Zambia children under the age of 5 die at a rate nearly six to more than ten times higher than in the United States. It’s estimated at 40-75 per 1000, compared to 6.98 per 1000. Rotem Lapidot, MD, assistant professor of pediatrics at Boston University School of Medicine (BUSM), determines why these children are dying.

“Significantly, over 80 percent of all infant deaths in the community have been associated with delays. While it is impossible to know what would have happened without such delays, the majority of infant deaths in Lusaka, the capital of Zambia, are due to causes Effective treatments currently exist, “said Lapidot, the corresponding author of the study, which appeared online in the journal Pediatrics. A significant number of infants die in the community and are referred to as “brought dead” (BID). There is limited data on the problem of deaths in the infant community and understanding the circumstances is critical to reducing child mortality.

To better identify the common health-seeking behaviors that contributed to these deaths, researchers from BUSM and the Boston University School of Public Health (BUSPH) analyzed free-text reports from verbal autopsies of 230 families of BID infants who were younger than were 6 months old. They found that nearly 83 percent of infants had one or more delays in care – the most common delay being the family’s decision to seek care (54.8 percent), although severe symptoms were commonly described. Almost 28 percent of infants died on the way to a health facility. Almost 25 percent of infants experienced delays in receiving adequate care, including infants who died while waiting in a clinic or being referred from a clinic to a hospital. While a third of the infants had been examined by a doctor in the days before their death.

According to the researchers, delays in care have been the rule rather than the exception in this infant population. “In many cases, infants die from receiving no treatment at all or only when the disease is beyond salvation. If our goal is to reduce infant mortality, these results will have profound implications,” adds Lapidot, who also one patient is a pediatric infectious disease specialist at Boston Medical Center.

The researchers said it was important to emphasize that delays in finding care are likely to be complex, multifactorial, and not necessarily reflect negligence on the part of caregivers for the child. Logistical barriers that they believe are insurmountable, particularly in severely impoverished, resource-poor communities such as those typical of the urban poor in Lusaka. “However, our current analysis suggests that there are relatively simple interventions that are low-tech and can be performed at low cost to avoid such delays and save the lives of many infants,” said Lapidot.

“By analyzing open-ended narratives from the verbal autopsies, we were able to examine the context of infant death beyond what is written on a death certificate. We were able to gain a deeper understanding of the circumstances and social factors that led to infant death. This kind of Data is often not given in the scientific literature, but these voices and stories of infant death in underserved communities should be raised and heard urgently, “added former BUSPH research fellow Anna Larson, MPH.

The data used in this study were collected as part of the larger ZPRIME study (Zambia Pertussis RSV Infant Mortality Estimation). “In global health, we are often very focused on introducing new interventions, drugs, vaccines, or technologies as strategies to reduce child mortality. This study reminds us that sometimes very simple interventions have the potential to save lives,” the said Principal researcher on this study Christopher Gill, MD, Associate Professor of Global Health at BUSPH.

The highest child mortality rate for non-Hispanic blacks is provided by the Boston University School of Medicine

Quote: Delays in access to care occurred in more than 80 percent of all infant deaths in the Zambian cohort (March 4, 2021), posted on March 4, 2021 at 03-percent-infant-deaths-zambian- were retrieved. Cohort.html

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