Cause-specific child mortality in a mountainous community in Pakistan by verbal autopsy.

In Pakistans rural areas population-based cause of death data from systematic verbal autopsies are rare. Using verbal autopsy algorithms with multiple coding and decision rules the authors assigned causes of death among 79% of children aged under 5 years dying between July 1988 and December 1991 in Oshikhandass a remote mountainous community in Pakistans Northern Areas. Main causes of death were pneumonia (44%) diarrhea (35%) and neonatal sepsis (6%). Combined (main plus associated) analysis revealed 48% died with diarrhea 46% with malnutrition 44% with pneumonia 15% with neonatal sepsis and 15% with low birth weight. Median age of death with pneumonia was 2 months; with diarrhea 8 months. Half died by month 4. The inquiry was well received by villagers. Population-based verbal autopsy surveillance is a cost-effective strategy to guide health managers. Plans are underway to institute it for the surrounding population of 400000. Creative ways to access treat and reduce risk among young infants are needed. (authors)