title: Sociodemographic, behavioral, and environmental factors of child mortality in Eastern Region of Cameroon: results from a social autopsy study.
abstract: BACKGROUND
  While most child deaths are caused by highly preventable and treatable diseases such as pneumonia, diarrhea, and malaria, several sociodemographic, cultural and health system factors work against children surviving from these diseases.
  
  
  METHODS
  A retrospective verbal/social autopsy survey was conducted in 2012 to measure the biological causes and social determinants of under-five years old deaths from 2007 to 2010 in Doume, Nguelemendouka, and Abong-Mbang health districts in the Eastern Region of Cameroon. The present study sought to identify important sociodemographic and household characteristics of the 1-59 month old deaths, including the coverage of key preventive indicators of normal child care, and illness recognition and care-seeking for the children along the Pathway to Survival model.
  
  
  RESULTS
  Of the 635 deceased children with a completed interview, just 26.8% and 11.2% lived in households with an improved source of drinking water and sanitation, respectively. Almost all of the households (96.1%) used firewood for cooking, and 79.2% (n = 187) of the 236 mothers who cooked inside their home usually had their children beside them when they cooked. When 614 of the children became fatally ill, the majority (83.7%) of caregivers sought or tried to seek formal health care, but with a median delay of 2 days from illness onset to the decision to seek formal care. As a result, many (n = 111) children were taken for care only after their illness progressed from mild or moderate to severe. The main barriers to accessing the formal health system were the expenses for transportation, health care and other related costs.
  
  
  CONCLUSIONS
  The most common social factors that contributed to the deaths of 1-59-month old children in the study setting included poor living conditions, prevailing customs that led to exposure to indoor smoke, and health-related behaviors such as delaying the decision to seek care. Increasing caregivers' ability to recognize the danger signs of childhood illnesses and to facilitate timely and appropriate health care-seeking, and improving standards of living such that parents or caregivers can overcome the economic obstacles, are measures that could make a difference in the survival of the ill children in the study area.
authors.affiliation: Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, USA.
authors.forename: Alain K
authors.initials: AK
authors.lastname: Koffi
authors.affiliation: National Institute of Statistics, Yaoundé, Cameroon.
authors.forename: Romain S
authors.initials: RS
authors.lastname: Wounang
authors.affiliation: University of Yaoundé I, Department of Pediatrics, Yaoundé, Cameroon.
authors.forename: Félicitée
authors.initials: F
authors.lastname: Nguefack
authors.affiliation: Ministry of Health, Yaoundé, Cameroon.
authors.forename: Seidou
authors.initials: S
authors.lastname: Moluh
authors.affiliation: National Institute of Statistics, Yaoundé, Cameroon.
authors.forename: Paul-Roger
authors.initials: PR
authors.lastname: Libite
authors.affiliation: Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, USA.
authors.forename: Henry D
authors.initials: HD
authors.lastname: Kalter
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000706:statistics & numerical data; D001344:Autopsy / Q000379:methods*; D001519:Behavior; D002163:Cameroon / Q000453:epidemiology; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D002423:Cause of Death / Q000639:trends; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D018672:Community Health Planning / Q000458:organization & administration; D003657:Decision Making; D003695:Delivery of Health Care / Q000191:economics*; D004777:Environment; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015208:Smoke Inhalation Injury / Q000150:complications / Q000401:mortality; D012959:Socioeconomic Factors; D014186:Transportation / Q000191:economics