Causal Complexity of Perinatal and Late Neonatal Mortality in the Department of Cauca, Colombia from the Perspective of Systems Thinking

Abstract

Description of Background: Causes of perinatal and neonatal death are complex due to the multiple groups of factors, including clinical (biomedical), demographic, social, economic, and even political factors, as well as the interactions among them. The specific combination and interaction of those factors faced by one individual makes it more or less likely to have access to healthcare; in particular, they condition the effectiveness of key interventions to prevent perinatal and neonatal death such as accurate prenatal care. A holistic analysis of this variables and factors and interactions among them for subnational areas that lag in infant mortality is necessary to identify entry points to accelerate progress on mortality reduction results. Methods: Systemic and dynamic thinking methodology was applied to construct a causal loops diagram through brainstorming process among experts and executors and adapted to the Department of Cauca in Colombia, following the techniques of Williams B and Sturmber JP. Results: Many more reinforcing loops were found than balancing loops, while specific regional barriers were identified, facilitating the location of points for effective preventive interventions in the dynamic system that would allow the achievement of the United Nations Sustainable Development Goals (UN-SDG,2030). The causal loops diagram and referrals were validated through surveys of a group of first- and second-line experts in maternal and childcare, who provided feedback. Conclusions: The causal loops diagram adapted to regional particularities improves the Colombian path of compliance with the United Nations sustainable development goals and equity at the departments and subregions level. Relevance: In the Colombian case, because the main barrier in the Cauca Department, as others in the country, is the diversity in perinatal and late neonatal deaths by subregions when the whole Department average is acceptable in relation with UN-ODS, 2030.