When you have completed this unit you should be able to: Calculate the under-5 mortality rate. Understand the importance of knowing local mortality rates. Manage a mortality meeting. List common causes of under-5 mortality. Identify important modifiable factors.
These mortality rates depends on both: The health, nutrition and home environment of children The quality of health care that is available to children The mortality rate will increase if either the health, nutrition and home environment of children is poor or the health care service are poor. Often both poor socioeconomic conditions and inadequate [...]
Because they are one of the best ways of measuring the wellbeing of children. An improvement in mortality rates for a health district from one year to the next is a good way of showing that the wellbeing of children in that district is improving. An increase in the mortality rates indicates that the wellbeing [...]
No. Mortality rates may also differ between different time periods. In most countries mortality rates have fallen over the past years. With the AIDS epidemic in Southern Africa, infants and under-5 mortality rates are rising. Therefore, mortality rates allow you to compare different groups of children, either in different places (districts, regions, provinces or countries) [...]
No. Mortality rates often differ markedly between health districts. Usually the rates are higher for poor districts than wealthy districts. Similarly, rates are higher in developing (poorly resourced) than in industrialised (well resourced) countries. Therefore, a single mortality rate for the whole nation is only of limited value.
Yes. Mortality rate is usually calculated for a given health district (or region). For example, to determine the under-5 mortality rate for a health district, all under-5 deaths in each part of that service (each clinic and hospital) must be added together. The rate is then expressed per 1000 live births in that district. Sometimes [...]
Usually the infant and under-5 mortality rates are calculated for a calendar year. This is called the annual mortality rate. Sometimes the mortality rate is expressed over a longer period of time, e.g. over 10 years. It is less accurate to calculate mortality rates over periods shorter than one year.
Under-5 deaths are usually divided into age groups: Neonatal mortality includes all live born infants who die in the first 28 days of life. Often neonatal deaths are further divided into early neonatal deaths (deaths in the first 7 days of life) and late neonatal deaths (deaths between 8 and 28 days of life). The [...]
The number of children who die under the age of 5 years is usually expressed as a rate per 1000). Therefore, the under-5 mortality rate is defined as the number of children who die under the age of 5 years per 1000 live born infants. The under-5 mortality rate indicates the probability that a live [...]
This is the number of children who die expressed as a proportion of all the children who could possibly die. For example, if there are 1000 liveborn children and 10 die, the mortality rate for these children is 10 per 1000. It is more useful to know the mortality rate than only the number of [...]
The most common way of recording the number of deaths during childhood is to count the number of children who die before the age of 5 years, therefore children who are born alive but die before their fifth birthday will be counted as under-5 deaths but children who die on or after their fifth birthday [...]
How well a district, region, province or nation is caring for their children Which districts, regions or provinces have the greatest need for better child care It allows for comparison of mortality rates between different areas or countries with a similar income. In other words, how well we are using our income to improve the [...]
The infant mortality rate in South Africa is estimated to be about 55 per 1000. Therefore, out of every 1000 infants born alive in South Africa, 55 will die before reaching the age of 12 months. This can be compared to an infant mortality rate of less than 10/1000 in developed countries and 20/1000 or [...]
This is not accurately known because the collection of mortality data is not good in all regions as many childhood deaths are not reported. However, the under-5 mortality rate in South Africa is estimated to be about 70/1000. In other words, for every 1000 infants that are born alive in South Africa, 70 will die [...]
In under resourced (poor) countries or under resourced communities in wealthy countries the under-5 mortality rate is usually higher than 80. Every effort must be made to reduce the under-5 mortality rate in poor countries so that it approaches the rate in well resourced countries. Note the enormous difference in rates between wealthy and poor [...]
In well resourced (wealthy) countries or well resourced communities in poor countries the under-5 mortality rate is usually below 10. This reflects a high standard of child health, nutrition and home conditions as well as a good health care service. The neonatal mortality rate and infant mortality rate in industrialised countries is usually below 5/1000 [...]
Knowing the under-5 mortality rate is of limited value if you do not know why the children are dying, because the common causes of death during childhood vary greatly from one country to another. The common causes of death need to be known before interventions can be planned to lower the mortality rate. It is [...]
The fully history, detailed examination and any special investigations must be recorded and reviewed (discussed) before deciding on the most likely cause of death. Collecting this information is best done as soon as possible after the child’s death while the probable cause of death should be recorded after it has been discussed and reviewed. All [...]
Yes. All deaths are notifiable in most countries, including South Africa. The child’s age, gender and cause of death should be stated on the death notification form. Unfortunately the given cause of death is often unknown, incorrect or not helpful. For example, if a child with severe malnutrition due to poverty dies of pneumonia, it [...]
A modifiable (avoidable) factor is a missed opportunity for good care or an example of substandard care which probably lead to the child’s death. No measles immunisation would be a missed opportunity in a 2-year-old child who died of measles, while failure to give adequate rehydration at a clinic would be substandard care in a [...]
If possible, standard national protocols of care should be used. The management which was given can then be compared to the approved management. If a national protocol is not available, the most acceptable method of care should be obtained from a current textbook, journal article or expert on that condition. By asking questions at mortality [...]
For each child, the main cause of death must be identified. This is the most likely factor that lead to the death of the child. Sometimes it is not easy to decide which is the main cause and which are contributing causes. Any other contributing causes should also be recorded. If possible, an ICD 10 [...]
This is one of the most important parts of the mortality meeting. All the possible causes must be considered before agreement is reached on the main cause of death. This is often only agreed upon after some discussion. If the cause of death is not certain, then the probable cause must be used. The cause [...]
Full name, hospital or clinic number, gender (sex), age (date of birth) and date of death. Full clinical history including past history, record of immunisation, review of the growth chart in the Road-to-Health Card, family history and home conditions. Results of a full examination together with an assessment of the growth and nutritional status. Any [...]
A responsible person must be identified to arrange the meeting. This is usually a doctor working in the paediatric service. Regular meetings are held once or twice a month depending on the number of deaths. A suitable time and venue is needed. Often lunch times or late afternoons are best. All staff involved with child [...]
The main aims of a mortality review are to: Obtain data on the number of deaths and calculate the mortality rates. Identify the main cause of death as well as contributing causes. Identify any modifiable factors. Decide whether the child received good management. Allow all the staff involved with child care to contribute to the [...]
This is an in-depth investigation and discussion about each child death. The mortality review is usually done at special mortality meetings. These are regular meeting of staff where every childhood death in that service is reviewed. This includes all children who die in a hospital ward, outpatient or casualty department, and hospital or peripheral clinics. [...]
Modifiable factors can be divided into: Modifiable factors related to the family or caregiver. Examples include not taking children for immunisation, delay in taking an ill child to clinic, poor nutrition, not recognising that a child was ill, neglect and abuse. Modifiable factors associated with the clinical staff. Examples include poor clinical assessment, giving the [...]
Malnutrition is an important main or contributing cause of childhood death in most poor countries. Therefore it is important to determine the growth and nutritional status of all children seen at a clinic, admitted to a hospital, as well as all children who die. The nutritional status of all children who die must be recorded.
An assessment of the HIV status of each under-5 deaths should be made. Otherwise children who have died with AIDS may be misclassified. Often the HIV status of children who die is not known. As a result, the role of HIV infection is missed. Clinical signs of HIV infection must always be looked for and [...]
AIDS is becoming a much more common cause of death both in children and adults. Many of these children will eventually die of other infections such as pneumonia, diarrhoea, septicaemia and tuberculosis. Even if a child is not HIV-infected, death of one or both parents will increase their risk of dying under the age of [...]
Lower respiratory tract infection Diarrhoeal disease Septicaemia AIDS Severe malnutrition Tuberculosis This data is from the Child Health Care Problem Identification Programme (Child PIP). Infections are the most common cause of under-5 mortality in South Africa. The most common cause of death in the 5–18 year age group in South Africa is trauma (e.g. motor [...]
Details of the basic information, e.g. number of infants born alive each year and total hospital admissions. Admissions can be divided into age groups and by nutritional status (e.g. below the 3rd centile for weight). Number of deaths and mortality rates Causes of death and modifiable factors Tables and graphs can be printed giving monthly [...]
Previously, the information was counted and analysed by hand, using paper information records. Today most analyses are done by computer. This is faster and more accurate. It is also possible to show the findings as graphs or tables. All the information recorded onto the mortality data capture forms at the mortality meetings has to be [...]
Two sets of information are needed to analyse mortality data: Baseline population data. For calculating infant and under-5 mortality rates, the number if liveborn infants each year in that service or region is needed. For hospital mortality data, the total number of admission are needed. All deaths must be counted. This hospital data should be [...]
The Child Health Care Problem Identification Programme (ChildPIP) is an important and innovative computer-based system to collect, analyse and report on childhood mortality data. It was developed in South Africa and is modelled on the highly successful Perinatal Problem Identification Programme (PPIP). The aim of ChildPIP is to determine the mortality rates, causes of death [...]
Regular assessments are needed to measure whether there are improvements in mortality rates and whether causes and modifiable factors are being addressed. Only with ongoing assessments can the impact of mortality reports be judged. It is very important to identify and correct causes of death that are not becoming less frequent and modifiable factors that [...]
This is usually an annual report prepared from the monthly results of the mortality meetings. The mortality report gives a summary of the results and also draws conclusions from the results. It is of little value to collect and analyse mortality data throughout the year without interpreting what the results mean. The mortality report should [...]
It is extremely important that the results of the analysis be made available to all who are interested, especially the staff and administration. The results must be used to improve the care of children.
A meeting of all role-players must be called to report and discuss the findings. It is important to identify the most common and most important modifiable factors, especially those that can be addressed and corrected. Doctors, nurses and administrators should work together to find practical answers. A plan must then be developed to implement changes [...]
Once the cause of each death has been established, it is important to look actively for any modifiable factors. It is of little value to know the cause of death if nothing is done to prevent similar deaths due to that cause in future.
By reviewing the data in hospitals and clinics, it is possible to decrease the under-5 mortality and improve the care of children. The problem of a high under-5 mortality rate cannot be addressed until the common causes of death and modifiable factors are fully understood. All health facilities should conduct regular mortality reviews as this [...]
Improve the general health, nutrition and home environment of children. This can be achieved by reducing poverty. Improve the access and quality of care provided by the health system.
