High mortality despite good care-seeking behaviour : a community study of childhood deaths in Guinea-Bissau

• Published in: Bulletin of the World Health Organization 1997-05, Vol.75 (3), p.205-212
• Main Authors: SODEMANN, M, JAKOBSEN, M. S, MØLBAK, K, ALVARENGA, I. C, AABY, P
• Format: Article
• Language: English
• Subjects: Age; Analysis. Health state; Autopsies; Biological and medical sciences; Births; Case management; Case-Control Studies; Child mortality; Children; Children & youth; Childrens health; Developing countries; Disease; Epidemiology; General aspects; Guinea-Bissau - epidemiology; Health aspects; Health facilities; Health surveillance; Hospitalization; Hospitals; Households; Humans; Illnesses; Immunization; Infant; Infant Mortality; LDCs; Medical sciences; Morbidity; Mortality; Mothers; Odds Ratio; Outpatient care facilities; Parents - psychology; Patient Acceptance of Health Care; Patient outcomes; Population; Prenatal care; Primary care; Public health. Hygiene; Public health. Hygiene-occupational medicine; Socioeconomic factors; Surveys and Questionnaires; Survival Analysis; Tropical medicine
• ISSN: 0042-9686; 1564-0604

The care-seeking behaviour of mothers of 125 children deceased aged 1-30 months was investigated by verbal autopsy in an urban area of Guinea-Bissau. A total of 93% of the children were seen at a health centre or hospital during the 2 weeks before death. In a previous survey covering the period 1987-90 we found that 78% of the children who died had presented for consultation (8); despite this increase in care seeking, infant mortality had not decreased. Comparison of elapsed time from disease onset to first consultation between children who died and matched surviving controls indicated that the interval was shorter for children who died than for those who survived (odds ratio (OR) = 0.7; 95% confidence interval (CI): 0.5-0.99). Of the 125 terminally ill children, 56 were hospitalized. A total of 20 children died on the way to hospital or while waiting in the outpatient clinic. Lack of hospital beds resulted in 15 mothers being refused hospitalization for their child. Of hospitalized children, 42% were discharged as improved or recovered during the 30 days preceding death. These results reveal a need for improved hospital admission criteria, improved recognition of the symptoms of serious illness, better discharge criteria, and the implementation of quality assurance systems for health services.