ABSTRACT
Lymphatic filariasis (LF) is endemic in 81 countries in the world, and a number of these countries have targeted for LF elimination. This review of literature and analysis was conducted to identify additional and sustainable strategies to accelerate LF elimination from endemic countries. This review noted that adverse events due to mass drug administration (MDA) of diethyl carbamazine (DEC) tablets, poor knowledge and information about LF amongst health workers & community members, and limited focus on information, education & communication (IEC) activities and interpersonal communication are the major barriers in LF elimination. The new approaches to increase compliance with DEC tablets (including exploring the possibility for DEC fortification of salt), targeted education programmes for physicians and health workers, and IEC material and inter personal communication to improve the knowledge of community are immediately required. There is a renewed and pressing need to conduct operational research, evolve sustainable and institutional mechanisms for education of physicians and health workers, ensure quality of trainings on MDA, strengthen IEC delivery mechanisms, implement internal and external monitoring of MDA activities, sufficient funding in timely manner, and to improve political and programmatic leadership. It is also time that lessons from other elimination programmes are utilized to accelerate targeted LF elimination from the endemic countries.
ABSTRACT
Objective To understand the causes of child deaths in order to implement appropriate child survival interventions in the country. We present a systematic review of studies reporting causes of child, infant, and neonatal deaths from India for 1985 to 2008. Methods PubMed, EMBASE, Google Scholar, and WHO regional databases were searched along with a hand search and personal communication with researchers in child health to obtain studies and reports for the database. Study data was summarized and analyzed using appropriate statistical tools. Results We identified 28 published/unpublished studies and reports (6 multi-centric and 22 single sites). There was one nation wide study and rest were from 15 unique sites in 9 different states of India. There were differences in study design and cause of death assignment methods between the studies, which made comparisons and synthesis difficult. The median percentage of causes of deaths in neonatal period were sepsis/pneumonia: 24.9% (Q1: 19.6% and Q3: 33.4%); asphyxia: 18.5% (Q1: 14.2% and Q3: 21.9%); and pre-maturity/LBW: 16.8% (Q1: 12.5% and Q3: 26.5%). Amongst the infants, sepsis/pneumonia, asphyxia, and prematurity/low birth weight (LBW) remain substantial causes of deaths. The median proportional contribution of neonatal deaths to total infant deaths was 48.5% (Q1: 36.5– Q3: 57.5%). The proportion of deaths due to infectious diseases like diarrhoea, pneumonia, and measles seem to be greater in infancy, in comparison to that in neonatal period. There was no statistically significant difference in the proportional contribution of neonatal deaths to total deaths occurring during infancy (<1 year) between the two equal periods before and after 1996 (p=0.141). There also was no difference in the proportional contribution by cause of death assignment method (Verbal autopsy vs. other methods; p=0.715) or by study setting (urban vs. rural; p= 0.175). The median percentage of neonatal deaths by day 1 is 36.7% (Range: 20.0–58.0%). The median cumulative percentage of neonatal deaths by day 3 was 49.7% (Range 35.0–64.6%), and 70.9% (Range: 46.5–92.3%) by day 7. In addition, the timing of deaths during neonatal period seems to be static during the last 2 decades, with majority of deaths occurring during first week of life. Conclusions This review demonstrates the need for more studies with consistent methodological rigor investigating the causes of child death in India. We conclude that the structure of neonatal causes of death in India may be different from the rest of the world and that interventions to reduce neonatal deaths in first week of life may rapidly improve child survival in the country.