TY - JOUR
T1 - Monitoring child mortality through community health worker reporting of births and deaths in Malawi
T2 - Validation against a household mortality survey
AU - Amouzou, Agbessi
AU - Banda, Benjamin
AU - Kachaka, Willie
AU - Joos, Olga
AU - Kanyuka, Mercy
AU - Hill, Kenneth
AU - Bryce, Jennifer
N1 - Funding Information:
With support from the Government of Canada, the Institute for International Programs (IIP) at Johns Hopkins University is implementing a “real-time mortality monitoring” (RMM) project in five countries in Africa (Ethiopia, Ghana, Malawi, Mali and Niger), working closely with in-country research partners. The RMM project aims to develop and test low cost and sustainable methods for measuring mortality among children under the age of five in settings without fully functional vital registration systems.
PY - 2014/2/18
Y1 - 2014/2/18
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84895868026&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84895868026&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0088939
DO - 10.1371/journal.pone.0088939
M3 - Article
C2 - 24558453
AN - SCOPUS:84895868026
SN - 1932-6203
VL - 9
JO - PloS one
JF - PloS one
IS - 2
M1 - e88939
ER -