title: Social determinants of child mortality in Niger: Results from the 2012 National Verbal and Social Autopsy Study.
abstract: BACKGROUND
  Understanding the determinants of preventable deaths of children under the age of five is important for accelerated annual declines - even as countries achieve the UN's Millennium Development Goals and the target date of 2015 has been reached. While research has documented the extent and nature of the overall rapid decline in child mortality in Niger, there is less clear evidence to provide insight into the contributors to such deaths. This issue is the central focus of this paper.
  
  
  METHODS
  We analyzed a nationally representative cross-sectional sample of 620 child deaths from the 2012 Niger Verbal Autopsy/Social Autopsy (VASA) Survey. We conducted a descriptive analysis of the data on preventive and curative care, guided by the coverage of proven indicators along the continuum of well child care and illness recognition and care-seeking for child illnesses encompassed by the BASICS/CDC Pathway to Survival model.
  
  
  RESULTS
  Six hundred twenty deaths of children (1-59 months of age) were confirmed from the VASA survey. The majority of these children lived in households with precarious socio-economic conditions. Among the 414 children whose fatal illnesses began at age 0-23 months, just 24.4% were appropriately fed. About 24% of children aged 12-59 months were fully immunized. Of 601 children tracked through the Pathway to Survival, 62.4% could reach the first health care provider after about 67 minutes travel time. Of the 306 children who left the first health care provider alive, 161 (52.6%) were not referred for further care nor received any home care recommendations, and just 19% were referred to a second provider. About 113 of the caregivers reported cost (35%), distance (35%) and lack of transport (30%) as constraints to care-seeking at a health facility.
  
  
  CONCLUSIONS
  Despite Niger's recent major achievements in reducing child mortality, the following determinants are crucial to continue building on the gains the country has made: improved socio-economic state of the poor in the country, investment in women's education, adoption of the a law to prevent marriage of young girls before 18 years of age, and implementation of health programs that encourage breastfeeding and complementary feeding, immunization, illness recognition, prompt and appropriate care-seeking, and improved referral rates.
authors.affiliation: The Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Alain K
authors.initials: AK
authors.lastname: Koffi
authors.affiliation: Institut National de la Statistique, Niamey, Niger.
authors.forename: Abdou
authors.initials: A
authors.lastname: Maina
authors.affiliation: Ministry of Health, Niamey, Niger.
authors.forename: Asma Gali
authors.initials: AG
authors.lastname: Yaroh
authors.affiliation: Institut National de la Statistique, Niamey, Niger.
authors.forename: Oumarou
authors.initials: O
authors.lastname: Habi
authors.affiliation: UNICEF/Niger country office, Niamey, Niger (retired staff).
authors.forename: Khaled
authors.initials: K
authors.lastname: Bensaïd
authors.affiliation: The Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Henry D
authors.initials: HD
authors.lastname: Kalter
mesh_terms: D001344:Autopsy / Q000379:methods; D002423:Cause of Death; D000067576:Child Health; D046688:Child Mortality; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition / Q000401:mortality / Q000517:prevention & control; D009548:Niger; D011203:Poverty; D012959:Socioeconomic Factors