Engaging community health workers in maternal and infant death identification in Khayelitsha, South Africa : a pilot study
Date
2020-11-26
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
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.
Description
CITATION: Igumbor, J., et al. 2020. Engaging community health workers in maternal and infant death identification in Khayelitsha, South Africa : a pilot study. Pregnancy and Childbirth, 20:736, doi:10.1186/s12884-020-03419-4.
Keywords
Verbal autopsy, Mothers -- Death -- Causes -- South Africa -- Cape Town -- Khayelitsha, Infants -- Death -- Causes -- South Africa -- Cape Town -- Khayelitsha, Community health services -- South Africa -- Cape Town -- Khayelitsha
Citation
Igumbor, J., et al. 2020. Engaging community health workers in maternal and infant death identification in Khayelitsha, South Africa : a pilot study. Pregnancy and Childbirth, 20:736, doi:10.1186/s12884-020-03419-4