The PREMAND project is focused on understanding why mothers and babies are dying- including both the clinical causes and the social and cultural factors that may play a role in mortality.
What is a verbal autopsy?
Without the resources to conduct clinical autopsies, health officials sometimes conduct what is called a “verbal autopsy.” This involves talking to the family and friends of the deceased to understand the events that led to an individual’s death.
These verbal autopsies help determine the most likely clinical cause of death. We know mothers in Ghana most often die from dying hemorrhage, sepsis, hypertensive disorders, obstructed labor, and complications from abortions, while newborns most often die from sepsis, birth asphyxia, and complications from prematurity.
But, this doesn’t tell us why these deaths are occurring.
Social autopsy seeks to identify the social and cultural factors that influence illness, illness recognition, and care seeking behaviors; factors that ultimately influence health outcomes. Through an extensive interview process that builds on the verbal autopsy, family and community members are able to comment on the social, cultural, and behavioral factors that may have impacted maternal and neonatal outcomes. Social autopsy produces a richer and more substantive understanding of the context of deaths. In identifying the root causes of illness, the goal is to target these factors, preventing future negative health outcomes from occurring.
More information on social autopsy can be found in two recent publications by the PREMAND team:
- Using social autopsy to understand maternal, newborn, and child mortality in low-resource settings: a systematic review of the literature (2017).
- PREventing Maternal and Neonatal Deaths (PREMAND): a study protocol for examining social and cultural factors contributing to infant and maternal deaths and near-misses in rural northern Ghana (2016).
The issues are similar for situations in which mothers and babies may get very sick, but survive. These situations, termed “near-misses,” are also not well understood and are rarely documented. What are the factors that led up to their illness, and what were the factors that allowed them to survive? As is the case with deaths, understanding the social and cultural factors that influence near-misses is likely to vastly enhance the ability of communities, governments, and programs to prevent maternal and infant deaths in the future.
While data from the region suggest that many different social and cultural factors influence maternal and neonatal health outcomes, it is not clear which are most directly linked to deaths. In the absence of this level of detail it is difficult to design and launch the effective programming necessary to address and ultimately reduce maternal and neonatal mortality in the region.