Care pathways during a child’s final illness in rural South Africa: Findings from a social autopsy study


Autoři: Jessica Price aff001;  Merlin Willcox aff002;  Chodziwadziwa Whiteson Kabudula aff003;  Kobus Herbst aff004;  Lisa Hinton aff001;  Kathleen Kahn aff003;  Anthony Harnden aff001
Působiště autorů: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, United Kingdom aff001;  Department of Primary Care and Population Sciences, University of Southampton, Southampton, England, United Kingdom aff002;  MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa aff003;  Africa Health Research Institute, KwaZulu-Natal, South Africa aff004;  School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224284

Souhrn

Background

Half of under-5 deaths in South Africa occur at home, however the reasons remain poorly described and data on the care pathways during fatal childhood illness is limited. This study aimed to better describe care-seeking behavior in fatal childhood illness and to assess barriers to healthcare and modifiable factors that contribute to under-5 deaths in rural South Africa.

Methods

We conducted a social autopsy study on all under-5 deaths in two rural South African health and demographic surveillance system sites. Descriptive analyses based on the Pathways to Survival Framework were used to characterise how caregivers move through the stages of seeking and providing care for children during their final illness and to identify modifiable factors that contributed to death.

Findings

Of 53 deaths, 40% occurred outside health facilities. Rates of antenatal and perinatal preventative care-seeking were high: over 70% of mothers had tested for HIV, 93% received professional assistance during delivery and 79% of children were reportedly immunised appropriately for age. Of the 48 deaths tracked through the stages of the Pathways to Survival Framework, 10% died suddenly without any care, 23% received home care of whom 80% had signs of severe or possibly severe illness, and 85% sought or attempted to seek formal care outside the home. Although half of all children left the first facility alive, only 27% were referred for further care.

Conclusions

Modifiable factors for preventing deaths during a child’s final illness occur both inside and outside the home. The most important modifiable factors occurring inside the home relate to caregivers’ recognition of illness and appreciation of urgency in response to the severity of the child’s symptoms and signs. Outside the home, modifiable factors relate to inadequate referral and follow-up by health professionals. Further research should focus on identifying and overcoming barriers to referral.

Klíčová slova:

Autopsy – Health care facilities – Health care providers – Child health – Children – Mothers – Neonates – South Africa


Zdroje

1. Sustainable Development Goals: 17 goals to transform our world [Internet]. 2015 [cited 5 Jan 2016]. http://www.un.org/sustainabledevelopment/health/

2. World Bank. Mortality rate, under-5 (per 1,000 live births) | Data [Internet]. 2017 [cited 19 May 2019]. https://data.worldbank.org/indicator/SH.DYN.MORT?locations=ZA

3. Price J, Willcox M, Kabudula CW, Herbst K, Kahn K, Harnden A. Home deaths of children under 5 years in rural South Africa: a population-based longitudinal study. Trop Med Int Heal. John Wiley & Sons, Ltd (10.1111); 2019;24: 862–878. doi: 10.1111/tmi.13239 31002201

4. National Department of Health. 2nd Triennial Report of the Committee on Morbidity and Mortality in Children Under 5 Years (CoMMiC): 2014. 2014; http://www.kznhealth.gov.za/mcwh/2nd-CoMMiC-Triennial-Report-Abridged.pdf

5. Källander K, Kadobera D, Williams TN, Nielsen RT, Yevoo L, Mutebi A, et al. Social autopsy: INDEPTH Network experiences of utility, process, practices, and challenges in investigating causes and contributors to mortality. Popul Health Metr. K. Kallander, Department of Health Policy, Planning and Management, School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda. E-mail: k.kallander@malariaconsortium.org: BioMed Central; 2011;9: no pagination. doi: 10.1186/1478-7954-9-44 21819604

6. 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. H.D. Kalter, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, 21205, United States. E-mail: hkalter@jhsph.edu, England: BioMed Central Ltd. (Floor 6, 236 Gray’s Inn Road, London WC1X 8HB, United Kingdom); 2011;9: no pagination. doi: 10.1186/1478-7954-9-45 21819605

7. Moyer C, Aborigo R, Kaselitz E, James K, Chatio S, Williams J. Preventing maternal and neonatal deaths in rural northern ghana (premand): Using social autopsy and gis to understand neonatal deaths and near-misses. Ann Glob Heal. (Moyer, Kaselitz, James) University of Michigan, Ann Arbor, United States (Aborigo, Chatio, Williams) Navrongo Health Research Centre, Navrongo, Ghana; 2017;Conference: 196. http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=emexb&AN=620061018 http://oxfordsfx.hosted.exlibrisgroup.com/oxford?sid=OVID:embase&id=pmid:&id=doi:&issn=2214-9996&isbn=&volume=83&issue=1&spage=196&pages=196&date=2017&title=Annals+of+

8. Källander K. Social Autopsy -A method to examine barriers to health care, risky behaviours and missed opportunities for health interventions. Improving data improving health: Verbal Autopsy for health systems strengthening. London; 2016.

9. Koffi AK, Libite P, Moluh S, Wounang R, Kalter HD. Social autopsy study identifies determinants of neonatal mortality in Doume, Nguelemendouka and Abong–Mbang health districts, Eastern Region of Cameroon. J Glob Health. 2015;5. doi: 10.7189/jogh.05.010413 26171142

10. Koffi AK, Maina A, Yaroh AG, Habi O, Bensaïd K, Kalter HD. Social determinants of child mortality in Niger: Results from the 2012 National Verbal and Social Autopsy Study. J Glob Health. United Kingdom: Edinburgh University Global Health Society; 2016;6: 10603. http://dx.doi.org/10.7189/jogh.06.010603

11. Koffi AK, Kalter HD, Loveth EN, Quinley J, Monehin J, Black RE. Beyond causes of death: The social determinants of mortality among children aged 1–59 months in Nigeria from 2009 to 2013. PLoS One. United States, United States: Public Library of Science (E-mail: plos@plos.org); 2017;12: e0177025. http://dx.doi.org/10.1371/journal.pone.0177025 28562610

12. Price J, Lee J, Willcox M, Harnden A. Place of death, care-seeking and care pathway progression in the final illnesses of children under five years of age in sub-Saharan Africa—a systematic review. under Rev J Glob Heal. 2019;

13. Pattinson R, Rhoda N. Saving babies 2012–2013: Ninth report on perinatal care in South Africa. Pretoria: Tshepesa Press; 2014.

14. Patrick ME, Stephen CR, editors. Saving Children: 2005. A survey of child healthcare in South Africa [Internet]. 2005. http://www.ispotauthenticate.co.za/Joomla/documents/report_saving_children_2005.pdf

15. SAPRIN: South African Population Research Infrastructure Network [Internet]. [cited 7 Jun 2019]. http://saprin.mrc.ac.za/nodes.html

16. Tanser F, Hosegood V, Bärnighausen T, Herbst K, Nyirenda M, Muhwava W, et al. Cohort Profile: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey. Int J Epidemiol. Oxford University Press; 2008;37: 956–62. doi: 10.1093/ije/dym211 17998242

17. Kahn K, Collinson MA, Gomez-Olive FX, Mokoena O, Twine R, Mee P, et al. Profile: Agincourt health and socio-demographic surveillance system. Int J Epidemiol. England; 2012;41: 988–1001. doi: 10.1093/ije/dys115 22933647

18. Gómez-Olivé FX, Montana L, Wagner RG, Kabudula CW, Rohr JK, Kahn K, et al. Cohort Profile: Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). Int J Epidemiol. 2018; doi: 10.1093/ije/dyx247 29325152

19. Audet CM, Ngobeni S, Graves E, Wagner RG. Mixed methods inquiry into traditional healers’ treatment of mental, neurological and substance abuse disorders in rural South Africa. Vermund SH, editor. PLoS One. Public Library of Science; 2017;12: e0188433. doi: 10.1371/journal.pone.0188433 29261705

20. Kabudula CW, Houle B, Collinson MA, Kahn K, Tollman S, Clark S. Assessing Changes in Household Socioeconomic Status in Rural South Africa, 2001–2013: A Distributional Analysis Using Household Asset Indicators. Soc Indic Res. Springer Netherlands; 2017;133: 1047–1073. doi: 10.1007/s11205-016-1397-z 28931968

21. Kabudula CW, Houle B, Collinson MA, Kahn K, Gómez-Olivé FX, Tollman S, et al. Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis. Lancet Glob Heal. Elsevier; 2017;5: e924–e935. doi: 10.1016/S2214-109X(17)30297-8 28807190

22. Nyirenda M, McGrath N, Newell M-L. Gender differentials in the impact of parental death: Adolescent’s sexual behaviour and risk of HIV infection in rural South Africa. Vulnerable Child Youth Stud. Taylor & Francis; 2010;5: 284–296. doi: 10.1080/17450128.2010.507804 21270964

23. Kahn K, Tollman SM, Garenne M, Gear JSS. Validation and application of verbal autopsies in a rural area of South Africa. Trop Med Int Heal. K. Kahn, Department of Communith Health, University of the Witwatersrand, Johannesburg, South Africa. E-mail: kathy@orion.wits.ac.za: Blackwell Publishing Ltd (9600 Garsington Road, Oxford OX4 2XG, United Kingdom); 2000;5: 824–831. http://dx.doi.org/10.1046/j.1365-3156.2000.00638.x

24. D’Ambruoso L, Kahn K, Wager RG, Twine R, Spies B, van der Merwe M, et al. Moving from medical to health systems classifications of deaths: extending verbal autopsy to collect information on the circumstances of mortality. Glob Heal Res Policy. BioMed Central; 2016;1: 2. doi: 10.1186/s41256-016-0002-y 29202052

25. Waldman R, Campbell CC, Steketee RW. Overcoming Remaining Barriers: The Pathway to Survival [Internet]. Arlington; 1996. https://pdf.usaid.gov/pdf_docs/PNABZ644.pdf

26. Moyer CA, Johnson C, Kaselitz E, Aborigo R. Using social autopsy to understand maternal, newborn, and child mortality in low-resource settings: a systematic review of the literature. Glob Health Action. Taylor & Francis; 2017;10: 1413917. doi: 10.1080/16549716.2017.1413917 29261449

27. Koffi AK, Maina A, Yaroh AG, Habi O, Bensaïd K, Kalter HD. Social determinants of child mortality in Niger: Results from the 2012 National Verbal and Social Autopsy Study. J Glob Health. Edinburgh University Global Health Society; 2016;6: 010603. doi: 10.7189/jogh.06.010603 26955473

28. Koffi AK, Libite P-R, Moluh S, Wounang R, Kalter HD. Social autopsy study identifies determinants of neonatal mortality in Doume, Nguelemendouka and Abong-Mbang health districts, Eastern Region of Cameroon. J Glob Health. Scotland; 2015;5: 10413. doi: 10.7189/jogh.05.010413 26171142

29. Kagabo DM, Kirk CM, Bakundukize B, Hedt-Gauthier BL, Gupta N, Hirschhorn LR, et al. Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda. PLoS One. D.M. Kagabo, Partners in Health/Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda. E-mail: dankagabo@gmail.com: Public Library of Science (E-mail: plos@plos.org); 2018;13: e0190739. http://dx.doi.org/10.1371/journal.pone.0190739 29320556

30. Massyn N, Peer N, Padarath A, Barron P, Day C, editors. District Health Barometer 2014/5 [Internet]. Durban; 2015. http://www.hst.org.za/publications/District%20Health%20Barometers/District%20Health%20Barometer%202014-15.pdf

31. Sharkey A, Chopra M, Jackson D, Winch PJ, Minkovitz CS. Influences on healthcare-seeking during final illnesses of infants in under-resourced South African settings. J Heal Popul Nutr. A. Sharkey, United Nations Children’s Fund, 3 United Nations Plaza, New York, NY 10017, United States. E-mail: asharkey@unicef.org, Bangladesh: International Center for Diarrhoeal Disease Research (GPO Box 128, Dhaka 1212, Bangladesh); 2011;29: 379–387. http://www.jhpn.net/index.php/jhpn/article/download/798/783

32. Pattinson R, editor. Saving babies 2008–2009: Seventh report on perinatal care in South Africa. [Internet]. Pretoria: Tshepesa Press; 2011. https://www.ppip.co.za/wp-content/uploads/Saving-Babies-2008-9.pdf

33. Scribante J, Bhagwanjee S. National audit of critical care resources in South Africa—transfer of critically ill patients. South African Med J. Health and Medical Publishing Group; 2007;97: 1323–1326. Available: https://www.ajol.info/index.php/samj/article/view/13939/128375

34. Yeap AD, Hamilton R, Charalambous S, Dwadwa T, Churchyard GJ, Geissler PW, et al. Factors influencing uptake of HIV care and treatment among children in South Africa—a qualitative study of caregivers and clinic staff. AIDS Care. A. D. Yeap, London School of Hygiene and Tropical Medicine, London, United Kingdom. E-mail: adyeap@doctors.org.uk, England: Routledge (4 Park Square, Milton Park, Abingdon, Oxfordshire OX14 4RN, United Kingdom); 2010;22: 1101–1107. doi: 10.1080/09540121003602218 20824563

35. Bogart LM, Chetty S, Giddy J, Sypek A, Sticklor L, Walensky RP, et al. Barriers to care among people living with HIV in South Africa: Contrasts between patient and healthcare provider perspectives. AIDS Care. 2013;25: 843–853. doi: 10.1080/09540121.2012.729808 23061894

36. Gittings L, Price J, Cluver L, Hinton L, Hodes R, Moshabela M, et al. Medical pluralism among children and adolescents in South Africa: methodological findings from mixed methods research. AIDSImpact. London; 2019. http://www.aidsimpact.com/

37. Prost A, Colbourn T, Seward N, Azad K, Coomarasamy A, Copas A, et al. Women’s groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. Lancet. 2013;381: 1736–1746. doi: 10.1016/S0140-6736(13)60685-6 23683640

38. Perry H, Freeman P, Gupta S, Rassekh B. Building on the Current Evidence to Strengthen Community-Based Service Delivery Strategies for Promoting Child Survival [Internet]. 2010. http://207.226.255.123/ccm/ccm_fi

39. Kirkwood BR, Manu A, ten Asbroek AH, Soremekun S, Weobong B, Gyan T, et al. Effect of the Newhints home-visits intervention on neonatal mortality rate and care practices in Ghana: a cluster randomised controlled trial. Lancet. 2013;381: 2184–2192. doi: 10.1016/S0140-6736(13)60095-1 23578528

40. WHO, UNICEF. WHO/UNICEF Joint Statement: Home visits for the newborn child: a strategy to improve survival [Internet]. 2009. https://apps.who.int/iris/bitstream/handle/10665/70002/WHO_FCH_CAH_09.02_eng.pdf;jsessionid=87DD27355A8EEE80022B237CB8290351?sequence=1

41. Perry HB, Sacks E, Schleiff M, Kumapley R, Gupta S, Rassekh BM, et al. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects. J Glob Health. Edinburgh University Global Health Society; 2017;7: 010906. doi: 10.7189/jogh.07.010906 28685044

42. Sutter E, Maphorogo S. The Elim Care Groups: A Community Project for the Control of Trachoma. Community Eye Heal. International Centre for Eye Health; 2001;14: 47. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1705937/

43. Tomlinson M, Doherty T, Ijumba P, Jackson D, Lawn J, Persson LÅ, et al. Goodstart: a cluster randomised effectiveness trial of an integrated, community-based package for maternal and newborn care, with prevention of mother-to-child transmission of HIV in a South African township. Trop Med Int Heal. John Wiley & Sons, Ltd (10.1111); 2014;19: 256–266. doi: 10.1111/tmi.12257 24433230


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PLOS One


2019 Číslo 10