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Institute for International Programs

Niger Verbal Autopsy and Social Autopsy Studies (VASA)

The VASA interviews in Niger were conducted on the platform of a 25,024 household national mortality survey (NNMS) undertaken by the National Statistics Institute (INS). This survey identified deaths of children up to 59 months of age from a full birth history of women age 15-49 years. Following completion of the NNMS, the INS conducted the VASA study with technical support from the Johns Hopkins Bloomberg School of Public Health (JHSPH).

The VASA interviewers returned to households where a death was determined to have occurred in the prior 5 years, and conducted the VASA interviews with recall periods (the time from death until interview) of up to 5 years. Ideally, a VASA interview should be conducted within 1 year after a death, but it was necessary to extend the period in order to obtain an adequate sample size of deaths. The VASA study provided estimates of the proportions of deaths due to important causes for neonates such as birth asphyxia, preterm birth and sepsis, and for 1-59 month olds such as malaria, pneumonia and diarrhea; and also estimated the percentage of deaths lacking key preventive actions and affected by behavioral and social factors such as problematic careseeking and inadequate care given by formal heath care providers, as well as examined the reasons for these problems. The VASA study directly measured neonatal and child mortality and its determinants in Niger, providing data that are vital to developing effective interventions and which could meaningfully contribute to global mortality estimates, with the following three specific aims:

  1. Estimate the cause distributions of death, separately for neonates (0-27 days old) and young children (1-59 months old), in Niger;
  2. Estimate the proportions of deaths, by cause, of neonates and young children that occur in  health facilities in Niger; and
  3. Estimate the prevalence of social factors contributing to deaths of neonates and young children in Niger.

VASA interviews were successfully completed for 1166 deceased children including 93 stillbirths, 453 neonatal deaths and 620 young child deaths. Although the deaths were identified by the platform NNMS survey’s birth history, which did not identify stillbirths, some of the deaths were determined by the VASA study to be stillbirths. The majority of the deceased children’s parents were illiterate, and poor socioeconomic conditions were reported for most of the households. According to the results, most newborns and young children in Niger died of preventable illnesses, with the main causes of death being pneumonia, birth asphyxia and sepsis for neonates, and pneumonia, meningitis and malaria among 1-59 month olds. When outside care was sought, the majority of caregivers (of 92% of neonates and 96% of young children) sought or tried to seek some kind of formal care. Cost, distance, and lack of transportation were the main constraints to formal health care seeking.

Detailed findings, conclusions and recommendations can be found in the study report and related materials.

In addition to the CHERG grant funding, the VASA study in Niger was supported by the Niger country office of UNICEF.

Publications

Verbal/Social Autopsy in Niger 2012–2013: a new tool for a better understanding of the neonatal and child mortality situation. Bensaid K, Yaroh AG, Kalter HD, Koffi AK, Amouzou A, Maina A, Kazmi N. JOGH. 2016. doi: 10.7189/jogh.06.010602 

Social determinants of child mortality in Niger: results from the 2012 National Verbal and Social Autopsy Study. Koffi AK, Maina A, Yaroh AG, Habi O, Bensaid K, Kalter HD. JOGH. 2016. doi: 10.7189/jogh.06.010603

Verbal/social autopsy study helps explain the lack of decrease in neonatal mortality in Niger, 2007–2010. Kalter HD, Yaroh AG, Maina A, Koffi AK, Bensaid K, Amouzou A, Black RE. JOGH. 2016. doi: 10.7189/jogh.06.010604

Direct estimates of national neonatal and child cause–specific mortality proportions in Niger by expert algorithm and physician–coded analysis of verbal autopsy interviews. Kalter HD, Roubanatou AM, Koffi A, Black RE. JOGH. 2015. doi: 10.7189/jogh.05.010415