i) The contents of verbal autopsy
form are available at https://nhm.gov.in/images/pdf/programmes/childhealth/guidelines/Operational_Guidelines_Child_Death_
Review.pdf and have been modified in the Tamil Nadu
State verbal autopsy form to include health seeking behavior,
each cause of death based on symptoms or problems in the
child. The State verbal autopsy tool has maternal
characteristics as well as neonatal characteristics. For
neonatal deaths as well as post neonatal deaths, there are
set of questions under each cause of deaths and depending
upon the answers, one of the major causes is selected.
Probable main cause of death (only one cause) is to be given
at the end.
ii) All young infant deaths (< 2
months) between March, 2013 and March, 2015 were line-listed
as per government orders. Investigation of the same was done
using the State verbal autopsy forms for infant deaths.
Line-listing of young infant deaths is routinely done by
field workers assigned in each Chennai corporation zone, and
it was not done solely for the purpose of the study.
Investigation of these deaths are done using verbal autopsy
forms after getting informed consent from the parents by the
field workers (auxiliary nursing midwives, ANM), also called
as urban health nurse in urban area. These health workers
had finished the ANM course and had undergone a two-week
training on verbal autopsy.
iii) Permission for procuring line
listing as well as verbal autopsy questionnaires from all
zones of Chennai Corporation for the purpose of our study
was obtained from the Deputy Project coordinator, district
family welfare, Chennai Corporation. Babies having residence
within Chennai Corporation zones and who died within 2
months of age between April, 2013 and March, 2015 were
included in the study.
Deaths that occurred at home and private
hospitals were also line-listed and included. Case sheets of
those collected and scrutinized before the district level
verbal audit of infant deaths (government, private, home
deaths) done bi-monthly and the physician who treated the
baby also attends the audit. The case sheet details and
clinical diagnoses of deaths in private setup were noted by
us for the study. In case of home deaths, diagnosis as given
at arrival to hospital or in the death certificate was
taken.
iv) We have provided the "young"
infant (<2 months) mortality rate in the article and not the
infant mortality rate. Total live births among the residents
of Chennai corporation zones were 164009, out of which there
were 865 young infant deaths.
v) Regarding transport, 108 ambulance
service is utilized for neonatal services as well in Tamil
Nadu, with the calls requesting for neonatal services
getting filtered and channelized separately.
1. Devi RU, Bharathi SM, Kumutha J. Analysis of young infant
deaths using verbal autopsies and accuracy of verbal autopsy
tool in Chennai, India. Indian Pediatr. 2021;58:363-66.