Causes and determinants of infant mortality using verbal autopsy and social autopsy methods in a rural population of Odisha: a community-based matched case-control study.

BACKGROUND

The avoidable causes of infant mortality should be identified, and interventions should be made to improve the infant mortality rate. The cause of infant deaths should be assessed in both medical and social contexts.

OBJECTIVES

We aimed to determine the medical causes of infant mortality by verbal autopsy and its determinants in two rural blocks of the Khordha district of Odisha and assess the pathway of care and delay in seeking care for the illness preceding infant death using the three-delay model.

DESIGN

We conducted this community-based matched case-control study to identify the medical causes of infant mortality using the verbal autopsy method along with the identification of delay and pathway of care related to infant deaths using a social autopsy method.

SETTINGS: Two rural blocks of Odisha, India.

PARTICIPANTS

We enumerated 100 infant deaths by active surveillance and data triangulation from Accredited Social Health Activists, Auxiliary Nurse Midwives and block-level health information systems. We selected an equal number of alive infants matched with cases in a 1:1 ratio with regard to age, gender and residential address.

OUTCOME MEASURES: We conducted the verbal autopsy using the Sample Registration System verbal autopsy tool, where the cause of death ascertainment was done by two independently trained physicians followed by adjudication by one senior trained physician in case of conflicts. We used the prevalidated International Network for the Demographic Evaluation of Population and Their Health tool to assess three delays and pathways of care related to infant deaths.

RESULTS

Most infant deaths (70%) happened during the first day of life, and almost 50% of neonatal deaths occurred during the first week of life. The three most common causes of infant mortality were birth asphyxia (30%), pneumonia (18%), prematurity and low birth weight (14%). Larger family size (>5) and the education status of fathers till class 10 were significant determinants of infant mortality. Among the 49 infants whose illnesses were identified at home, 2 died at home without receiving any care. Formal or informal care was sought for 32 and 8 infants, respectively. The median delay was found to be 24 hours for level 1 delay. Level 1 delay was observed for 20 cases (40.8%), with more than 24 hours in decision-making in care-seeking. Thirty-seven (75.5%) sick infants reached the healthcare facility 30 min after deciding to seek care.

CONCLUSION

Birth asphyxia, pneumonia prematurity and low birth weight were found to be the common causes of infant mortality, with larger family sizes and lower education status among fathers being the significant determinants of infant mortality. We observed a significant delay in decision-making regarding seeking care among caregivers of sick infants.