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American Academy of Pediatrics
Article

Verbal Autopsies for Out-of-Hospital Infant Deaths in Zambia

Rotem Lapidot, Anna Larson Williams, William B. MacLeod, Magdalene Mwale, Ronke Olowojesiku, Andrew Enslen, Lawrence Mwananyanda, Gertrud Munanjala, Charles Chimoga, Benard Ngoma, Donald L. Thea and Christopher John Gill
Pediatrics April 2021, 147 (4) e20201767; DOI: https://doi.org/10.1542/peds.2020-1767
Rotem Lapidot
aDivision of Pediatric Infectious Diseases, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts;
bDepartment of Pediatrics, School of Medicine and
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Anna Larson Williams
cDepartment of Global Health, School of Public Health, Boston University, Boston, Massachusetts;
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William B. MacLeod
cDepartment of Global Health, School of Public Health, Boston University, Boston, Massachusetts;
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Magdalene Mwale
dRight to Care, Equip, Lusaka, Zambia;
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Ronke Olowojesiku
eMedical College of Georgia, Augusta, Georgia; and
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Andrew Enslen
fSchool of Medicine, University of California, San Diego, San Diego, California
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Lawrence Mwananyanda
cDepartment of Global Health, School of Public Health, Boston University, Boston, Massachusetts;
dRight to Care, Equip, Lusaka, Zambia;
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Gertrud Munanjala
dRight to Care, Equip, Lusaka, Zambia;
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Charles Chimoga
dRight to Care, Equip, Lusaka, Zambia;
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Benard Ngoma
dRight to Care, Equip, Lusaka, Zambia;
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Donald L. Thea
cDepartment of Global Health, School of Public Health, Boston University, Boston, Massachusetts;
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Christopher John Gill
cDepartment of Global Health, School of Public Health, Boston University, Boston, Massachusetts;
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Abstract

OBJECTIVES: In Zambia, a significant number of infants die in the community. It is hypothesized that delays in care contribute to many of these so-called “brought in dead” infants.

METHODS: We analyzed free-text narratives from verbal autopsies, in which families narrate the final series of events leading to each infant’s death. Using the 3-delays model framework and working iteratively to achieve consensus, we coded each narrative using NVivo software to identify, characterize, and quantify the contribution of delays and other factors to the fatal outcome.

RESULTS: Verbal autopsies were collected from 230 families of brought in dead infants younger than 6 months of age. As many as 82.8% of infants had 1 or more delays in care. The most-common delay was in the family’s decision to seek care (54.8%), even as severe symptoms were frequently described. Similarly, 27.8% of infants died en route to a health care facility. Delays in receiving adequate care, including infants dying while waiting in line at a clinic or during referral from a clinic to a hospital, occurred in 24.7% of infants. A third of infants had been previously evaluated by a clinician in the days before their death.

CONCLUSIONS: Delays in care were the rule rather than the exception in this population of Zambian infants. Accessing care requires families to navigate significant logistic barriers, and balance complex forces in deciding to seek care. Strategies to avoid such delays could save many infants lives.

  • Accepted December 28, 2020.
  • Copyright © 2021 by the American Academy of Pediatrics

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Pediatrics
Vol. 147, Issue 4
1 Apr 2021
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Verbal Autopsies for Out-of-Hospital Infant Deaths in Zambia
Rotem Lapidot, Anna Larson Williams, William B. MacLeod, Magdalene Mwale, Ronke Olowojesiku, Andrew Enslen, Lawrence Mwananyanda, Gertrud Munanjala, Charles Chimoga, Benard Ngoma, Donald L. Thea, Christopher John Gill
Pediatrics Apr 2021, 147 (4) e20201767; DOI: 10.1542/peds.2020-1767

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Verbal Autopsies for Out-of-Hospital Infant Deaths in Zambia
Rotem Lapidot, Anna Larson Williams, William B. MacLeod, Magdalene Mwale, Ronke Olowojesiku, Andrew Enslen, Lawrence Mwananyanda, Gertrud Munanjala, Charles Chimoga, Benard Ngoma, Donald L. Thea, Christopher John Gill
Pediatrics Apr 2021, 147 (4) e20201767; DOI: 10.1542/peds.2020-1767
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