Svay Rieng Child Verbal Autopsy Study Preliminary Findings Child Health Review Workshop September 27-29, 2010

Why do this study? Actual causes of death for children in Cambodia are not known clearly No vital registration with cause of death assigned WHO causes are based on modeling from surrounding countries No recent data was available

Study Design & Population Conducted in Svay Rieng Operational District Child deaths were first identified through the records of the Svay Rieng Operational District office, the Health Centres in the Svay Rieng OD and through VHSG’s and village chiefs in the 352 villages

Cause of Death (Physician Review) Two pediatricians from the National Pediatric Hospital in Phnom Penh independently reviewed the data For each case the primary cause of death, was assigned and recorded by each physician.

Limitations of the Study Recall bias due to interviews being conducted up to 15 months after the death Under reporting of neonatal deaths Only 10% of deaths reported were neonatal compared to an expected 34% No Gold Standard to compare or validate data for cause of death (e.g. hospital records, autopsy) Only one cause of death assigned but in many cases there were overlapping symptoms that could be attributed to more than one illness

Findings The study reviewed a total of 367 childhood deaths from 0-59 months from August 2008 – October 2009. 37 were neonatal deaths 0-28 days (approximately 10%) 337 were post neonatal deaths 1-59 months (approximately 90%)

Findings Neonates (0-28 days) All mothers had ANC care 95% had TT, most with 3 or more doses 54% of babies were born at health centre or hospital 65% had skilled birth attendance 24% were less than 2.5kg at birth 62% of children died at home; 30% died in hospital Only one third of caregivers received treatment for their sick baby 31% at health centre 69% at Referral Hospital 15% from drug sellers

Findings Post neonates (1mo-59mo) 13% reported to be small at birth 58% died at home, 40% died at hospital and 1% at health centre 11% did not seek care at all; 35% had at least one contact and 54% had two or more contacts for treatment 57% went to health centre 56% went to Referral Hospital 28% went to private clinic (4% to Vietnam) 20% to traditional healer

Age at death Neonates Post Neonates

Age at death 0-59 months

Age at death for Neonates (0-28days)

Age at death for Post Neonates and Children(1-59 months

Causes of Neonatal Deaths (0-28 days)

Causes of Post Neonatal & Child deaths under- nutrition

Conclusions Children are dying at a young age – neonates and young infants <6mo Most neonates are dying from infection (sepsis or pneumonia) followed by birth asphyxia and prematurity/low birth weight Pneumonia is the leading cause of death for post-neonates followed by diarrhoea, meningitis, sepsis and beriberi