title: Etiology of child mortality in Goroka, Papua New Guinea: a prospective two-year study.
abstract: OBJECTIVE
  To collect accurate data on disease- and microbial-specific causes and avoidable factors in child deaths in a developing country.
  
  
  METHODS
  A systematic prospective audit of deaths of children seen at Goroka Hospital in the highlands of Papua New Guinea was carried out. Over a 24-month period, we studied 353 consecutive deaths of children: 126 neonates, 186 children aged 1-59 months, and 41 children aged 5-12 years.
  
  
  RESULTS
  The most frequent age-specific clinical diagnoses were as follows: for neonates--very low birth weight, septicaemia, birth asphyxia and congenital syphilis; for children aged 1-59 months--pneumonia, septicaemia, marasmus and meningitis; and for children aged 5-12 years--malignancies and septicaemia. At least one microbial cause of death was identified for 179 (50.7%) children and two or more were identified for 37 (10.5%). Nine microbial pathogens accounted for 41% of all childhood deaths and 76% of all deaths that had any infective component. Potentially avoidable factors were identified for 177 (50%) of deaths. The most frequently occurring factors were as follows: no antenatal care in high-risk pregnancies (8.8% of all deaths), very delayed presentation (7.9%), vaccine-preventable diseases (7.9%), informal adoption or child abandonment leading to severe malnutrition (5.7%), and lack of screening for maternal syphilis (5.4%). Sepsis due to enteric Gram-negative bacilli occurred in 87 (24.6%). The strongest associations with death from Gram- negative sepsis were adoption/abandonment leading to severe malnutrition, village births, and prolonged hospital stay.
  
  
  CONCLUSIONS
  Reductions in child mortality will depend on addressing the commonest causes of death, which include disease states, microbial pathogens, adverse social circumstances and health service failures. Systematic mortality audits in selected regions where child mortality is high may be useful for setting priorities, estimating the potential benefit of specific and non-specific interventions, and providing continuous feedback on the quality of care provided and the outcome of health reforms.
authors.affiliation: Goroka Base Hospital, Goroka, Papua New Guinea. duket@cryptic.rch.unimelb.edu.au
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
authors.forename: Audrey
authors.initials: A
authors.lastname: Michael
authors.forename: Joyce
authors.initials: J
authors.lastname: Mgone
authors.forename: Dale
authors.initials: D
authors.lastname: Frank
authors.forename: Tilda
authors.initials: T
authors.lastname: Wal
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sehuko
mesh_terms: D017677:Age Distribution; D001424:Bacterial Infections / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015986:Confounding Factors, Epidemiologic; D004352:Drug Resistance, Microbial; D005260:Female; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D010219:Papua New Guinea / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality; D014777:Virus Diseases / Q000401:mortality