Abstract
BACKGROUND: Vital statistics are critical for effective public health and monitoring progress towards child survival. Nigeria has the highest global under-five mortality rate; however, deaths are often under- or misreported. OBJECTIVE: We explored perceptions of child deaths and socio-cultural factors influencing the reporting of child deaths in Jigawa State, Nigeria. METHODS: We conducted a triangulation mixed-methods study in Kiyawa local government area, Jigawa, including: four focus group discussions (FGDs) with 8-12 women, six key informant interviews (KII) with Imams, and process data from 42 verbal autopsies (VAs) conducted with caregivers of deceased children. Data was collected between November 2019-April 2021. Purposive sampling was used to recruit FDG and KII participants and two-stage systematic and simple random sampling was employed to recruit VA participants. Qualitative data was analysed using content analysis; VA data was described with proportions. RESULTS: Five categories emerged from FGDs: culturally grounded perceptions of child death, etiquette in mourning and offering condolence, formal procedures surrounding child death, the improving relationship between hospital and community, and reporting practices. Women expressed that talking or crying about a death was not culturally accepted, and that prayer is the most acceptable form of coping and offering condolence. Many women expressed that death was God's will. These findings correlated with VAs, in which visible signs of emotional distress were recorded in 31% of the interviews. Three categories emerged from KIIs: religion as part of formal procedures surrounding child death, communities support the bereaved, and multilayered reasons for unreported deaths. Imams serve a key role as community leaders, involved in both the logistical and religious aspects of their community, though they are not involved in mortality reporting. CONCLUSION: Religion plays a central role in burial practices, community mourning rituals, and expression of grief, but does not extend to reporting of child deaths. Imams could provide an opportunity for improving vital registration.