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Institute for International Programs

Demographic and Health Survey

A Verbal/Social Autopsy Study to Improve Estimates of the Causes and Determinants of Neonatal and Child Mortality (Nigeria)

Completed in late 2013, the 40,680 household 2013 Demographic and Health Survey (DHS) was supported by USAID and conducted by the National Population Commission (NPC) of Nigeria to plan and conduct the 2013 Demographic and Health Survey (DHS) that identified recent deaths of children under 5 years old from a full birth history of women age 15-49 years. With support from USAID and US Fund for UNICEF’s Child Health and Epidemiology Reference Group (CHERG) grant from the Bill and Melinda Gates Foundation, JHU faculty is working with the NPC to implement a national-level verbal autopsy-social autopsy (VASA) study on the platform of the DHS.  The VASA interviewers will return to households where a death was determined to have occurred in up to the prior 5 years to conduct the VASA interviews. Data on the biological causes or social and behavioral determinants of these deaths are vital to the Government of Nigeria’s efforts to develop effective interventions and which could meaningfully contribute to global mortality estimates.  The VASA study will directly measure neonatal and child mortality and its determinants in Nigeria, with the following three specific aims:

Verbal autopsy (VA) – causes of death

Verbal autopsy is the most useful tool available to determine cause of death in settings with limited access to health care. A VA inquiry of a child’s death consists of interviewing the main caregiver about the fatal illness. The cause of death is determined from predefined combinations of the reported illness signs; by independent classification of the interview findings by one or more study physicians; or by statistical methods that examine the associations between particular signs and illnesses.

Social autopsy (SA) – social and behavioral determinants of death 

While knowledge of the biological causes of child death is important, 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 (figure), organizes the steps that families, communities and health systems must take to prevent illness and return sick children to health.

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