Assessing the causes of under-five mortality in the Albert Schweitzer Hospital service area of rural Haiti.

OBJECTIVES: Limited information is available regarding the causes of under-five mortality in nearly all of the countries in which mortality is the highest. The purpose of this study was to use a standard computerized protocol for defining the leading causes of death among children in a high-mortality rural population of Haiti and to highlight the need for similar studies else-where in Haiti and throughout the high-mortality areas of Latin America and the Caribbean. METHODS: In 2001 a standardized, closed-ended verbal autopsy questionnaire endorsed by the World Health Organization was administered to a representative, population-based sample of the mothers or other caregivers of 97 children who had died before reaching 5 years of age between 1995 and 1999 in the service area of the Albert Schweitzer Hospital, which is located in the rural Artibonite Valley of Haiti. With the data from the questionnaires we used a computerized algorithm to generate diagnoses of the cause of death; the algorithm made it possible to have more than one cause of death. RESULTS: Acute lower respiratory infection (ALRI) was the leading diagnosis, present in 45% of all under-five deaths, followed by enteric diseases, present in 21% of deaths. Neonatal tetanus, preterm birth, and other early neonatal causes unassociated with ALRI or diarrhea were present in 41% of the neonatal deaths. Among children 1-59 months of age, ALRI was present in 51% of the deaths, and enteric diseases in 30%. Deaths were concentrated during the first few months of life, with 35% occurring during the first month. Among the neonatal deaths, 27% occurred on the first day of life, and 80% occurred during the first 10 days of life. CONCLUSIONS: In the Albert Schweitzer Hospital program area--and presumably in other areas of Haiti as well--priority needs to be given to the prevention of and the early, effective treatment of ALRI, diarrhea, and early neonatal conditions. This study points to the need for more, similar standardized assessments to guide local, regional, and national programs.

Assessing the causes of under-five mortality in the Albert Schweitzer Hospital service area of rural Haiti

OBJETIVOS: Hay poca información acerca de las causas de mortalidad en niños menores de cinco años en casi todos los países donde la mortalidad alcanza las cifras más altas. El objetivo del presente estudio fue usar un protocolo computadorizado estandarizado para determinar cuáles son las principales causas de muerte entre los niños de una zona rural de Haití que tiene tasas de mortalidad elevadas, así como llamar la atención a la necesidad de realizar estudios semejantes en otros lugares de Haití y en todas las zonas de América Latina y el Caribe donde la mortalidad es alta. MÉTODOS: En 2001 se administró un cuestionario estándar de autopsia verbal a base de preguntas cerradas, respaldado por la Organización Mundial de la Salud, a una muestra poblacional representativa de las madres o guardianes de 97 niños que habían fallecido entre 1995 y 1999 antes de cumplir los 5 años de edad en la zona atendida por el Hospital Albert Schweitzer, situado en el valle rural de Artibonita en Haití. Los datos obtenidos mediante los cuestionarios permitieron crear un algoritmo computadorizado para generar los diagnósticos asociados con la causa de muerte. El algoritmo daba cabida a más de una causa de muerte. RESULTADOS: La infección respiratoria baja (IRB) fue el diagnóstico más frecuente, habiéndose encontrado en 45% de las defunciones de niños menores de 5 años. Le siguieron las enfermedades entéricas, que se hallaron en 21% de los casos. El tétanos neonatal, el nacimiento prematuro y otras causas neonatales tempranas que no se asociaban con una IRB ni con diarrea estuvieron presentes en 41% de los casos de muerte neonatal. Entre los niños de 1 a 59 meses de edad, se encontró el diagnóstico de IRB en 51% de los casos de defunción y el de alguna enfermedad entérica en 30%. Las defunciones se produjeron eminentemente en los primeros meses de vida, con 35% de ellas durante el primer mes. De las muertes neonatales, 27% tuvieron lugar durante el primer día de vida, y 80% en los primeros 10 días después de nacer...

Assessing the causes of under-five mortality in the Albert Schweitzer Hospital service area of rural Haiti

OBJECTIVES. Limited information is available regarding the causes of under-five mortality in nearly all countries in which mortality is the highest. The purpose of this study was to use a standard computerized protocol for defining the leading cause of death among children in a high-mortality rural population of Haiti and to highlight the need for similar studies elsewhere in Haiti and throughout the high-mortality areas of Latin America and the Caribbean. METHODS. In 2001 a standardized, closed-ended verbal autopsy questionnaire endorsed by the World Health Organization was administered to a representative, population-based sample of the mothers or other caregivers of 97 children who had died before reaching 5 years of age between 1995 and 1999 in the service area of the Albert Schweitzer Hospital, which is located in the rural Artibonite Valley of Haiti. With the data from the questionnaires we used a computerized algorithm to generate diagnoses of the cause of death; the algorithm made it possible to have more than one cause death. RESULTS. Acute lower respiratory infection (ALRI) was the leading diagnosis, present in 45 percent of all under-five deaths, followed by enteric diseases, present in 21 percent of deaths. Neonatal tetanus, preterm birth, and other early neonatal causes unassociated with ALRI or diarrhea were present in 41 percent of the neonatal deaths. Among children 1-59 months of age, ALRI was present in 51 percent of the deaths, and enteric diseases in 30 percent. Deaths were concentrated during the first few months of life, with 35 percent occuring during the first month. Among the neonatal deaths, 27 percent occurred on the first day of life and 80 percent occured during the first 10 days of life. CONCLUSIONS. In the Albert Schweitzer Hospital program area - and presumably in other areas of Haiti as well - priority needs to be given to the prevention of and early, effective treatment of ALRI, diarrhea, and early neonatal conditions. This study points to the need for more, similar standardized assessments to guide local, regional, and national programs (AU)

Assessing the causes of under-five mortality in the Albert Schwitzer Hospital service area of rural Haiti

OBJECTIVES: Limited information is available regarding the causes of under-five mortality in nearly all of the countries in which mortality is the highest. The purpose of this study was to use a standard computerized protocol for defining the leading causes of death among children in a high-mortality rural population of Haiti and to highlight the need for similar studies elsewhere in Haiti and throughout the high-mortality areas of Latin America and the Caribbean. METHODS: In 2001 a standardized, closed-ended verbal autopsy questionnaire endorsed by the World Health Organization was administered to a representative, population-based sample of the mothers or other caregivers of 97 children who had died before reaching 5 years of age between 1995 and 1999 in the service area of the Albert Schweitzer Hospital, which is located in the rurual Artibonite Valley of Haiti.With the data from the questionnaires we used a computerized algorithm to generate diagnoses of the causes of death; the algorithm made it pssible to have more than one cause of death. RESULTS: Acute lower respiratory infection (ALRI) was the leading diagnosis, present in 45 percent of all under-five deaths, followed by enteric diseases, present in 21 percent of deaths. Neonatal tetanus, preterm birth, and other early neonatal causes unassociated with ALRI or diarrhea were present in 41 percent of the neonatal deaths. Among children 1-59 months of age, ALRI were present in 51 percent of the deaths, and enteric diseases in 30 percent. Deaths were concentrated during the first few months of life, with 35 percent ocurring during the first month. Among the neonatal deaths, 27 percent occurred on the first day of life, and 80 percent occurred during the first 10 days of life. CONCLUSIONS: In the Albert Schweitzer Hospital program area - and presumably in the areas of Haiti as well - priority needs to be given to the prevention of and the early, effective treatment of ALRI, diarrhea, and early neonatal conditions. This study points to the needs for more, similar standardized assessments to guide local, regional and national programs(AU)