Child Death Review (CDR) is a strategy to understand the geographical variation in causes of child deaths and thereby initiating specific child health interventions.
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Child Death Review.pptx
1. Child Death Review
Reducing IMR by strengthening CDR
Dr.Darshna Sarvaiya
1st year resident
Community Medicine
2. Definitions
• Neonatal Deaths : Neonatal deaths are deaths occurring the neonatal period, commencing at birth
and ending 28 completed days after birth
• Post-Neonatal Deaths : Deaths occurring from 29 days of life to under one year are called post-
natal deaths
• Infant Deaths : Deaths of children less than 1 year of age
• Child Deaths : Deaths of children less than 5 years of age
• Still Birth : still birth is the birth of a new born after of a new born after 20th completed week of
gestation, weighing 500gms or more ,when the baby does not breath or show any sign of life after
delivery
3. Child Death Review
• Child Death Review (CDR) is a strategy to understand the geographical variation in causes of child
deaths and thereby initiating specific child health interventions.
• Action –oriented review mechanism
• Reviewing the CDR data and using it for improved planning and Instituting corrective measures
4. Key Steps in Child Death Review
• Children age group 0-5 year
• All deaths in this age group recorded
• The review process remain same for all children but details to be investigated will vary in neonates
and children
Child Death Review
Community Based Child
Death Review (CBCDR)
Facility Based Child
Death Review (FBCDR)
5. ASHA-informs about child deaths(0-5 year) to the ANM and the BMO within 24 hours of death and fills the
notification card within 48 hours
ANM- Conducts the first brief investigation within 2 weeks of death of the child and submits report to the BMO
within a month
BMO- Prepares the line list and selects the cases for
detailed investigation.Copy of the verbal autopsy form
sent to DNO within week
CMO- Reviews the child deaths monthly in the DCDRC
meeting and minutes sent to SNO
State level Task Force – Technical & administrative issues reviewed with clear timelines for action & further
steps.
State Nodal Officer – Prepares the state CDR report for presentation at the State level Task Force meeting
conducted twice yearly
INVESTIGATORS – Conduct the verbal
autopsy of cases selected by BMO and
submit the report to the BMO
DM- Selected deaths are reviewed
monthly in the presence of 2 family
members of the deceased child
CBCDR
Flow
Chart
6. Guidelines for drawing equity-based sample
• Select deaths from different PHCs.
• Prioritize blocks: High deaths, underserved and marginalized population
• Do not include more than one death from any age category occurring in a PHC/block area
• Give priority to common causes of deaths in each category
• While selecting deaths in subsequent cases avoid repetition of the geographical areas as well as
causes of deaths
• If there is clustering of deaths in certain population groups or blocks or village in a certain month,
select cases from this cluster in order to identify if there are common underlying or direct
causes/factors
7. DMO- Informs the FNO immediately about the child death in facility and fills the notification card within 24
hours and conduct the detailed investigation within 48 hours of death
FNO- All child deaths reviewed by the FBCDR committee every month and reports sent to the DNO every
months
CMO- Reviews the child deaths monthly in the DCDRC
meeting and minutes sent to SNO
SNO- prepares the state CDR report for presentation at the state level Task force meeting conducted twice
yearly
State Level Task Force – Technical & administrative reviewed with clear timelines for action & further steps
DM – Selected deaths are reviewed monthly
in the presence of 2 family members of the
deceased child
FBCDR
Flow
Chart
8. Analysis involves circumstances of each death, identification of avoidable factors and action to improve care at all levels
of the health of the health system, from home to hospital .
Most child deaths result from a chain of events that includes many social, cultural, and medical factors.
Some of these prevented by taking action to this events & focus on three delays :
Third delay –lack
of medicines ,
blood ,
consumables
,skilled
manpower,etc..
Second delay- lack
of transport, poor
roads, long
commute to the
nearest healthy
facility, or delay in
organizing funds if
they have to pay
for it
First delay:
decision making
process, not
recognizing danger
signs, using
traditional home
care ,low
education &
poverty aggravate
Analyses of CDR Report
9. Expected outcomes of Analysis
• Analysis of child deaths provides information about ……
- Medical cause of death
- Social factors that contribute to child deaths
- Helps to identify the gaps in health services delivery and
• Comparison between diff. block & population groups
• An analysis of trend over a period of time regarding the causes of death capturing change over
time and to see any epidemiological changes and had the corrective measures have a positive
effect on child mortality.
11. Social Causes
• Lack of awareness
• Low education / economical conditions
• Maternal Nutrition
• Health seeking behaviour
• Customs culture
• Gender discrimination
• Community level delay
12. Expectation from the group of experts
1.Review the CDR process :
• Check weather all norm are being followed for CDR (CBCR & FBD)
• Timeliness of notification, filling of all forms by the appropriate persons as per guidelines.
• Utilization of the information for actions by district heath teams based on the information.
• Preparing a comprehensive report above observations and recommendations to improve
them.
13. 2.Desk review of current death review of CDR forms of last three months of assigned
district and give comments/recommendations.
• Reviewing District level line-list and validate the causes cited as well as improve the causes
based on the reviewing the detail , with especial emphasize on the improving the cause of
death. Carrying out the analysis, draw inferences and give inferences based on the observation
• Preparing the line list (excel sheet) based on the social autopsy and carrying out the analysis,
draw inferences and give inferences based on the observation
14. 3.CDR by experts
• Minimum eight deaths review by expert per district :
• To be carried out in the two talukas showing high children deaths as per the list shared by state
child health team. For urban areas it can be done in consultation with the MOH/RCHO and U-PHCs
can be selected.
• A team of two members for autopsy : Expert from the Medical College and another THO/ PHC MO
or Taluka Health Supervisor.
