The care-seeking behaviour of mothers of 125 children deceased aged 1-30 months was investigated by verbal autopsy in an urban area of Guinea-Bissau. A total of 93% of the children were seen at a health centre or hospital during the 2 weeks before death. In a previous survey covering the period 1987-90 we found that 78% of the children who died had presented for consultation (8); despite this increase in care seeking, infant mortality had not decreased. Comparison of elapsed time from disease onset to first consultation between children who died and matched surviving controls indicated that the interval was shorter for children who died than for those who survived (odds ratio (OR) = 0.7; 95% confidence interval (CI): 0.5-0.99). Of the 125 terminally ill children, 56 were hospitalized. A total of 20 children died on the way to hospital or while waiting in the outpatient clinic. Lack of hospital beds resulted in 15 mothers being refused hospitalization for their child. Of hospitalized children, 42% were discharged as improved or recovered during the 30 days preceding death. These results reveal a need for improved hospital admission criteria, improved recognition of the symptoms of serious illness, better discharge criteria, and the implementation of quality assurance systems for health services.
PIP: The care-seeking behavior of mothers of 125 children who died at age 1-30 months in the Bandim 1 and Bandim 2 suburbs of Bissau was investigated by verbal autopsy. 93% of the children were seen at a health center or hospital during the 2 weeks before death. Comparison of the elapsed time from disease onset to first consultation between children who died and matched surviving controls found that the interval was shorter for children who died than for those who survived. 56 of the 125 terminally ill children were hospitalized, while 20 children died on the way to the hospital or while waiting in the outpatient clinic. A lack of hospital beds resulted in 15 mothers being refused hospitalization for their child. 42% of hospitalized children were discharged as improved or recovered during the 30 days preceding death. These findings point to the need to improve hospital admission criteria, the recognition of the symptoms of serious illness, and discharge criteria, as well as the implementation of quality assurance systems for health services.