Perceptions of child death in Jigawa State, Nigeria: a mixed-methods study on how sociocultural nuances shape paediatric mortality reporting

Figures & data

Table 1. Example of the qualitative content analysis process.

Participant	Quote	Code	Sub-category	Category
Participant 1 (FGD 1, Kiyawa)	“Honestly in this town we see death as an act God, once it is your turn you will be taken whether you like it or not, whether he is in authority or not.’	Death as inevitable or as an act of God	Non-medical perceptions of cause of death	Culturally grounded perceptions of child death
Participant 7, FGD 1 Kiyawa	‘The truth is, if it is not prayer that one wants to offer on behalf of the dead or what God instructs about the dead then, too much talking is not good’	Excessive talking about death is taboo	Prayer is the best way to show support and offer condolence	Etiquette in mourning and offering condolence
Participant 5, FGD 2 Maje	‘The reason why we report or share details of the death of a child is because people will know what exactly brought about the death to avoid spreading wrong information and also get help in order to avoid the spread of the disease’	Mortality reporting as preventative public health measure	Motivation for reporting to a hospital	Child mortality reporting practices
KII 1, Maje	‘The difference is that a child has no sin on him so his prayer is just a minor one but that of an adult who has a lot of sin on him we will pray for Allah to forgive all his wrong doings’	Appropriate prayer depends on age	Funeral rites for children are less elaborate than for adults	Religion as part of formal procedures surrounding child deaths

Table 2. Demographic and verbal autopsy information (n = 42).

Demographics, deceased child		N (%)
Sex	Female	17 (40)
	Male	25 (60)
Age at death*	<1 month^†	8 (19)
	1–12 months	14 (33)
	12–59 months	19 (45)
Location of death	Hospital	8 (19)
	Home	33 (79)
	En Route	1 (2)
Cause of death, reported	Anaemia	1 (2)
by caregiver	Asphyxia	1 (2)
	Fever/ Febrile Convulsion	3 (7)
	Teething	1 (2)
	Jaundice	2 (5)
	Malaria, breathlessness	1 (2)
	Malnutrition	1 (2)
	Not reported	32 (76)
Verbal autopsy data N (%)
Main respondent	Mother	36 (85)
	Father	5 (12)
	Maternal grandmother	1 (2)
Other respondents	Partner (mother/father)	47 (38)
(n = 125)	Grandparent	17 (14)
	Other female relative	13 (10)
	Other male relative	30 (24)
	Neighbour	16 (13)
	Other	2 (1)
Care-seeking	Yes	25 (60)
	No	17 (40)
Location first sought care	Private pharmacy	2 (8)
(n = 25)	Govt. primary care	14 (56)
	Private hospital	1 (4)
	Govt. hospital	4 (16)
	Traditional care	4 (16)
Health facility > 2 hours	Yes	1 (2)
From home	No	38 (90)
	Don’t Know	3 (7)
Visible signs of emotional	Yes, crying	0 (0)
Distress	Yes, long silence	11 (26)
	Yes, other signs	2 (5)
	No	29 (69)
Interview paused due to	Yes, once	4 (31)
Emotion^‡	Yes, more than once	0 (0)
(n = 13)	No	9 (69)

* In one record, the date of death was recorded incorrectly, and age of death was not determined

† This category includes stillbirths

‡ This question was only asked to those who displayed visible signs of emotional distress

Table 3. Schematic presentation of categories and sub-categories from focus group discussions with community women.

Category	Sub-category
Culturally grounded perceptions of child death	Child death triggers an acute emotional response Language used for death Non-medical perception of causes of death Young children are grieved equally
Etiquette in mourning & offering condolence	Prayer is the best way to show support and offer condolence Role of the community in mourning Young children who die are mourned differently Only positive attributes about the deceased can be expressed Taboos
Formal procedures surrounding child death	Religious rituals Community participation
Improving relationship between hospital and community	Formal discussions about child death Greater trust in hospital for pregnancy and birth
Child mortality reporting practices	Location of child death influences reporting Hospital role in child death and reporting Motivation for reporting to a hospital

Table 4. Schematic presentation of categories and sub-categories from key informant interviews with Imams.

Category	Sub-category
Religion as part of formal procedures surrounding child death	Imam role in funeral rites Funeral rites for children are less elaborate than for adults
Communities support the bereaved	Community engagement in funeral rites Shared prayer
Multilayered reasons for unreported deaths	Current practices for mortality reporting External responsibility for mortality reporting Barriers to mortality reporting