“Malaria, Malnutrition, or Myth?”
COLETTE SOLEBO, PETER SIDEBOTHAM, NEIL RAYMOND
WARWICK MEDICAL SCHOOL, THE UNIVERSITY OF WARWICK, AND THE UNIVERSITY OF LAGOS, COLLEGE OF MEDICINE
1. INTRODUCTION
3. AIM AND OBJECTIVES
Aim
To evaluate the effectiveness, validity and acceptability of current systems for investigating unexpected U5 child
deaths in Lagos, Nigeria; in order to more fully inform the development of further preventive measures
Over 90% of the 10.6 million deaths in children in 2004
occurred in developing countries, and Sub-Saharan
Africa alone contributed to over 40% of this figure(1).
This massive proportion of child deaths is due to the
burden of disease associated with 5 major health
conditions shown below (2) in red:
Objectives
1. Describe what constitutes an “unexpected death” why it is important in this population in Lagos, Nigeria
2. Determine the causal distribution of all deaths in childhood at the Children’s Emergency Room, LUTH Lagos.
Figure 2 (5)
Sudden Death In Developing Countries- Not all
Children Die of Malaria
In developing countries, not all children with signs and
symptoms of an identified disease will die, and so those who
do succumb within a defined time frame such as that
provided by the Fleming (6), are in fact dying suddenly
2. BACKGROUND
Fewer and Farther between: Childhood
Deaths in Developed Countries
The massive economic and industrial growth of the 19th
century, resulted in many developed countries no
longer having an overwhelming number of deaths
from these 5 causes, as they were found to be
preventable, and amenable to advances in science
and medicine such as antibiotics, improved obstetric
and perinatal care & immunization (3).
Due to slower economic development, and factors such
as unchecked population growth, civil wars &
administrative corruption, these interventions are not
as successful in developing countries
Under5 Deaths=How healthy is your
population?
The under 5 mortality index is the most closely watched
indicator of a country’s development (4), and as a
result the epidemiology of the causes of death
affecting that age group is very important in planning
health policy.
Understanding childhood death requires investigating
the factors in and around the child (see Fig. 2) which
exert the greatest influence, and how they interrelate.
3. Evaluate current practice and procedure involved in arriving at the causes of deaths which are unexpected in the
LUTH Children’s Emergency Room, for effectiveness, validity and acceptability to staff and patients’ parents.
4. Explore what alternative procedures or processes exist and are in use in similar settings in developing and
developed countries for reviewing childhood deaths
4. PROPOSED METHODOLOGY
The effectiveness of available systems of investigation
for the common causes of unexpected death in the 05 age groups,
Identifying preventable causes still leading to sudden
death i.e. within 24 hours of presentation in this age
group,
The part played by socio-cultural factors in sustained
high rates of child death.
Impact of these factors on the implementation of
available child death investigation methods
A “sudden/unexpected” death is:
"the death of a child which was not anticipated as a significant possibility
24 hours before the death, or where there was a collapse leading to or
precipitating the events which led to the death” (6)
It is unusual to consider these explained deaths to be “sudden”
quite in the same way as developed countries.
Developed countries more often apply the criteria provided by
this definition, to their unexpected deaths, from less obvious
causes e.g. following child abuse and/or neglect, and
Sudden Infant Death Syndrome (SIDS).
6. POSSIBLE BARRIERS
Reluctance of parents to participate in interviews, due to
different cultural responses to bereavement.
“Abiku”, “Vaccines are poison” –The impact of
beliefs systems on Child Health in Nigeria
Availability of only hard copy data and so retrieval may
take up additional time, and may require additional
assistance-
The population selected for this study is based in Lagos,
Nigeria, West Africa which has the 6th highest U5 mortality
in the region, but the 2nd highest child mortality globally (7).
It is essential to also observe the sociocultural context of the
location, e.g. impact of belief systems on healthcare delivery
in Nigeria, e.g. the fear of polio vaccination, => Polio
resurgence circa 2004 (8), traditional beliefs such Abiku (9),
where the child was believed to be a roaming spirit who dies
to be reborn into the same family. Such beliefs have an as
yet undetermined impact e.g. are “Abiku” parents resigned
to “impending death”?
5. ANTICIPATED BENEFITS
7. REFERENCES
1.
2.
3.
4.
Figure 3
5.
6.
7.
8.
9.
LOPEZ, A.D.; MATHERS,C.D.; EZZATI,M.; JAMISON, D.T.; MURRAY, C.J.L (2006) Global and regional burden of disease and risk factors, 2001:
systematic analysis of population health data. Lancet 367: 1747–57
BRYCE, J., BOSCHI-PINTO, C., SHIBUYA, K., BLACK, R. E. & REFER, W. H. O. C. H. E. (2005) WHO estimates of the causes of death in children.
Lancet, 365, 1147-1152.
AHMAD, O. B., LOPEZ, A. D. & INOUE, M. (2000) The decline in child mortality: a reappraisal. Bulletin of the World Health Organization, 78, 11751191.
MORRIS, S. (2004) Commentary: Monitoring trends in under-5 mortality: better believe it’s true. International Journal of Epidemiology 2004;33:1302–
1303
SIDEBOTHAM, P. & FLEMING, P. (2007) Unexpected Death in Childhood; a handbook for Practitioners, Chichester, John Wiley and Sons.
FLEMING, P., BLAIR, P., BACON, C. & BERRY, P. (2000) Sudden Unexpected deaths in infancy. The CESDI SUDI studies. London.
BLACK, R. E., MORRIS, S. S. & BRYCE, J. (2003) Where and why are 10 million children dying every year? Lancet, 361, 2226-2234
YAHYA, M. (2007) Polio vaccines - "No thank you"! Barriers to polio eradication in northern Nigeria. African Affairs, 106, 185-204.
OGUNJUYIGBE, P. (2004) Under-Five Mortality in Nigeria: Perception and Attitudes of the Yorubas towards the Existence of “Abiku”.
DEMOGRAPHIC RESEARCH, 11, 43-56.
Contact: DR COLETTE SOLEBO email: C.Solebo@warwick.ac.uk