Using social autopsy to understand maternal, newborn, and child mortality in low-resource settings: a systematic review of the literature

Cheryl A Moyer; Cassidy Johnson; Elizabeth Kaselitz; Raymond Aborigo

doi:10.1080/16549716.2017.1413917

Using social autopsy to understand maternal, newborn, and child mortality in low-resource settings: a systematic review of the literature

Glob Health Action. 2017;10(1):1413917. doi: 10.1080/16549716.2017.1413917.

Authors

Cheryl A Moyer^{1

2}, Cassidy Johnson², Elizabeth Kaselitz², Raymond Aborigo³

Affiliations

¹ a Departments of Learning Health Sciences and Obstetrics & Gynecology , University of Michigan Medical School , Ann Arbor , MI , USA.
² b Global REACH , University of Michigan Medical School , Ann Arbor , MI , USA.
³ c Navrongo Health Research Centre , Navrongo , UE/R Ghana.

Abstract

Background: Social, cultural, and behavioral factors are often potent upstream contributors to maternal, neonatal, and child mortality, especially in low- and middle-income countries (LMICs). Social autopsy is one method of identifying the impact of such factors, yet it is unclear how social autopsy methods are being used in LMICs.

Objective: This study aimed to identify the most common social autopsy instruments, describe overarching findings across populations and geography, and identify gaps in the existing social autopsy literature.

Methods: A systematic search of the peer-reviewed literature from 2005 to 2016 was conducted. Studies were included if they were conducted in an LMIC, focused on maternal/neonatal/infant/child health, reported on the results of original research, and explicitly mentioned the use of a social autopsy tool.

Results: Sixteen articles out of 1950 citations were included, representing research conducted in 11 countries. Five different tools were described, with two primary conceptual frameworks used to guide analysis: Pathway to Survival and Three Delays models. Studies varied in methods for identifying deaths, and recall periods for respondents ranged from 6 weeks to 5+ years. Across studies, recognition of danger signs appeared to be high, while subsequent care-seeking was inconsistent. Cost, distance to facility, and transportation issues were frequently cited barriers to care-seeking, however, additional barriers were reported that varied by location. Gaps in the social autopsy literature include the lack of: harmonized tools and analytical methods that allow for cross-study comparisons, discussion of complexity of decision making for care seeking, qualitative narratives that address inconsistencies in responses, and the explicit inclusion of perspectives from husbands and fathers.

Conclusion: Despite the nascence of the field, research across 11 countries has included social autopsy methods, using a variety of tools, sampling methods, and analytical frameworks to determine how social factors impact maternal, neonatal, and child health outcomes.

Keywords: Social autopsy; developing countries; infant mortality; maternal mortality; neonatal mortality; verbal autopsy.

Publication types

Review
Systematic Review

MeSH terms

Autopsy / methods*
Child
Child Mortality / ethnology*
Costs and Cost Analysis
Developing Countries*
Female
Humans
Infant
Infant Mortality / ethnology*
Infant, Newborn
Maternal Mortality / ethnology*
Poverty

Grants and funding

This research was conducted in part with funding from USAID-Ghana, AID-641-A-14-00008. USAID-Ghana had no role in the study design, data collection, analysis, interpretation of the data or manuscript drafting.