Verbal autopsy analysis of childhood deaths in rural Gambia

Background In low-resource settings, it is challenging to ascertain the burden and causes of under-5 mortality as many deaths occur outside health facilities. Verbal autopsy (VA) is an important tool that provides data on causes of death in communities with limited access to health care. We aimed to determine the causes of childhood deaths by VA in rural Gambia. Methodology We used WHO standard questionnaires to conduct VAs for deaths under-5 years of age in the Basse and Fuladu West Health and Demographic Surveillance Systems in rural Gambia between September 01, 2019, and December 31, 2021. Two physicians assigned a cause of death and discordant diagnoses were resolved by consensus. Causes of death were classified using the International Classification of Disease 10th edition codes. Results VAs were conducted for 89% (647/727) of deaths. Of these deaths, 49.5% (n=319) occurred at home, 50.1% (n=324) in females, 37.1% (n=240) in neonates, and 27.1% (n=175) in infants aged 1-11 months. Outside the neonatal period, pneumonia (27.0%, n=110), diarrhoeal diseases (23.3%, n=95), and sepsis (21.6%, n=88) were the commonest primary causes of death. In the neonatal period, unspecified perinatal causes of death (29.6%, n=71), birth asphyxia (23.8%, n=57) and prematurity/low birth weight (17.1%, n=41) were the commonest causes. Severe malnutrition (28.6%, n=185), unspecified perinatal deaths (10.7%, n=69), pneumonia (10.2%, n=66), and prematurity/low birth weight (10.2%, n=66) were the commonest underlying causes of death. Conclusion According to VA analysis, half of deaths amongst children under-5 in rural Gambia occur at home. Pneumonia, diarrhoea, and sepsis, and the underlying cause of severe malnutrition, as well as birth asphyxia in neonates, remain the predominant causes of child mortality in rural Gambia. Improved health care and health-seeking behaviour may reduce childhood deaths in rural Gambia. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The collection of VA data is one of the procedures undertaken by the Basse and Fuladu West HDSSs. The HDSSs include hundreds of thousands of residents and constitute minimal risk observational research with data used by multiple research projects, non-government organisations, and government agencies. For these reasons, verbal consent is sought from the head of each household at each household visit. The operation and procedures of both the Basse and Fuladu West HDSS have been approved by the Gambia Government/MRCG Joint Ethics Committee (SCC number 1577). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files