Time-critical conditions : assessment of burden and access to care using verbal autopsy in Agincourt, South Africa

Autor: Lucia D'Ambruoso, Peter Byass, Kathleen Kahn, Stephen Tollman, Justine Davies, Jessica Newberry Le Vay, Andrew Fraser
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Rural Population
Medicine (General)
030231 tropical medicine
Quality care
Infectious and parasitic diseases
RC109-216
urologic and male genital diseases
Health Services Accessibility
03 medical and health sciences
South Africa
R5-920
0302 clinical medicine
Environmental health
Cause of Death
Medicine
Humans
030212 general & internal medicine
Health policy
Original Research
business.industry
Health Policy
Public Health
Environmental and Occupational Health
Health services research
Infant
Newborn
Time critical
Public Health
Global Health
Social Medicine and Epidemiology
Verbal autopsy
health services research
female genital diseases and pregnancy complications
infections
diseases
disorders
injuries
Identification (information)
Folkhälsovetenskap
global hälsa
socialmedicin och epidemiologi
Autopsy
business
health systems
Healthcare system
Zdroj: e002289
BMJ Global Health
BMJ Global Health, Vol 5, Iss 4 (2020)
Popis: BackgroundTime-critical conditions (TCC) are estimated to cause substantial mortality in low and middle-income countries. However, quantification of deaths and identification of contributing factors to those deaths are challenging in settings with poor health records.AimTo use verbal autopsy (VA) data from the Agincourt health and sociodemographic surveillance system in rural South Africa to quantify the burden of deaths from TCC and to evaluate the barriers in seeking, reaching and receiving quality care for TCC leading to death.MethodologyDeaths from 1993 to 2015 were analysed to identify causality from TCC. Deaths due to TCC were categorised as communicable, non-communicable, maternal, neonatal or injury-related. Proportion of deaths from TCC by age, sex, condition type and temporal trends was described. Deaths due to TCC from 2012 to 2015 were further examined by circumstances of mortality (CoM) indicators embedded in VA. Healthcare access, at illness onset and during the final day of life, as well as place of death, was extracted from free text summaries. Summaries were also analysed qualitatively using a Three Delays framework to identify barriers to healthcare.ResultsOf 15 305 deaths, 5885 (38.45%) were due to TCC. Non-communicable diseases were the most prevalent cause of death from TCC (2961/5885 cases, 50.31%). CoM indicators highlighted delays in a quarter of deaths due to TCC, most frequently in seeking care. The most common pattern of healthcare access was to die outwith a facility, having sought no healthcare (409/1324 cases, 30.89%). Issues in receipt of quality care were identified by qualitative analysis.ConclusionTCCs are responsible for a substantial burden of deaths in this rural South African population. Delays in seeking and receiving quality care were more prominent than those in reaching care, and thus further research and solution development should focus on healthcare-seeking behaviour and quality care provision.
Databáze: OpenAIRE
Externí odkaz: