South Africa - Why do so many children die at home in Rural South Africa?

This research will constitute Jessica's DPhil project in Primary Health Care Sciences at Oxford University. The projects aims to better understand the factors that contribute to the large proportion of under-5 deaths that occur at home (as opposed to in health facilities). This involves characterizing home deaths (in comparison to hospital deaths) by cause of death, household socioeconomic and sociodemographic risk factors, and determinants of treatment-seeking behavior/health care usage. It is suspected that many of the children who died at home had some engagement with the health system over the course of illness leading to death. Understanding how this engagement was interpreted, and why families did not access care again at the time of death is of great importance. A comparative analysis of findings across the 3 HDSS sites in South Africa will be included, in addition to a comparison of verbal autopsy findings from the HDSS sites to national statistics and local PPIP/ChIP data. A better understanding of the factors limiting access to care will better enable the design and modelling of health systems interventions to a “package of care” which is cost effective and practical within the specific constraints of the rural South African setting.