title: Verbal autopsy and therapeutic itinerary of children who die before arrival in a paediatric centre in Yaoundé, Cameroon.
abstract: BACKGROUND
  In Cameroon the rate of infant-juvenile mortality remains high and most death occur in the community. Mortality statistics is usually based on hospital data which are generally insufficient and less reliable. In a context where legislation on death registration is not applied, and where conventional autopsy is not often done, verbal autopsy (VA) provides information on mortality. This study tried to experiment this method and also analyses the therapeutic pathway of a group of children who died before arrival at the emergency department of a pediatric hospital.
  
  
  METHODS
  A cross sectional descriptive study was carried out on children who died before arrival, at the Mother and Child Centre of the Chantal Biya Foundation in Yaounde, between October 2013 and April 2014. The addresses of parents or relatives of the deceased children were registered at the start of the study. Each respondent was interviewed 5 to 6 weeks later at the residence of the deceased child, with the aid of a VA questionnaire. Information obtained was on the socio-demographic characteristics of the families, past history of deceased, clinical presentation and the different health care services sought before the death.
  
  
  RESULTS
  In all, 40 children who died were included in the study. The majority of the deceased children were less than 5 years (82.5%) with 50.0% being less than 1 year of age. Almost half of them (47.5%) had been ill for more than 24 hours, 40% for more than 3 days. Up to 50.0% had not been taken to a health facility. Most of them had visited 2 or 3 other health facilities before dying on the way to our hospital. Auto medication was frequent (42.5%); parents initially recourse to drugs which were either bought or obtained from home. Some parents (25.0%) brought their children only after they had been to a private dispensary, or a traditional healer (15.0%). Only 7.5% benefited from consultation in a public health facility and 2.5% resorted to prayers and incantations. Whatever the kind of care sought, the choice was mostly guided by its proximity (32.5%), advice from a relative (27.5%) or its affordability.
  
  
  CONCLUSIONS
  It is of crucial importance that the government reinforces the measures to avoid the existence of clandestine health centres and check the competence of health care professionals. Improving referral/counter referral system will permit the limitation of fatal medical errors.
authors.affiliation: 1 Faculty of Medicine and Biomedical Sciences, Yaoundé-University I, Yaoundé, Cameroon ; 2 Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon ; 3 Gynaeco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon.
authors.forename: David
authors.initials: D
authors.lastname: Chelo
authors.affiliation: 1 Faculty of Medicine and Biomedical Sciences, Yaoundé-University I, Yaoundé, Cameroon ; 2 Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon ; 3 Gynaeco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon.
authors.forename: Félicitée
authors.initials: F
authors.lastname: Nguefack
authors.affiliation: 1 Faculty of Medicine and Biomedical Sciences, Yaoundé-University I, Yaoundé, Cameroon ; 2 Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon ; 3 Gynaeco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon.
authors.forename: Anicet
authors.initials: A
authors.lastname: Ntoude
authors.affiliation: 1 Faculty of Medicine and Biomedical Sciences, Yaoundé-University I, Yaoundé, Cameroon ; 2 Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon ; 3 Gynaeco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon.
authors.forename: Florence
authors.initials: F
authors.lastname: Soh
authors.affiliation: 1 Faculty of Medicine and Biomedical Sciences, Yaoundé-University I, Yaoundé, Cameroon ; 2 Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon ; 3 Gynaeco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ngou
authors.affiliation: 1 Faculty of Medicine and Biomedical Sciences, Yaoundé-University I, Yaoundé, Cameroon ; 2 Mother and Child Centre of the Chantal Biya Foundation, Yaoundé, Cameroon ; 3 Gynaeco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon.
authors.forename: Paul O
authors.initials: PO
authors.lastname: Koki Ndombo
keywords: Children; death before arrival at hospital; therapeutic itinerary; verbal autopsy (VA)
references.citation: Arch Dis Child. 1976 Jun;51(6):424-9
references.pmid: 942235
references.citation: J Gen Intern Med. 2003 Aug;18(8):646-51
references.pmid: 12911647
references.citation: Sante. 2006 Jan-Mar;16(1):13-9
references.pmid: 16777609
references.citation: BMC Med. 2014 Jan 09;12:5
references.pmid: 24405531
references.citation: Arch Dis Child. 1992 May;67(5):600-2
references.pmid: 1599296
references.citation: PLoS One. 2013;8(1):e54865
references.pmid: 23372783
references.citation: Bull World Health Organ. 2006 Oct;84(10):819-26
references.pmid: 17128362
references.citation: J Clin Pharmacol. 2003 Jul;43(7):768-83
references.pmid: 12856392
references.citation: Indian J Pediatr. 2009 Jan;76(1):45-50
references.pmid: 19391002
references.citation: J Glob Health. 2015 Jun;5(1):010413
references.pmid: 26171142
references.citation: Sante. 2006 Jan-Mar;16(1):5-12
references.pmid: 16777608
references.citation: Sante. 2006 Apr-Jun;16(2):113-7
references.pmid: 17116635
references.citation: J Health Popul Nutr. 2011 Feb;29(1):61-70
references.pmid: 21528791
references.citation: BMC Health Serv Res. 2009 Apr 02;9:61
references.pmid: 19341473
references.citation: PLoS One. 2013 Jun 25;8(6):e66698
references.pmid: 23825556
references.citation: Indian J Pediatr. 2008 Apr;75(4):325-9
references.pmid: 18536884
references.citation: JAMA. 2011 Feb 16;305(7):682-90
references.pmid: 21325184
references.citation: J R Coll Gen Pract. 1982 Mar;32(236):149-62
references.pmid: 7086747
references.citation: Med Care. 2001 Sep;39(9):990-1001
references.pmid: 11502956
references.citation: Trop Med Int Health. 2005 Mar;10(3):240-5
references.pmid: 15730508
references.citation: PLoS Med. 2012;9(3):e1001183
references.pmid: 22412355
references.citation: Yale J Biol Med. 1997 Mar-Apr;70(2):149-60
references.pmid: 9493847
references.citation: Health Serv Res. 2002 Feb;37(1):173-86
references.pmid: 11949919
references.citation: CMAJ Open. 2014 May 01;2(2):E77-85
references.pmid: 25077133
references.citation: Leg Med (Tokyo). 2007 Mar;9(2):83-7
references.pmid: 17276126
references.citation: JAMA. 2007 Feb 28;297(8):831-41
references.pmid: 17327525
references.citation: PLoS One. 2012;7(6):e39391
references.pmid: 22745747
references.citation: Pediatrics. 2008 Mar;121(3):e421-7
references.pmid: 18310162