The 2019 Nigeria Verbal and Social Autopsy (VASA) study used a mixed methods approach to identify the main causes of under-five deaths in Nigeria and understand the social context and healthcare responses that preceded preventable child deaths. The results provide a compelling narrative on why Nigerian children die and inform strategies to address preventable deaths.
Why Study Child Deaths in Nigeria?
According to the Nigerian Demographic Health Surveys (NDHSs), under-five mortality in Nigeria has declined from 201 per 1000 live births in 2003 to 132 per 1000 live births in 2018, a 35% decline in 15 years. Despite this decline, progress has been significantly slower than what has been achieved in most other African countries and is much slower than what is needed to achieve the Sustainable Development Goal (SDG) 3 target of reducing under-five mortality to 25 deaths per 1,000 live births by 2030.
Like many Sub-Saharan African countries, Nigeria has historically depended on data modeling by the Child Health Epidemiology Reference Group (CHERG), an indirect method of estimating causes of under-five deaths, to determine the cause distributions of deaths in neonates, infants and children. As part of the country’s effort to accelerate reductions in child mortality, the first Nigerian VASA was conducted in 2014 using households with histories of under-five deaths identified during the 2013 Nigeria Demographic and Health Survey (NDHS). The 2014 VASA provided a primary estimate of causes of under-five deaths as well as information on the sociocultural factors that might have been barriers to caregivers accessing care for their sick children.1
What is Verbal and Social Autopsy?
Verbal autopsy of deaths uses retrospective interviews with caregivers to document and understand the symptoms and signs of the fatal illness. It is a useful tool to estimate the causes of deaths in a specific population with poor vital registration or medical certification of the causes of deaths.2 Verbal autopsy has been widely used in household surveys, demographic surveillance sites, vital registration systems and special studies. Social autopsy builds on verbal autopsy by studying the setting, and sequence of decisions and events that leads to death. The focus of social autopsy is to understand the decision-making, care-seeking and actual care that preceded death, to provide insight into social determinants of death and how deaths might be prevented.3
Objectives
The CIRCLE project, led by Social Solutions International, Inc., was tasked by USAID/Nigeria to support the 2019 VASA, which was implemented by the National Population Commission (NPC), in collaboration with the Federal Ministry of Health (FMOH). The objectives of the 2019 Nigeria VASA were to provide:
- National and zonal level estimates of the major causes of under-five mortality in Nigeria in the 2013-2018 period.
- Data on national and zonal patterns of care-seeking, social factors, and interventions received as related to deaths in children under-five, along with qualitative narratives of factors associated with these patterns.
- Further analysis and insights into the causes and social determinants of death among children to enable policy makers to make evidence-based decisions and programs.
Approach
The data collection of the 2019 VASA, both the survey and qualitative components, was conducted between October and December 2019. Fifteen survey teams followed up on 3,215 under-five deaths recorded in the NDHS 2018 survey, which were scattered among 1,014 locations in all the 36 states and the Federal Capital Territory. Qualitative data were collected across 12 states in the six geopolitical zones of Nigeria. A total of 72 in-depth interviews with caretakers, 48 focus group discussions with community leaders, 12 key informant interviews with health providers, and one facility observation in each state, were conducted between October and November, 2019. Learn more about the data collection process by watching this video.
The 2019 VASA approach also included a strong emphasis on stakeholder engagement. To learn more about the stakeholder engagement activities, see this first VASA blog.
The 2019 VASA was completed and launched by the Honorable Minister of Health in November 2020 through national and regional dissemination events. Read this second VASA blog to learn more about the country disseminations.
For more information about the 2019 VASA, please contact circle@socialsolutions.biz
2019 VASA Products
Key Findings and Policy Implications Brief
The 2019 VASA products are also available on the National Population Commission website.
- Adewemimo A, Kalter HD, Perin J, Koffi AK, Quinley J, Black RE (2017) Direct estimates of cause-specific mortality fractions and rates of under-five deaths in the northern and southern regions of Nigeria by verbal autopsy interview. PLoS ONE 12(5): e0178129. https://doi.org/10.1371/journal.pone.0178129
- Kalter HD, Roubanatou AM, Koffi A, Black RE. Direct estimates of national neonatal and child cause–specific mortality proportions in Niger by expert algorithm and physician–coded analysis of verbal autopsy interviews. J Glob Health. 2015;5:010415. Medline:25969734 pmid:25969734
- Koffi AK, Kalter HD, Loveth EN, Quinley J, Monehin J, Black RE. Beyond the causes of death: The social determinants of deceased children 1–59 months of age in Nigeria from 2009–2013. PLoS ONE. Forthcoming 2017.
