Home deaths of children under 5 years in rural South Africa: a population-based longitudinal study.
Price J., Willcox M., Kabudula CW., Herbst K., Kahn K., Harnden A.
OBJECTIVES: To determine the proportion of under-5 deaths that occurred at home in rural South Africa, whether care was sought prior to death, and determinants of home deaths amongst those who sought care. METHODS: Verbal autopsy data were used for all under-5 deaths, 2000-2015, in two health and demographic surveillance system sites. Trends in place of death and care-seeking were assessed. Associations between sociodemographic factors and home death despite seeking care were assessed by multivariate logistic regressions. RESULTS: There were 3760 under-5 deaths; 1954 (53%) at home and 1510 (41%) in health facilities. 84% of children who died at home accessed healthcare during their final illness. Among neonates for whom care was sought, those who were 8-27 days old were more likely to die at home than those who were 0-7 days old (OR=5.56, 95%CI 2.69-11.55, p<0.001). Factors associated with home death of infants and young children despite seeking care included low maternal education (OR=1.71, 95%CI 1.31-2.24, p<0.001), larger household size (OR=1.56, 95%CI 1.17-2.06, p=0.002), traditional medicine use (OR=2.33, 95%CI 1.75-3.12, p<0.001) and Mozambican descent (OR=1.47, 95%CI 1.06-2.03, p=0.020). The proportion of HIV-related deaths that occurred at home fell from 60% in 2008-2011 to 39% in 2012-2015 (Chi2 =13.86, p<0.001). CONCLUSION: More than half of under-5 deaths in rural South Africa occurred at home although healthcare was sought for most children, highlighting that home deaths are not simply a function of poor care-seeking. Interventions should target high-risk sociodemographic groups. This article is protected by copyright. All rights reserved.