HIGH MORTALITY DESPITE GOOD CARE-SEEKING BEHAVIOR - A COMMUNITY STUDYOF CHILDHOOD DEATHS IN GUINEA-BISSAU

The care-seeking behaviour of mothers of 125 children deceased aged 13 0 months was investigated by verbal autopsy in an urban area of Guinea -Bissau. A total of 93% of the children were seen at a health centre o r hospital during the 2 weeks before death. In a previous survey cover ing the period 1987-90 we found that 78% of the children who died had presented for consultation (8); despite this increase in care seeking, infant mortality had not decreased. Comparison of elapsed time from d isease onset to first consultation between children who died and match ed surviving controls indicated that the interval was shorter for chil dren who died than for those who survived (odds ratio (OR) = 0.7; 95% confidence interval (CI): 0.5-0.99). Of the 125 terminally ill childre n, 56 were hospitalized A total of 20 children died on the way to hosp ital or while waiting in the outpatient clinic. Lack of hospital beds resulted in 15 mothers being refused hospitalization for their child. Of hospitalized children, 42% were discharged as improved or recovered during the 30 days preceding death. These results reveal a need for i mproved hospital admission criteria, improved recognition of the sympt oms of serious illness, better discharge criteria, and the implementat ion of quality assurance systems for health services.