Confidential enquiry is a relatively simple process for existing health staff to carry out, and we have shown it can be effective at reducing child mortality in Uganda and Mali.
- Dr Merlin Willcox, University of Oxford.
Child mortality in Africa could be reduced through a process known as confidential enquiry, according to research led by Dr Merlin Willcox, Prof Anthony Harnden and Prof David Mant from the University of Oxford's Nuffield Department of Primary Care Health Sciences.
The project won the Global Health Dragon's Den at the Royal College of General Practice Annual Conference on 8th October.
In his winning pitch to global health “dragons”, Dr Willcox explained that by studying specific cases of deaths in children under five across Africa, and gaining a better understanding of what went wrong in each case, health workers can identify avoidable factors and make recommendations for how their health system can be improved to reduce mortality.
Dr Willcox’s teams carried out confidential enquiries in several sub-districts of Mali and Uganda, and were able to reduce mortality in children under five in those subdistricts by 18% in Mali, and 27% in Uganda. He believes it can be scaled up to more areas.
“A child in Mali is thirty-times more likely to die before their fifth birthday than a child in the UK,” said Dr Willcox, an Oxford-based GP and clinical researcher in Oxford University’s Nuffield Department of Primary Care Health Sciences. “Child deaths have been investigated through a confidential enquiry in the UK, so we adapted this process to the situation in Africa to see if it could be effective there as well.”
The study was part of the EU-funded HUPAPRIM project, which aimed to assess and develop ways to address the personnel crisis in Africa’s health sector.
“We worked with fieldworkers in Mali and Uganda who investigated each child’s death by interviewing family members and any health workers involved. This information was then reviewed by a panel of local health staff every month who made recommendations for improvements, which can often be implemented immediately.”
The enquiry is participatory, and has had long lasting benefits in Uganda and Mali. “By involving local health workers in the enquiry to identify avoidable factors in each case, there is a better chance of success as they are motivated to improve their own health systems and better target scarce resources. What has been most encouraging is that the project has had a legacy – even after the research team departed, the local health staff have continued to use their new skills to review child deaths and make improvements.
“Confidential enquiry is a relatively simple process for existing health staff to carry out, and we have shown it can be effective at reducing child mortality in Uganda and Mali. So by embedding it in other areas in Africa and low-income countries where health personnel are challenged by few available resources, it could help curb the number of preventable deaths,” concluded Dr Willcox.
Pitches in the Global Health Dragon’s Den were judged on need, impact, sustainability and pitching skill. The five pitches were judged by three expert dragons - including Oxfordshire GP Dr Jill Edwards, RCGP Medical Director for International Programmes Dr Elizabeth Goodburn, and CEO of the Myanmar Academy of Family Physicians Dr Win Zaw.
Dr Willcox is currently applying for funding to continue this work and plans to continue collaborating with colleagues in Africa.