Investigating the feasibility of child mortality surveillance with postmortem tissue sampling: generating constructs and variables to strengthen validity and reliability in qualitative research

The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to generate reliable data on the causes of death among children aged <5 years using all available information, including minimally invasive tissue sampling (MITS). The sensitive nature of MITS inevitably evokes religious, cultural, and ethical questions influencing the feasibility and sustainability of CHAMPS.Due to limited behavioral studies related to child MITS, we developed an innovative qualitative methodology to determine the barriers, facilitators, and other factors that affect the implementation and sustainability of CHAMPS surveillance across 7 diverse locations in sub-Saharan Africa and South Asia. We employed a multimethod grounded theory approach and analytical structure based on culturally specific conceptual frameworks. The methodology guided data interpretation and collective analyses confirming how to define dimensions of CHAMPS feasibility within the cultural context of each site while reducing subjectivity and bias in the process of interpretation and reporting.Findings showed that the approach to gain consent to conduct the MITS procedure involves religious factors associated with timing of burial, use of certain terminology, and methods of transporting the body. Community misperceptions and uncertainties resulted in rumor surveillance and consistency in information sharing. Religious pronouncements, recognition of health priorities, attention to pregnancy, and advancement of child health facilitated community acceptability. These findings helped formulate program priorities, guided site-specific adaptations in surveillance procedures, and verified inferences drawn from CHAMPS epidemiological and formative research data. Results informed appropriate community sensitization and engagement activities for introducing and sustaining mortality surveillance, including MITS

Changes in the spatial distribution of the under-five mortality rate: Small-area analysis of 122 DHS surveys in 262 subregions of 35 countries in Africa.

The under-five mortality rate (U5MR) is a critical and widely available population health indicator. Both the MDGs and SDGs define targets for improvement in the U5MR, and the SDGs require spatial disaggregation of indicators. We estimate trends in the U5MR for Admin-1 subnational areas using 122 DHS surveys in 35 countries in Africa and assess progress toward the MDG target reductions for each subnational region and each country as a whole. In each country, direct weighted estimates of the U5MR from each survey are calculated and combined into a single estimate for each Admin-1 region across five-year periods. Our method fully accounts for the sample design of each survey. The region-time-specific estimates are smoothed using a Bayesian, space-time model that produces more precise estimates (when compared to the direct estimates) at a one-year scale that are consistent with each other in both space and time. The resulting estimated distributions of the U5MR are summarized and used to assess subnational progress toward the MDG 4 target of two-thirds reduction in the U5MR during 1990-2015. Our space-time modeling approach is tractable and can be readily applied to a large collection of sample survey data. Subnational, regional spatial heterogeneity in the levels and trends in the U5MR vary considerably across Africa. There is no generalizable pattern between spatial heterogeneity and levels or trends in the U5MR. Subnational, small-area estimates of the U5MR: (i) identify subnational regions where interventions are still necessary and those where improvement is well under way; and (ii) countries where there is very little spatial variation and others where there are important differences between subregions in both levels and trends. More work is necessary to improve both the data sources and methods necessary to adequately measure subnational progress toward the SDG child survival targets

Cause‐specific neonatal morbidity and mortality in the Solomon Islands: An assessment of data from four hospitals over a three‐year period

AIM: Data on stillbirths and neonatal morbidity and mortality in low-middle income Pacific Island Nations such as Solomon Islands is limited, partly due to weak health information systems. We describe the perinatal mortality and clinical factors associated with poor newborn outcomes at four hospitals in Solomon Islands. METHODS: This was a registry based retrospective cohort study at three provincial hospitals and the National Referral Hospital (NRH) from 2014-2016 inclusive. RESULTS: 23 966 labour ward births and 3148 special care nursery (SCN) admissions were reviewed. Overall still birth rate was 29.2/1000 births and the perinatal mortality rate was 35.9/1000 births. PNMR were higher in provincial hospitals (46.2, 44.0 and 34.3/1000) than at NRH (33.3/1000). The commonest reasons for admission to SCN across the hospitals were sepsis, complications of prematurity and birth asphyxia. SCN mortality rates were higher in the 3 provincial hospitals than at NRH (15.9% (95/598) vs. 7.9% (202/2550), P value <0.01). At NRH, the conditions with the highest case fatality rates were birth asphyxia (21.3%), congenital abnormalities (17.7%), and prematurity (15.1%). Up to 11% of neonates did not have a diagnosis recorded. CONCLUSIONS: The perinatal mortality rates are high and intrapartum complications, prematurity and sepsis are the main causes of morbidity and mortality for neonates at hospitals in Solomon Islands. Stillbirths account for 81% of perinatal deaths. These results are useful for planning for quality improvement at provincial level. Improved vital registration systems are required to better capture stillbirths and neonatal outcomes