Monitoring child mortality through community health worker reporting of births and deaths in Malawi: Validation against a household mortality survey

Agbessi Amouzou, Benjamin Banda, Willie Kachaka, Olga Joos, Mercy Kanyuka, Kenneth Hill, Jennifer Bryce

Research output: Contribution to journalArticle

Abstract

Background: The rate of decline in child mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five mortality by two-thirds between 1990 and 2015. Effective strategies to monitor child mortality are needed where accurate vital registration data are lacking to help governments assess and report on progress in child survival. We present results from a test of a mortality monitoring approach based on recording of births and deaths by specially trained community health workers (CHWs) in Malawi. Methods and Findings: Government-employed community health workers in Malawi are responsible for maintaining a Village Health Register, in which they record births and deaths that occur in their catchment area. We expanded on this system to provide additional training, supervision and incentives. We tested the equivalence between child mortality rates obtained from data on births and deaths collected by 160 randomly-selected and trained CHWs over twenty months in two districts to those computed through a standard household mortality survey. CHW reports produced an under-five mortality rate that was 84% (95%CI: [0.71,1.00]) of the household survey mortality rate and statistically equivalent to it. However, CHW data consistently underestimated under-five mortality, with levels of under-estimation increasing over time. Under-five deaths were more likely to be missed than births. Neonatal and infant deaths were more likely to be missed than older deaths. Conclusion: This first test of the accuracy and completeness of vital events data reported by CHWs in Malawi as a strategy for monitoring child mortality shows promising results but underestimated child mortality and was not stable over the four periods assessed. Given the Malawi government's commitment to strengthen its vital registration system, we are working with the Ministry of Health to implement a revised version of the approach that provides increased support to CHWs.

Original languageEnglish (US)
Article numbere88939
JournalPLoS One
Volume9
Issue number2
DOIs
StatePublished - Feb 18 2014

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community health workers
Malawi
Child Mortality
households
Health
Parturition
death
Mortality
Monitoring
monitoring
Birth Certificates
Death Certificates
Surveys and Questionnaires
Motivation
household surveys
Catchments

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Monitoring child mortality through community health worker reporting of births and deaths in Malawi : Validation against a household mortality survey. / Amouzou, Agbessi; Banda, Benjamin; Kachaka, Willie; Joos, Olga; Kanyuka, Mercy; Hill, Kenneth; Bryce, Jennifer.

In: PLoS One, Vol. 9, No. 2, e88939, 18.02.2014.

Research output: Contribution to journalArticle

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