VERBAL AUTOPSY IN KARACHI SLUMS - COMPARING SINGLE AND MULTIPLE CAUSEOF CHILD DEATHS

Background: Children dying in developing countries often have more tha n one serious disease process. Identifying the single most important i s difficult and risks omitting valuable information. We report pattern s of childhood death in Karachi slums comparing single and multiple ca use analysis. Methods: The Aga Khan University has developed primary h ealth care programmes in Karachi slums where community health workers maintain monthly surveillance of families with children aged under fiv e years. We investigated all deaths among children under five from 199 0 to 1992 when the overall IMR was 78. We used a structured verbal aut opsy questionnaire comprised of verbatim and symptom check-list sectio ns. Reviewers assigned up to four diagnoses per death. We compared ana lysis by single (main) cause and multiple (consolidated) causes per ca se. Results: Overall, the 431 cases had 627 causes of death; 156 cases (36%) had more than one cause of death. By consolidated analysis, dia rrhoea, malnutrition, row birth weight (LBW), acute respiratory infect ion (ARI), and vaccine preventable diseases played roles in 41%, 24%, 22%, 13%, and 2% of deaths, respectively. Proportionate mortality rati os by main cause (1 diagnosis per child) analysis for the same diagnos es were: 39%, 1%, 8%, 11%, and 1%, respectively. Half of all child dea th occurred by age 3 months. Eighty-three per cent (146/176) of fatal diarrhoea syndromes were due to acute watery diarrhoea, and 41% (72/17 6) were associated with severe malnutrition (vs 21% [12/56] of fatal A RI cases). Each verbal autopsy cost an estimated US$4.00, an annual co st of US$0.08 per programme child. Implications: Compared to single ma in cause analysis, consolidated analysis more completely assesses reas ons for child death to guide programme response. We propose that healt h planning for populations with low vaccine coverage or common co-morb id conditions, such as malaria and anaemia, would particularly benefit from analysis of death seeking multiple causes.