Can a Village Headman Use an Electronic Village Register and a Simplified Community-Based Verbal Autopsy Tool to Record Numbers and Causes of Death in Rural Malawi?

Sophie Kang'oma,Simeon Yosefe,Chawanangwa Lupafya,Khazgani Nasasara,Lindiwe M. Zaina,Martha Kwataine,Isaac Dambula,Chimango V. T. Munthali,Anthony D. Harries,Kudakwashe C. Takarinda,Jacob Mziya

doi:10.3389/fpubh.2018.00246

Abstract

Introduction: Most people in Africa die without appearing in official vital statistics records. To improve this situation, Malawi has introduced solar-powered electronic village registers (EVR), managed by village headmen, to record birth and death information for production of vital statistics. The EVR is deployed in 83 villages in Traditional Authority Mtema, Lilongwe, which is an area without electricity. In 17 villages, village headmen were also trained to use a simple verbal autopsy (VA) tool adapted from one developed by the World Health Organization (WHO). Study objectives were to (i) document numbers and causes of death occurring in 17 villages between April 2016 and September 2017, and (ii) assess percentage measures of agreement on causes of death as recorded by village headmen using a simple VA tool and by a team of health surveillance assistant (HSA)/medical doctor using the WHO VA tool.Methods: The study was in two-parts: (i) a cross-sectional study using secondary data from the EVR; (ii) primary data collection study comparing causes of death obtained by village headmen using a simple VA tool and by HSA/medical doctor using the WHO VA tool.Results: Over 18 months, 120 deaths were recorded by EVR in 14,264 residents - crude annual death rate 5.6/1,000 population. Median age at death was 43 years with 69 (58%) deaths being in males. Death occurred at home (75%) and at health facility (25%). Malaria, diarrhoeal disease, pulmonary tuberculosis, acute respiratory infection, and stroke accounted for 56% of deaths recorded by village headmen using the simple VA tool. Causes of death between village headmen and the HSA/medical doctor team were compared for 107 deaths. There was full agreement in causes of death in 33 (31%) deaths, mostly for malaria, severe anemia, intentional self-harm, cancer, and epilepsy. Unknown-sudden death and sepsis recorded by the HSA/medical doctor team were responsible for most disagreements.Conclusion: It is feasible for village headmen in rural Malawi to use an EVR and simple VA tool to document numbers and causes of deaths. More work is needed to improve accuracy of causes of death by village headmen.

Highlights

Most people in Africa die without appearing in official vital statistics records
Data variables collected from the electronic village registers (EVR) and the Verbal Autopsy tools included: number of residents living in each village collected at the time the EVR became functional; EVR recorded deaths; date of death; name of the village where the deceased was resident; age at death; sex; the place of death; the family or other informant who was interviewed; date of death; date of interview by the village headmen and the health surveillance assistant (HSA); and the causes of death according to each verbal autopsy instrument used
This study in 17 rural villages in traditional authorities (TAs) Mtema, Lilongwe, Malawi, showed that village headmen were able to use an EVR to numerically document the numbers of deaths, and the EVR system has already been expanded to the 83 villages in TA Mtema

Summary

Introduction

Most people in Africa die without appearing in official vital statistics records. To improve this situation, Malawi has introduced solar-powered electronic village registers (EVR), managed by village headmen, to record birth and death information for production of vital statistics. New momentum for civil registration and vital statistics is building, driven by increasing demand for accountability and results in health, equity, and rights-based approaches to development (2) Despite this gathering momentum and the importance of vital statistics, most people in sub-Saharan Africa still die without leaving any trace in legal records or official statistics, and the situation has remained largely unchanged for the last few decades (3, 4). In 2007, the Malawi Government through the National Registration Bureau (NRB) introduced a registration system for births and deaths based on paper-based village registers, and this reached full country-wide coverage by 2011 These registers were a potential source of vital statistics data at the grass-roots level, but the manual collection, collation and analysis of data from villages up to traditional authorities (TA) and up to the district commissioner were almost impossible due to poor infrastructure, lack of intermediary human resources and inadequate transport (11)

Methods

Results

Conclusion