Engaging community health workers in maternal and infant death identification in Khayelitsha, South Africa: a pilot stud
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(2020) 20:736
RESEARCH ARTICLE
Open Access
Engaging community health workers in maternal and infant death identification in Khayelitsha, South Africa: a pilot study Jude Igumbor1* , Olatunji Adetokunboh2,3, Jocelyn Muller2, Edna N. Bosire4, Ademola Ajuwon5, Rene Phetlhu6, Marjorie Mbule2, Agnes Ronan2, Fiona Burtt2, Esca Scheepers2 and Kathrin Schmitz2
Abstract Background: Engaging community health workers in a formalised death review process through verbal and social autopsy has been utilised in different settings to estimate the burden and causes of mortality, where civil registration and vital statistics systems are weak. This method has not been widely adopted. We piloted the use of trained community health workers (CHW) to investigate the extent of unreported maternal and infant deaths in Khayelitsha and explored requirements of such a programme and the role of CHWs in bridging gaps. Methods: This was a mixed methods study, incorporating both qualitative and quantitative methods. Case identification and data collection were done by ten trained CHWs. Quantitative data were collected using a structured questionnaire. Qualitative data were collected using semi-structured interview guides for key informant interviews, focus group discussions and informal conversations. Qualitative data were analysed thematically using a content analysis approach. Results: Although more than half of the infant deaths occurred in hospitals (n = 11/17), about a quarter that occurred at home (n = 4/17) were unreported. Main causes of deaths as perceived by family members of the deceased were related to uncertainty about the quality of care in the facilities, socio-cultural and economic contexts where people lived and individual factors. Most unreported deaths were further attributed to weak facilitycommunity links and socio-cultural practices. Fragmented death reporting systems were perceived to influence the quality of the data and this impacted on the number of unreported deaths. Only two maternal deaths were identified in this pilot study. Conclusions: CHWs can conduct verbal and social autopsy for maternal and infant deaths to complement formal vital registration systems. Capacity development, stakeholder’s engagement, supervision, and support are essential for a community-linked death review system. Policymakers and implementers should establish a functional relationship between community-linked reporting systems and the existing system as a starting point. There is a need for more studies to confirm or build on our pilot findings. Keywords: Verbal autopsy, Social autopsy, Death surveillance and response, Death review, Infant mortality, Stillbirth, Neonatal mortality
* Correspondence: [email protected] 1 School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits
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