Causes of death among children in the West Bank in the years 2009-2018, a retrospective study
Basma Damiri1*, Omar Safarini2*, Nesma Ghanim2, Masa Soroghli2, Saad Zidan2, Ibrahim Damiri2
1 Faculty of Medicine and Health Sciences, Drugs and Toxicology Division, An-Najah National University, Nablus-Palestine
2 Department of Medicine, An-Najah National University Nablus-Palestine
Introduction: Mortality data is essential to improve the health system and develop effective policies in any country. This study aimed to address the manner and cause of death in children in the West Bank from 2009 to 2018 based on gender, age, and sociodemographic distribution.
Methods: All death notifications (9133 records) for children aged between 0-18 years old at the Palestinian Ministry of Health from 2009 to Dec 2018 were retrospectively reviewed and analyzed.
Results: The majority of the study cases were males (56.1%), infants (70.3%), from villages (52.9%), and the North of the West Bank (53.1%). Children aged less than five years constituted 83.7% of the death cases. Early neonates constituted 45.1% of the neonatal category, followed by the post-neonatal category (33.1%). The highest percentages of death occurred in winter (30.8%). Natural death (83.3%) is the leading manner of death followed by undetermined cause of death (8.1%), accident (6.8%), homicide (1.3%), and finally, suicide (0.8%). Based on age, undetermined cause of death (94.5%) and natural death (86.4%) were the most frequent manners in neonates and specifically in the early neonatal stage (92.3% and 34.0% respectively). Homicide was the most frequent manner of death in winter (35.0%), while suicide was the most frequent manner of death evenly in spring and summer (37.5%). In the infant category, the logistic regression revealed that males are more likely to die than females naturally (OR: 1.3, P-value: 0.005). Moreover, infants in the late neonatal stage (7-28 days) are more likely to die from natural death (OR: 8.3). Natural death in children less than five years is more likely to occur in spring (OR:3.3, P-value 0.027) while accidental death is more likely to occur in spring (OR: 4.2, P-value 0.0) and summer (OR:4.5, P-value 0.008), and homicidal death is more likely to occur in summer (OR: 4.8, P-value 0.04). Death cases are more likely to happen in the North than the South of the West Bank in all age groups. Disorders related to short gestation and low birth weight (13.07%), in addition to the respiratory distress syndrome of newborns (13.03%), were the most frequent causes of death, followed by congenital malformations of cardiac chambers and connections (9.01%), bacterial sepsis (7.05%), fetal death of unspecified cause ranked the fifth among causes (7.0%), neonatal aspiration syndromes (4.11%), and sudden infant death syndrome (3.33%). Deaths from car accidents (3.7%) ranked the sixth among causes, while unspecified falls were ranked the eighteenth among causes (1.06%).
Conclusion: Infant deaths comprise the majority of under five years old mortality, by which two-thirds were neonates necessitating special care for these three age groups. The major causes of neonatal mortality were disorders related to short gestation and low birth weight. As a result, we recommend conducting additional protocols to deal with short gestation and low birth weight babies. Further researches should be conducted to link the correlation between male predominance in children mortality with seasonal and demographic association.
Keywords: Mortality, Manner of death, Causes of death, Palestine, Sudden infant death, Notification of death, Homicide, Suicide, Accidental death, Neonatal