Failures in the “pathways to survival”
Knowledge of the biological causes of child death is important, but additional information on failures at household, community and health system levels to avert death is critical to improving programs to reduce mortality. Effective delivery of child survival interventions depends on improved understanding of modifiable cultural, social and health system factors affecting health care access and utilization. The “Pathway to Survival” conceptual framework, developed to support implementation of the Integrated Management of Childhood Illness (IMCI) approach, organizes the steps that families, communities and health systems must take to prevent illness and return sick children to health, and provides a useful template for investigating community-health system interaction. (Waldman R, et al. BASICS, 1996) A “social autopsy” data collection tool following the Pathway framework has been used to collect essential information on home care practices, careseeking, treatments and compliance, and the reasons for taking particular actions during the fatal illness of a child in several countries (Kalter HK, et al. BASICS II, 2004). However, these studies used varied methods and none was conducted in nationally representative populations, limiting their generalizability and utility. In addition, recent mortality reductions in older infants have increased the contribution of neonatal death to overall infant mortality, requiring an update of the social autopsy instrument.
Methods and Expected Products
CHERG will establish a working group of experts in cultural and social factors affecting health careseeking to review and ensure that the social autopsy emphasizes factors subject to health program intervention and update the tool to include factors affecting access to and utilization of late fetal and newborn care. CHERG will coordinate, using the new standardized instrument, supporting tools and uniform methods, studies of nationally or country-region representative populations in five countries that will provide broadly applicable information on social contributors to child mortality, while demonstrating the tool’s utility to national health programs in designing the community component of IMCI.
The country working groups will analyze and interpret the data, which will identify amenable factors affecting the provision of home care and careseeking in each country, and will compare the findings across countries to assess whether the importance of particular factors differs across cultural settings. The study findings will be widely disseminated through reports and publications starting in spring 2011.
Kalter HD, Mohan P, Mishra A, Gaonkar N, Biswas AB, Balakrishnan S, Arya G, Babille M. Maternal death inquiry and response in India–the impact of contextual factors on defining an optimal model to help meet critical maternal health policy objectives. Health Res Policy Syst. 2011 Nov 30;9:41.
Kalter HD, Salgado R, Babille M, Koffi AK, Black RE. Social autopsy for maternal and child deaths: a comprehensive literature review to examine the concept and the development of the method. Popul Health Metr. 2011 Aug 5;9:45.