Bangladesh – Community-run Verbal Autopsies followed by local action planning decreases maternal and child deaths in rural Bangladesh

BACKGROUND: High maternal and child mortality are commonplace in rural Bangladesh. The majority of deaths occur outside health facilities and without a death certificate. This lack of information limits the design of effective public health programs. PROGRAM: In 2008, Plan International, a child-centered community development organization, began implementing a maternal and child health program in the northern part of the country, targeting 610 rural communities and 1.5 million people. To enhance community participation and mobilization, Plan introduced community-run verbal autopsies (VA) with 53 community-based organizations (CBOs). Plan trained CBO members to conduct VAs within 10-12 days of the death of a child or pregnant woman and after obtaining family consent. The VA session, with an open-ended structured questionnaire was conducted by community health workers (CHWs) with the primary caretaker of the deceased as the primary informant. Then, all members participating in the VA session (family members, CBO representatives) identify actions to prevent similar deaths in the future. RESULTS: After two years of intervention, maternal and child mortality in project areas are 156/100,000 live births and 28.4/1,000 live births respectively, significantly lower than the national averages of 320/100,000 live births and 52/1,000 live births. Moreover, community members and leaders consider community-run VA exercises among the most important project interventions because of the action planning exercise. CONCLUSIONS: VA sessions and community action planning are effective in reducing maternal and child mortality. Plan International is now reporting to the government this experience to include it in the government's health programs.