Child mortality: preventing future child deaths and optimizing family support

Abstract

Worldwide 6.1 million live-born children under the age of five died from natural and external causes in 2014. According to the Convention on the Rights of the Child appropriate measures should be taken by State Parties to ensure the survival and development of the child to a maximum extent and to diminish infant and child mortality. As countries have tried to reduce the global under-five child mortality rate with two-thirds between 1990 and 2015, which is defined as the Millennium Development Goal 4 by the World Health Organization, only 62 of the 195 countries have achieved this degree of reduction. As a consequence world leaders have renewed their goals in which every nation is expected to make every effort to further reduce preventable child deaths. In the Netherlands child mortality has declined in the past centuries due to improvements in social circumstances, sanitation, housing, hygiene and health care, and lower birth rates. Although 1130 Dutch children aged 0 up to and including 19 years (mortality rate 29.4 per 100.000 children) died in 2014, there are still child deaths that are avoidable. Understanding the nature and patterns of child mortality and the factors that have contributed to death is essential to direct preventive strategies. The aim of this thesis is to investigate how to prevent future child deaths and optimize family support in the Netherlands. In order to answer these questions the patterns of child mortality in the Netherlands are described in part A, ‘Epidemiology’. Then, the way Dutch professionals respond the a child’s death, including the support they provide to parents of deceased children, is explored in part B, ‘Responding to child deaths’. As Child Death Review (CDR) has the potential to identify avoidable factors that contributed to death and pays attention to the needs of bereaved parents, CDR might contribute to prevent future child deaths and to improve relatives’ coping with bereavement in the Netherlands. Therefore, the possibility and analyzing child deaths systematically in the Netherlands according to the CDR method is examined in part C, ‘Implementation of Child Death Review.’ The results of this study might support health care professionals and health policy makers in their efforts to prevent future child deaths and optimize family support in the Netherlands.