Causes of under-five mortality using verbal autopsy and social autopsy studies (VASA) in Alexandria, Egypt, 2019

Abstract

# Background Determination of death causes is an important building block for civil registration and vital statistics (CRVS). This study aimed at identifying the causes of under-five mortality (U5M) in Alexandria using verbal autopsy (VA). # Methods Data of 645 under-fives (452 neonates & 193 post-neonates and children) deaths were retrieved from records from January 2018 to June 2019, care-givers were interviewed using Verbal Autopsy and Social Autopsy Studies (VASA), version 1.5.1 developed by the World Health Organization. Questionnaires (neonatal and child forms) were uploaded to the Open Data Kit collector (ODK), analyzed by Smart-VA software to identify the underlying cause of death (UCOD). # Results The response rate to VASA was 66%. Neonatal mortality, post-neonatal mortality, and child mortality represented 70.1%, 24.5%, and 5.4% of U5M respectively. There was no statistically significant difference between males and females in cause-specific mortality fraction (CSMF), P > 0.05. The main UCODs among neonates were preterm delivery (57.3%), congenital malformation (17.3%), congenital pneumonia (10.8%), birth asphyxia (8.4%), and stillbirth (3.1%). The most-reported UCODs among post-neonates and children were pneumonia (25.9%), childhood cardiovascular diseases (22.8%), digestive system diseases (11.9%), and diarrhea and dysentery (7.8%). The main UCODs among under-five children were preterm delivery (40.2%), followed by congenital malformation (12.1%), pneumonia (7.8%), congenital pneumonia (7.6%), childhood cardiovascular diseases (6.8%), and birth asphyxia (5.9%). Communicable diseases, maternal, neonatal, and nutritional diseases caused 72.0% of U5M, while non-communicable diseases and injuries caused 25.7% and 2.4% of all U5M, respectively. # Conclusions VASA declared that communicable diseases, maternal, nutritional, and neonatal diseases remain the main killer of U5C in Alexandria.