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Reducing infant death and use of social autopsy survey

The NDHS  indicate that  neonatal mortality (age 1 to 27 days) rate show that the country looses 37 out of every 1000 live birth,  infant…

The NDHS  indicate that  neonatal mortality (age 1 to 27 days) rate show that the country looses 37 out of every 1000 live birth,  infant (less than one year)  69 deaths in every 1,000 live births and Under five years mortality rate stood at  128 death in every 1,000 live births.
The simple  implication of these data according to the NDHS is that 1 out of every 15 Nigerian children dies before age one year and one out of every eight Nigerian children does not survive to his/her fifth birthday.
Globally, fewer than one third of the 7.6 million  child deaths occurring annually are medically certified.
Whereas it is common information that most neonatal and young child deaths occur in developing countries in Africa and Asia, there are very few data available on the biological cause or the behavioral and social determinant of these deaths.
While a biological illness is defined as the cause of death, in fact most neonatal and young child deaths result from a chain of events that include many cultural, social and health systems factors. Some of these can be prevented even before a woman becomes pregnant by ensuring that she is well nourished and that there is sufficient time between her pregnancies.
As a follow up to the 2013 NDHS, National Population Commission, the John Hopkins School of Public Health and the USAID are taking the collaboration further  to embark on the first ever Nigeria Verbal and Social Autopsy Survey (VASA) before the end of the year.
VASA is designed to directly estimate the cause of death and to indentify health programme priorities. Having identified households where there have been recent deaths during the 2013 NDHS,  a team of interviewers under the VASA arrangement would revisit these household to conduct a verbal/social autopsy interview.
Verbal Autopsy asks about the signs and symptoms that a child has during his or her illness such as cough, difficult breathing and loose stool, it is used to determine the biological cause of death.
Social Autopsy on the other hand is conducted with verbal autopsy to examine the behavioral and social determinant of death, which include actions that were taken to keep the child healthy and to care for the child after taking ill.
Speaking at the national training workshop organized for interviewers, the chairman of NPopC, Eze Duru Iheoma, said: “ This survey means a lot to this country, what the death statistics say about us is very embarrassing. We owe the unborn the duty to stop these avoidable deaths and as such we need to identify the gaps through these survey, the result of which will help spur the critical intervention that would be required,” he said.
 Also speaking at the event, the Chief Technical Assistant of the project, Dr Henry Kalter of the John Hopkins School of Public Health said: “ Nigeria was chosen  for the 2014 VASA because of its large contributions to global mortality.”
According to the Central Intelligence Agency  World Factbook, Nigeria ranks 16th on the world chart for highest infant mortality rate for 2013.
The World Health Organization (WHO) has continually stressed  that the increased use of social autopsy is needed to improve maternal, neonatal and child health programmes in low-income countries.
According to WHO: “Countries unable to record the number of people who die or why they die cannot realize the full potential of their health systems.”
The success of this exercise would rest largely with the communities disposal to the team of interviewers as was the case during the 2013 NDHS. Sensitization would be required at every level of governance to make a massive success of this exercise.
Speaking to Homefront  on the issue, Mrs Amaka Ezenwa, the Project Coordinator said; “We will write to  President Goodluck Ebele Jonathan , state governors, the State Security Service and the Inspector General of Police to inform them that our men will be on the field for 52 days starting from the 1st of November through 22nd December.
“The Federal Commissioners who are representatives of all states of the federation will go ahead of our field officers to soften the ground for us,  what we are embarking on  is the best available method for diagnosing causes of death in settings where many deaths occur outside of medical care and lack proper medical certification,” she said.
Professionals have also expressed  hope that area-specific disease profiles generated from these data can help states  and national health planners improve health resource allocation.
 The chairman of NpopC, Duru Iheoma, also stressed on an aspect of the exercise which borders on ethical training and administration of informed consent of the interviewer.
He said: “We have assembled the interviewers here for another 20 days to take them through, amongst other things, the ethical aspect of conducting research interviews, all respondents have the right, by the way,  to determine for themselves whether or not they will participate in the interview.”
 Experience of VASA exercise from other climes have shown that the data afforded by social autopsy can create awareness that maternal and child deaths are preventable, empower communities to actively participate in interventions for reducing child and maternal deaths, and increase health programme responsiveness and accountability.
Although 2015 is only two months  away, Nigeria  amongst many other  countries are not on track to reach the United Nations Millennium Development Goals (MDGs), particularly Goals 4 and 5, which call for reductions in child and maternal mortality rates. Targeted interventions nonetheless will be needed for rapid progress to take place starting with the success of the VASA exercise.

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