccination card or when there was no written record, from the respondent (mainly the mother). Polio0 is the Polio vaccination given at birth; Fully Immunized children received BCG, measles, and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth).

Figure 3

The “Pathway to Survival” for 614 Young Child deaths in Doume, Nguelemendouka and Abong-Mbang districts, in Eastern Region of Cameroon, from 2007-2010. ¶Median values are reported for the age at illness onset, the delay to formal care, and the illness duration due to the skewed values for these variables. §Illness severity at onset. §§Illness severity at onset and when caregiver decided to seek formal care. N/M=normal/mild, Mod=moderate, Svr=severe *CHWs - Trained Community Health worker. **DK Don’t know.

Figure 4

Illness severity ranking at onset and at decision to seek care among children for whom caregivers tried to seek or sought some formal care (N = 506). 8 children had missing information that did not allow their illness severity ranking.

Figure 5

Main care–seeking constraints for child illness (N = 400 caregivers).